社区超重绝经后女性代谢综合征与骨转换指标、髋部骨几何参数的研究  

Bone turnover markers, hip bone geometry parameters and metabolic syndrome in community overweight postmenopausal women

作　　者：路迪迪 张平[1] 刘盼 周文斌[3] 王金娣 杨涛[1] 徐晶晶[1] 何畏[1] Lu Didi;Zhang Ping;Liu Pan;Zhou Wenbin;Wang Jindi;Yang Tao;Xu Jingjing;He Wei(Department of Endocrinology and Metabolism,First Affiliated Hospital,Nanjing Medical University,Nanjing 210029,China;Department of Rehabilitation Medicine,Gaochun People′s Hospital,Nanjing 211300,China;Department of Breast Surgery,First Affiliated Hospital,Nanjing Medical University,Nanjing 210029,China;Lianhu Community Service Center,Danyang 212310,China)

机构地区：[1]南京医科大学第一附属医院内分泌科,南京210029 [2]高淳人民医院康复医学科,南京211300 [3]南京医科大学第一附属医院乳腺外科,南京210029 [4]练湖社区卫生服务中心骨质疏松科,丹阳212310

出　　处：《中华内分泌代谢杂志》2023年第6期479-485,共7页Chinese Journal of Endocrinology and Metabolism

基　　金：江苏省妇幼健康科研项目 (F201954)。

摘　　要：目的探讨超重绝经后代谢综合征(metabolic syndrome,MS)女性骨转换指标、髋部骨几何参数的变化及MS各成分对其影响,并分析骨折发生风险与其相关性。方法选取2017年1月至12月在江苏省丹阳市练湖社区卫生服务中心体检的超重绝经后女性患者505例,根据2009年国际糖尿病联盟MS诊断标准,分为MS组(331例)和非MS组(174例),抽空腹静脉血测定1型原胶原氨基端前肽(procollagen type 1 N-terminal propeptide,P1NP)、1型胶原交联羧基端肽(carboxy-terminal cross-linked telopeptide of type 1 collagen,CTX),并采用双能X线吸收仪及自带的髋结构分析软件获得骨密度和髋部骨几何参数。结果MS组骨质疏松性骨折、髋部骨折发生率显著高于非MS组(21.1%对13.8%、4.8%对1.1%,P<0.05),而腰椎1~4、股骨颈、全髋骨密度显著高于非MS组,在校正年龄后仍存在(P<0.05),进一步校正体重指数后差异消失(P>0.05)。MS组P1NP、CTX、股骨强度指数(femur strength index,FSI)、截面模量(section modulus,SM)、骨横截面积(cross-sectional area,CSA)显著低于非MS组,曲率比率(buckling ration,BR)显著高于非MS组,在校正年龄及体重指数后差异仍存在(P<0.05)。MS组骨折与非骨折者腰椎1~4、股骨颈、全髋骨密度、P1NP、CTX无明显差异,但骨折者FSI、SM、截面惯性矩(cross-sectional moment of inertia,CSMI)、CSA显著偏低,BR显著偏高(P<0.05),股骨强度下降。对骨折发生风险进行回归分析,显示BR是骨折发生的独立危险因素,FSI、SM、CSMI、CSA为保护因素。多元线性回归分析显示,影响骨密度、骨转换指标和髋部骨几何参数的主要MS成分为腰围、舒张压和空腹血糖。结论超重绝经后MS患者骨整体转换率减慢,股骨强度下降,骨质量相对较差。髋部骨几何参数可作为评估MS患者骨折风险的方法之一。腰围、舒张压和空腹血糖是影响骨量和骨质量的主要MS成分。Objective To explore the changes of bone turnover markers and geometric parameters of hip bone in overweight postmenopausal women with metabolic syndrome(MS),as well as the influence of MS components.To analyze the association of these factors with the risk of fracture.Methods A total of 505 overweight postmenopausal female patients who underwent health check-up in Lianhu Community Service Center,Danyang City,Jiangsu Province from January to December 2017 were selected.According to the MS diagnostic criteria of the International Diabetes Federation(2009),the patients were divided into MS group(n=331)and non-MS group(n=174).Blood samples were collected to determine the level of procollagen type 1 N-terminal propeptide(P1NP)and carboxy-terminal cross-linked telopeptide of type 1 collagen(CTX).Bone mineral density and hip bone geometry parameters were tested with dual-energy X-ray absorptiometry and hip structural analysis software.Results The incidence of osteoporotic fracture and hip fracture in MS group was significantly higher than that in non-MS group(21.1%vs 13.8%,4.8%vs 1.1%,P<0.05).However,the bone mineral density of lumbar vertebra 1-4,femoral neck,and total hip in MS group was significantly higher than that in non-MS group,which remained after adjusting for age(P<0.05),but the difference disappeared after further adjustment for body mass index(P>0.05).The P1NP,CTX,femur strength index(FSI),section modulus(SM),and cross-sectional area(CSA)of MS group were significantly lower than those of non-MS group,the buckling ration(BR)was significantly higher than that in non-MS group,and the differences were still statistically significant after adjusting for age and body mass index(P<0.05).There was no significant difference in bone mineral density of lumbar vertebra 1-4,femoral neck,total hip,P1NP,and CTX between fracture group and non-fracture group in patients with MS.But FSI,SM,cross-sectional moment of inertia(CSMI),and CSA were significantly lower,BR was significantly higher(P<0.05)and femur strength decreased

关 键 词：代谢综合征 骨密度 骨转换指标 髋部骨几何参数 骨质量 骨折 绝经后女性 

分 类 号：R711.75[医药卫生—妇产科学] R589[医药卫生—临床医学]