本文選題：雌激素受體 + 骨質(zhì)疏松癥�。� 參考：《北京中醫(yī)藥大學(xué)》2010年博士論文

【摘要】： 老年人髖部骨折是一個(gè)世界性的公共衛(wèi)生難題,因其高花費(fèi)、高死亡率、高致殘率而成為骨質(zhì)疏松性骨折中最嚴(yán)重的一種。隨著人口老齡化加劇,其帶來的社會(huì)問題也更加嚴(yán)峻�，F(xiàn)今,呼和浩特地區(qū)老年髖部骨折相關(guān)研究資料仍然很匱乏。本課題試圖通過以下三部分研究來完善本地區(qū)老年髖部骨折的流行病學(xué)資料,并探討髖部骨折與中醫(yī)體質(zhì)分型及雌激素受體基因多態(tài)性的關(guān)系。 第一部分呼和浩特地區(qū)老年髖部骨折住院患者的回顧性研究 目的：通過對(duì)呼和浩特地區(qū)老年人髖部骨折病例的回顧性研究,揭示本地區(qū)老年髖部骨折患者的發(fā)病特點(diǎn),為老年人髖部骨折的防治提供理論依據(jù)。 方法：收集2005年1月至2008年12月老年髖部骨折986例,設(shè)計(jì)調(diào)查表進(jìn)行相關(guān)因素的登記,對(duì)老年人髖部骨折的流行特征及4年發(fā)生情況進(jìn)行動(dòng)態(tài)分析。同時(shí)對(duì)髖部骨折患者骨質(zhì)疏松的診斷、治療情況進(jìn)行分析。結(jié)果：(1)老年髖部骨折發(fā)病例數(shù)有逐年遞增趨勢(shì),女性發(fā)生例數(shù)明顯多于男性(男性372例,女性614例),70至89歲是老年髖部骨折的高發(fā)年齡(該年齡段患者占總數(shù)的70.18%),呼和浩特老年髖部骨折有地區(qū)特點(diǎn)。(2)老年髖部骨折伴骨質(zhì)疏松癥診斷例數(shù)有逐年遞增趨勢(shì)(分別為10.19%、10.82%、18.36%、26.86%),但仍有大量漏診。雖然抗骨質(zhì)疏松治療病例逐年增加,但有明顯的盲目性和隨意性。 結(jié)論：(1)應(yīng)針對(duì)呼和浩特地區(qū)老年髖部骨折特點(diǎn),加強(qiáng)本地區(qū)人群髖部骨折,尤其是跌倒和骨質(zhì)疏松的預(yù)防工作。(2)呼和浩特地區(qū)骨科醫(yī)生骨質(zhì)疏松診療水平存在不足,需要加強(qiáng)骨科醫(yī)生的繼續(xù)教育,進(jìn)而采取更積極的態(tài)度,選擇合理的抗骨質(zhì)疏松治療方案。 第二部分老年髖部骨折患者中醫(yī)體質(zhì)類型及其與骨密度關(guān)系研究 目的：通過研究呼和浩特地區(qū)老年髖部骨折患者中醫(yī)體質(zhì)的分布規(guī)律及其與骨密度的關(guān)系,為篩選老年髖部骨折相對(duì)高危人群提供理論依據(jù),從而給予適當(dāng)?shù)母深A(yù)措施以防止骨折的發(fā)生。 方法：對(duì)156例老年髖部骨折患者和156例非老年髖部骨折患者進(jìn)行病例對(duì)照研究,體質(zhì)判定標(biāo)準(zhǔn)采用《中醫(yī)體質(zhì)分類判定》標(biāo)準(zhǔn),并對(duì)其腰椎的骨密度進(jìn)行測(cè)量。 結(jié)果：按照中醫(yī)體質(zhì)分型,兩組人群的體質(zhì)構(gòu)成比有統(tǒng)計(jì)學(xué)差異(P0.05),老年髖部骨折患者氣虛質(zhì)、陽虛質(zhì)、陰虛質(zhì)、血瘀質(zhì)、痰濕質(zhì)的構(gòu)成比高于正常人群,分別為21.15%,14.74%,15.39%,16.03%,16.67%。髖部骨折患者腰椎骨密度明顯低于正常人群。 結(jié)論：氣虛質(zhì)、陽虛質(zhì)、陰虛質(zhì)、血瘀質(zhì)、痰濕質(zhì)是呼和浩特地區(qū)老年髖部骨折患者的主要體質(zhì)影響因素,中醫(yī)體質(zhì)類型與骨密度關(guān)系密切。 第三部分老年男性骨質(zhì)疏松性髖部骨折患者ERα基因多態(tài)性的病例對(duì)照研究 目的：研究呼和浩特地區(qū)漢族老年男性髖部骨折患者雌激素受體基因多態(tài)性與骨質(zhì)疏松癥的關(guān)系。 方法：收集老年男性髖部骨質(zhì)疏松性骨折128例,按年齡配比選取漢族男性健康體檢者128名,進(jìn)行病例對(duì)照研究。所有受試者均行骨密度檢查,并進(jìn)行雌激素受體基因多態(tài)性檢測(cè)。 結(jié)果：骨質(zhì)疏松組雌激素受體PvuⅡ基因型PP、Pp及pp頻率分別為7.8%,42.2%和50.0%；對(duì)照組雌激素受體PvuⅡ基因型PP、Pp及pp頻率分別為13.3%,53.9%和32.8%,卡方檢驗(yàn)提示,骨質(zhì)疏松組和對(duì)照組之間Pp, pp, PP三種基因型的頻率分布差異有顯著性意義(P0.05)。骨質(zhì)疏松組雌激素受體XbaⅠ基因型XX、Xx及xx頻率分別為4.7%,44.5%和50.8%；對(duì)照組雌激素受體PvuⅡ基因型XX、Xx及xx頻率分別為3.1%,39.1%和57.8%,卡方檢驗(yàn)提示,骨質(zhì)疏松組和對(duì)照組之間XX、Xx及xx三種基因型的頻率分布差異無顯著性意義(P0.05)。 結(jié)論：雌激素受體基因型分布頻率均符合Hardy-Weinberg定律,呼和浩特地區(qū)老年男性ERα基因基因PvuⅡ酶切位點(diǎn)與原發(fā)性骨質(zhì)疏松癥存在相關(guān)性。老年髖部骨折與雌激素受體基因多態(tài)性可能存在相關(guān)性。
[Abstract]:Hip fracture in the elderly is a worldwide public health problem. Because of its high cost, high mortality and high disability rate, it has become one of the most serious types of osteoporotic fractures. With the aging of the population, the social problems are becoming more severe. Nowadays, the research data of hip fracture in the Hohhot area are still scarce. This topic attempts to improve the epidemiological data of hip fracture in the elderly by the following three parts, and to explore the relationship between hip fracture and TCM Constitution and the polymorphism of estrogen receptor gene.
The first part is a retrospective study of elderly patients with hip fracture in Hohhot.
Objective: to provide a theoretical basis for the prevention and treatment of hip fracture in the elderly, through a retrospective study of the cases of hip fracture in the elderly in Hohhot, and to reveal the characteristics of the elderly hip fracture in the local area.
Methods: 986 cases of hip fracture in the aged from January 2005 to December 2008 were collected, and the questionnaire was designed to register the related factors. The epidemiological characteristics and 4 years of the hip fracture in the elderly were analyzed dynamically. The diagnosis and treatment of the osteoporosis in the patients with hip fracture were analyzed. Results: (1) the cases of hip fracture in the elderly. The number of cases increased year by year, the number of female cases was more than men (372 men, 614 women), 70 to 89 years old is the age of hip fracture in the elderly (70.18% of the age group), and the hip fracture in Hohhot has regional characteristics. (2) the number of elderly hip fractures with osteoporosis is increasing year by year (respectively) For 10.19%, 10.82%, 18.36%, 26.86%, there is still a large number of missed diagnosis. Although the treatment of osteoporosis has increased year by year, it has obvious blindness and randomness.
Conclusion: (1) should strengthen the hip fracture characteristics of the elderly in Hohhot, strengthen the prevention of hip fracture in the local population, especially the fall and osteoporosis. (2) there is a shortage of diagnosis and treatment of osteoporosis in the Department of orthopedics in the Department of orthopedics. It is necessary to strengthen the continuing education of doctors in the Department of orthopedics, and take a more positive attitude, and choose a reasonable choice. The treatment of anti osteoporosis.
The second part is the relationship between TCM Constitution Types and bone mineral density in elderly hip fracture patients.
Objective: To study the distribution of TCM Constitution and the relationship with bone mineral density in the elderly hip fracture patients in Hohhot, and to provide the theoretical basis for screening the elderly hip fracture relative high risk population, so as to give appropriate intervention measures to prevent the fracture.
Methods: 156 cases of hip fracture in the elderly and 156 cases of non aged hip fracture were studied. The standard of constitution classification was determined by TCM constitution classification, and the bone mineral density of the lumbar spine was measured.
Results: according to the constitution of traditional Chinese medicine, the constitution ratio of the two groups was statistically different (P0.05). The constitution ratio of the elderly hip fracture patients with Qi deficiency, Yang deficiency, yin deficiency, blood stasis, blood stasis, and phlegm wet quality was 21.15%, 14.74%, 15.39%, 16.03%, respectively, and the lumbar bone density of the patients with hip fracture was significantly lower than that of the normal group.
Conclusion: Qi deficiency, Yang deficiency, yin deficiency, blood stasis and phlegm moisture are the main factors affecting the physique of the elderly patients with hip fracture in Hohhot, and the type of Chinese medicine is closely related to the bone mineral density.
The third part is a case control study of ER alpha polymorphism in elderly male patients with osteoporotic hip fracture.
Objective: To study the relationship between estrogen receptor gene polymorphism and osteoporosis in elderly male patients with hip fracture in Hohhot area.
Methods: 128 elderly male hip osteoporotic fractures were collected and 128 Han men were selected according to age ratio, and a case control study was carried out. All the subjects were examined with bone mineral density, and the polymorphism of estrogen receptor gene was detected.
Results: the frequency of estrogen receptor Pvu II genotype PP, Pp and PP were 7.8%, 42.2% and 50%, respectively, and the frequency of Pp and PP in the control group was 13.3%, 53.9% and 32.8%, respectively. The frequency distribution of Pp, PP, PP three genotypes between the osteoporosis group and the control group was significantly different. P0.05. The frequency of estrogen receptor Xba I genotype XX, Xx and XX were 4.7%, 44.5% and 50.8% in the osteoporosis group, and the Pvu II genotype XX, Xx and XX frequencies in the control group were 3.1%, 39.1% and 57.8% respectively. The chi square test suggested that there was no significant difference in the frequency distribution of XX, Xx and XX three genotypes between the osteoporosis group and the control group. Meaning (P0.05).
Conclusion: the distribution frequency of estrogen receptor genotypes conforms to Hardy-Weinberg's law. There is a correlation between the Pvu II enzyme cutting site of ER alpha gene gene and primary osteoporosis in elderly men in Hohhot, and there may be a correlation between the age of hip fracture and the polymorphism of estrogen receptor gene.

【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2010
【分類號(hào)】：R683;R181.3

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