肝硬化相关骨密度降低的流行病学、机制与防治

王凌云

doi:10.12449/JCH260603

肝硬化相关骨密度降低的流行病学、机制与防治

DOI: 10.12449/JCH260603

王凌云^, ,

中山大学孙逸仙纪念医院消化内科，广州 510120

基金项目:

广州市市校（院）企联合资助项目 (2025A03J4203);

广东省卫济医学发展基金会项目 (K-20240209)

利益冲突声明：本文不存在任何利益冲突。

详细信息

通信作者:
王凌云， wanglyun@mail.sysu.edu.cn （ORCID： 0000-0002-6646-7223）

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- 被引次数: 0
出版历程
- 收稿日期: 2026-02-27
- 录用日期: 2026-04-07
- 出版日期: 2026-06-25

Epidemiology， mechanism， prevention， and treatment of reduced bone mineral density associated with liver cirrhosis

Lingyun WANG^{,
,}

Department of Gastroenterology，Sun Yat-sen Memorial Hospital，Sun Yat-sen University，Guangzhou 510120，China

Research funding:

Guangzhou Municipal-University/Institute-Enterprise Joint Funding Project (2025A03J4203);

Guangdong Weiji Medical Development Foundation (K-20240209)

More Information

Corresponding author: WANG Lingyun， wanglyun@mail.sysu.edu.cn （ORCID： 0000-0002-6646-7223）

摘要

摘要: 肝硬化患者由于长期慢性肝功能损害和全身代谢紊乱，常伴随骨密度降低甚至骨质疏松，已成为影响其生活质量和长期预后的重要并发症之一。本文系统综述了肝硬化相关骨密度降低的流行病学特征，概括了不同病因肝硬化人群中骨密度降低的发生情况及其与疾病严重程度的关系；进一步探讨了肝硬化导致骨密度降低的主要病理生理机制，包括钙磷代谢紊乱、性激素失衡、慢性炎症反应及骨代谢失调等；同时概述了肝硬化相关骨密度降低的临床表现、骨折风险及其不良结局；归纳并总结了当前针对肝硬化相关骨质疏松的防治策略。本文旨在整合现有研究进展，为深入机制研究及临床规范化管理提供参考。
- 肝硬化 /
- 骨密度 /
- 骨质疏松
Abstract: Patients with liver cirrhosis often experience a reduction in bone mineral density （BMD） or even osteoporosis （OP） due to long-term chronic liver dysfunction and systemic metabolic disorders， and this condition has become one of the major complications affecting their quality of life and long-term prognosis. This article systematically reviews the epidemiological characteristics of reduced BMD associated with liver cirrhosis， summarizes the incidence of reduced BMD in liver cirrhosis patients with different etiologies， and analyzes its association with disease severity. This article further discusses the main pathophysiological mechanisms of reduced BMD induced by liver cirrhosis （including calcium/phosphorus metabolism disorders， sex hormone imbalance， chronic inflammatory response， and bone metabolism dysregulation）， reviews the clinical manifestations， fracture risk， and adverse outcomes associated with reduced BMD， and summarizes current prevention and treatment strategies for cirrhosis-related OP. This review aims to integrate recent research advances in this field and to provide a reference for future mechanistic studies and standardized clinical management.
- Liver Cirrhosis /
- Bone Density /
- Osteoporosis

HTML全文

表 1 肝硬化常见原发病的治疗与管理

Table 1. Treatment and management of common primary diseases leading to cirrhosis

原发病	治疗与管理方法
慢性乙型肝炎	抗病毒药物治疗，恩替卡韦、替诺福韦、丙酚替诺福韦、长效干扰素等^［47］
慢性丙型肝炎	抗病毒药物治疗，索磷布韦/维帕他韦等^［48］
酒精性肝病	戒酒、营养支持和对症治疗^［49］
代谢相关脂肪性肝病	减轻体重和降低腰围、改善胰岛素抵抗、防治代谢综合征、缓解肝脏炎症和逆转纤维化^［50］
自身免疫性肝炎	泼尼松（龙）联合硫唑嘌呤，布地奈德等^［51］
原发性胆汁性胆管炎	熊去氧胆酸、奥贝胆酸、布地奈德等^［52］

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