股骨颈骨折合并抑郁老年男性骨密度和骨代谢变化  

Bone mineral density and bone metabolism in elderly males with femoral neck fractures and depression

作　　者：刘驰[1,2] 石磊 何婧[3] 刘军川[1] 赵懋宇 张耀南 薛庆云[1,2] Liu Chi;Shi Lei;He Jing;Liu Junchuan;Zhao Maoyu;Zhang Yaonan;Xue Qingyun(Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Beijing l00730,China;Graduate School of Peking Union Medical College, Beijing 100005,China;Department of Neurology, Beijing Hospital, National Center of Gerontology, Beijing l00730,China)

机构地区：[1]北京医院骨科,国家老年医学中心,100730 [2]北京协和医学院研究生院,100005 [3]北京医院神经内科,国家老年医学中心,100730

出　　处：《中华关节外科杂志（电子版）》2020年第4期435-439,共5页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的分析老年男性股骨颈骨折合并抑郁患者骨密度和骨代谢生化指标变化,探讨抑郁对骨质疏松骨代谢的影响。方法选取于北京医院骨科2017年1月至2019年1月住院的老年男性股骨颈骨折患者102例。排除病理性骨折、认知功能障碍等患者。依据老年抑郁量表(GDS)将老年男性股骨颈骨折患者分为抑郁组和对照组。通过测定并比较两组患者的骨密度(BMD)、血清碱性磷酸酶(ALP)、血钙、血磷、25-羟基-维生素D[25(OH)D]、骨钙素(OC)、Ⅰ型原胶原氨基端前肽(P1NP)、血清Ⅰ型胶原羧基末端肽交联β特殊序列(β-CTX)水平,分析抑郁严重程度(GDS评分)与骨密度及骨代谢生化指标的相关性。分类变量的比较采用卡方检验,连续变量的比较采用t检验,两组连续性变量的相关性应用Pearson相关分析。结果抑郁组患者BMD明显低于对照组(腰椎t=5.964、髋部t=2.845,P<0.05)。与对照组相比,抑郁组血清25(OH)D水平下降(t=3.077,P<0.05),抑郁组血清OC水平低于对照组(t=2.013,P<0.05),而血清β-CTX水平高于对照组(t=2.938,P<0.05),P1NP水平与对照组差异无统计学意义(t=0.684,P>0.05)。抑郁严重程度(GDS评分)与BMD(r=-0.456,P<0.05)、25(OH)D(r=-0.546,P<0.05)、OC(r=-0.215,P<0.05)呈负相关,与P1NP(r=-0.115,P>0.05)相关性不显著,与β-CTX(r=0.372,P<0.05)呈正相关。结论抑郁症患者的骨形成标志物水平降低和骨吸收标志物水平升高,抑郁症是低骨密度和骨折的危险因素。应重视老年抑郁症患者骨代谢指标和25(OH)D的检测,及时进行维生素D的补充和有效的抗骨吸收药物治疗。Objective To analyze the changes of bone mineral density and biochemical markers of bone metabolism in elderly males with femoral neck fractures and depression,and to investigate the effect of depression on osteoporosis and bone metabolism.Methods Between January 2017 and January 2019 in Beijing Hospital,onehundredandtwo elderly males with femoral neck fractures were enrolled in the study.Pathological fracture and cognitive impairment were excluded.All the patients were divided into the depression group(52 cases)and the control group(50 cases)by geriatric depression scale(GDS).Bone mineral density(BMD)was detected using dual X-ray densitometry(DEXA).Bone metabolism biochemical markers,such as procollagen typeⅠN-peptide(P1NP),βisomer of C-terminal telopeptide of typeⅠcollagen(β-CTX),osteocalcin(OC),25-OH-VitD,alkaline phosphatase(ALP),calcium and phosphorus,were measured using enzyme linked immunosorbent assay(ELISA)method.Correlation of depression,bone metabolism and BMD was analyzed.The data were analyzed by chi-square test,t test,and Pearson correlation analysis.ResultsBMD of depression group was significantly lower than that of control group(lumbar t=5.964,hip neck t=2.845,P<0.05).Depression group(Compared with control group):the serum levels of 25(OH)D,OC,ALP and calcium were lower with statistically significant differences(t=3.077,2.013,2.111,2.020,all P<0.05).β-CTX and phosphorus level were higher(t=2.938,3.099,both P<0.05).No significant difference in P1NP(t=0.684,P>0.05).Depression scores were negatively correlated with BMD(r=-0.456,P<0.05),25(OH)D(r=-0.546,P<0.05),OC(r=-0.215,P<0.05)and positively correlated withβ-CTX(r=0.372,P<0.05),but not significantly correlated with P1NP(r=-0.115,P>0.05).Conclusion Depression is accompanied by the decrease of bone formation and increase of bone resorption,which is a risk factor for low bone density and fractures,so attention should be paid to the detection of bone metabolism makers and 25(OH)D in elderly patients with depression,and treating the osteoporosis

关 键 词：骨质疏松 股骨颈骨折 抑郁 维生素D 骨密度 

分 类 号：R58[医药卫生—内分泌]