妊娠哺乳相关骨质疏松症发病率及相关影响因素的调查研究  

Investigation on the Incidence of Osteoporosis Associated with Pregnancy and Lactation and Its Related Influencing Factors

作　　者：易少华 乔会峰[1] 吴宏梓 凯瑟尔[1] 刘芮君[1] 王慧[2] 张艳[1] 肖岚 张学平[3] 巴雪峰[1] 

机构地区：[1]新疆克拉玛依市中心医院骨科中心,新疆 克拉玛依 [2]新疆克拉玛依市中心医院妇产科,新疆 克拉玛依 [3]新疆克拉玛依市中心医院核医学科,新疆 克拉玛依

出　　处：《临床医学进展》2021年第6期2793-2800,共8页Advances in Clinical Medicine

摘　　要：目的:横断面调查妊娠哺乳相关骨质疏松症(pregnancy and lactation-associated osteoporosis, PLO)发病率及相关影响因素,为产妇骨骼健康提供指导。方法:对656例新疆克拉玛依市中心医院自愿参加X线吸收检测法(dual energy X-ray absorptiometry, DXA)骨密度测量的产妇于产后6个月进行腰椎、髋部的骨密度测量,采用自行设计的调查问卷进行PLO生活方式的调查,同时对骨量异常患者进行骨转换指标、生化指标检测。结果:产后6月骨质疏松症(T值 ≤ −2.5)患病率:8/656 = 1.21%、骨量减少(−2.5 【T值 【−1.0)患病率:72/656 = 10.97%,PLO (Z值 【−2.0) 11/656 = 1.67%。按T值标准,PLO组:1) 基础病因素:骨量减少患者:24例,骨质疏松8例;2) 二胎:骨质疏松6例,骨量减少8例;3) 所有骨量异常患者均钙、维生素D摄入不足且均运动小于30分钟/天;4) 日照时间小于30分钟/天者:骨质疏松4例,骨量减少30例;5) 长期喝茶9例均为骨量减少患者;6) 产后6个月月经未复潮者:骨质疏松8例,骨量减少30例;7) 骨转换指标:血清PINP、β-CTX、甲状旁腺激素、碱性磷酸酶除甲状腺功能亢进患者外均在正常范围;25-羟VitD平均13.2 ng/ml;8) 疼痛评分(VAS) 1.24 ±0.95分,疼痛、抽搐(月) 3.2月;9) 母乳喂养率100%且≥6个月。正常骨量组:1) 基础病因素:2例(慢性胃炎2例);2) 二胎2人;3) 钙、维生素D摄入不足56例,运动小于30分钟/天64例;4) 日照时间小于30分钟/天者14例;5) 不良健康习惯者0例;6) 6个月月经未复潮者0例;7) 骨转换指标:未测;25-羟VitD未测;8) 疼痛评分(VAS) 0.24 ±0.36分,无抽搐;9) 母乳喂养率30.1%,平均时间3.12月。结论:PLO发病率较低且伴随骨痛;PLO危险因素为基础疾病、不良饮食习惯、哺乳时间6个月、钙和维生素D摄入不足、日照时间不足及运动不足,混合危险因素可能存在叠加促进作用;以上结论需要大样本继续验证。Objective: To investigate the incidence of pregnancy and lactation-associated osteoporosis (PLO) and its related factors in a cross-sectional manner, and to provide guidance for bone health of parturients. Methods: The BMD of lumbar spine and hip of 656 parturients who volunteered to take part in Dual Energy X-Ray Absorptiometry (DXA) measurement in Karamay Central Hospital of Xinjiang at 6 months postpartum were measured. A self-designed questionnaire was used to investigate PLO lifestyle. Meanwhile, bone conversion indexes and biochemical indexes were detected in patients with abnormal bone mass. Results: The prevalence of osteoporosis (T value ≤ −2.5) at 6 months postpartum was 8/656 = 1.21%, the prevalence of osteopenia (−2.5 <T-value <−1.0) was 72/656 = 10.97% (T value), PLO (Z value) 11/656 = 1.67%. According to the T-value standard, PLO group: 1) Basic disease factors: osteopenia: 24 cases, 8 cases of osteoporosis;2) Second birth: osteoporosis in 6 cases, bone loss in 8 cases;3) All patients with abnormal bone mass had insufficient calcium and vitamin D intake and exercised less than 30 minutes per day;4) Patients with sunshine time less than 30 minutes per day had osteoporosis in 4 cases and bone loss in 30 cases;5) Drinking tea for a long time in 9 patients with osteopenia;6) 6 months of menstruation did not return to the tide: osteoporosis in 8 cases, bone loss in 30 cases;7) Bone turnover indexes: serum PINP, β-CTX, parathyroid hormone and alkaline phosphatase were all in the normal range except for patients with hyperthyroidism;the average 25-hydroxy VitD was 13.2 ng/mL;8) Pain score (VAS) 1.24 ±0.95, pain and convulsions (months) 3.2 months;9) Breastfeeding rate 100%, ≥6 months. Normal bone mass group: 1) basic disease factors: 2 cases (chronic gastritis 2 cases);2) there were 2 children in the second child;3) there were 56 patients with insufficient calcium and vitamin D intake and 64 patients with exercise less than 30 minutes per day;4) the sunshine time was less than 30 minu

关 键 词：妊娠哺乳相关骨质疏松症(PLO) 发病率 影响因素 防治 

分 类 号：R58[医药卫生—内分泌]