骨质疏松椎体变形与骨密度和骨代谢水平的相关性研究  

Correlations of osteoporotic vertebral deformation to bone mineral density and bone metabolic levels

作　　者：高飞[1] 张宇[2] 王洪伟[1] 乔巨峰[1] 高锋[1] 莫济贤[1] 汤奇[1] 

机构地区：[1]中山大学附属东华医院骨科,广东东莞523110 [2]广州军区广州总医院骨科医院,510010

出　　处：《中国骨科临床与基础研究杂志》2015年第3期133-140,共8页Chinese Orthopaedic Journal of Clinical and Basic Research

基　　金：广东省医学科研基金(B2013429)

摘　　要：目的：探讨骨质疏松患者椎体变形与骨密度（BMD）和骨代谢水平的相关性。方法以GENANT半定量法为标准，按照胸腰椎椎体不同变形程度将883例骨质疏松患者分为GENANT 0级、0.5级、1级、2级、3级共5组，测量各组的BMD、体质量指数以及Ⅰ型前胶原氨基端前肽（PINP）、β胶原降解产物β-crosslaps、N端中分子片段骨钙素（N-MID）等骨代谢指标，分析骨质疏松椎体变形程度与上述指标的相关关系，统计骨质疏松患者年龄、性别以及上述指标与骨折风险的相关性。结果椎体变形等级与BMD、体质量指数呈负相关（P＜0.05），与骨代谢指标呈正相关（P ＜0.05）；椎体变形GENANT 3级骨质疏松患者BMD、体质量指数低于其他GENANT等级，GENANT 1～3级患者骨代谢水平高于GENANT 0级、0.5级，GENANT 0级患者骨代谢水平最低（P＜0.05）。骨质疏松性椎体骨折女性患者多于男性，其发生随年龄增加而呈现增大趋势；80岁以上人群BMD、体质量指数和骨代谢水平均低于其他年龄组，且存在椎体变形的比例最高（P＜0.05）。结论骨质疏松患者的椎体变形与BMD、体质量指数以及PINP、β-crosslaps、N-MID等骨代谢指标有一定的相关关系；综合运用性别、年龄、BMD、体质量指数和骨代谢指标能提高骨质疏松椎体变形的诊断准确率，对预测骨质疏松患者椎体变形程度和骨折风险具有重要的指导意义。Objective To investigate the correlations of vertebral deformation to bone mineral density （BMD） and bone metabolic levels for osteoporotic patients. Methods According to GENANT semi-quantitative method, a total of 883 patients with osteoporosis were divided into 5 groups for different degrees of deformation of lumbar vertebrae （GENANT 0, 0.5, 1, 2, 3）. BMD, body mass index （BMI）, procollagen type Ⅰamino-terminal propeptide （PINP）, type I collagen degradation fragment （ β-crosslaps） and N-terminal mid-fragment of osteocalcin （N-MID） were measured in each group. Relationships of osteoporotic vertebral deformation and the above parameters were analyzed, and the correlations of fracture risks to age, gender and the above parameters were also observed. Results Vertebral deformation grade was negatively correlated with BMD and BMI （P〈0.05）, while positively related with levels of the bone turnover markers （P〈0.05）; BMD and BMI in GENANT 3 group were lower than those in the other groups, while the levels of bone turnover markers in GENANT 1, 2, 3 groups were higher than those of GENANT 0 or 0.5 group, that meant the lowest level was in GENANT 0 group （P〈0.05）. As for osteoporotic vertebral fractures, the incidence in female patients was higher than that in male patients, which showed increase tendency with age. For patients in group of 80 years old and over, BMD, BMI and levels of bone turnover markers were lowest, with the highest proportion of the vertebral body deformation （P〈0.05）. Conclusions Osteoporotic vertebral deformation is related to BMD, BMI and bone turnover markers such as PINP, β-crosslaps and N-MID. The comprehensive application of age, gender, BMD, BMI and bone turnover markers would improve the accuracy of the assessment of vertebral deformation, which could provide guidance to predict the degree of vertebral deformation and fracture risk for osteoporotic patients.

关 键 词：骨质疏松 椎体变形 脊柱骨折 骨密度 骨代谢 胶原 骨钙素 年龄因素 性别因素 人体质量指数 

分 类 号：R580[医药卫生—内分泌]