本文選題：云南省德宏州傣族 + 跟骨定量超聲�。� 參考：《昆明醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的：1.調(diào)查云南省德宏州傣族人群骨質(zhì)疏松癥的患病率并探討相關(guān)危險(xiǎn)因素。2.通過跟骨定量超聲技術(shù)測定云南省德宏州傣族人群跟骨骨量參數(shù),建立峰值骨量數(shù)據(jù)庫并探討其變化規(guī)律。3.運(yùn)用OSTA系統(tǒng)和FRAX評分對目標(biāo)人群的骨質(zhì)疏松癥及其骨質(zhì)疏松性骨折進(jìn)行自我診斷及風(fēng)險(xiǎn)預(yù)測并驗(yàn)證其有效性及實(shí)用性。4.通過測定云南省德宏州傣族40歲以上人群血清骨代謝標(biāo)志物測定,了解其一定的變化規(guī)律。方法：1.采用隨機(jī)抽樣法,抽取云南省德宏州傣族160人,其中男性49例,女性111例,年齡從20歲-77歲,分組標(biāo)準(zhǔn)為按10歲為一個(gè)年齡段,將人群分為6組。進(jìn)行跟骨定量超聲檢測(包括跟骨BMD值、T值、SI值)、基本體征測量、骨質(zhì)疏松相關(guān)因素問卷調(diào)查,整合后計(jì)算患者OSTA指數(shù)、FRAX評分,將問卷數(shù)據(jù)量化后進(jìn)行統(tǒng)計(jì)學(xué)分析。2.采用隨機(jī)抽樣法,抽取目標(biāo)人群40歲以上人群104人,年齡40-77歲,按年齡段分為4組,用ELISA法檢測25-(OH)Vit D3、甲狀旁腺激素PTH、骨鈣素BGP及降鈣素CT,骨堿性磷酸酶、總I型膠原氨基端延長肽(NTX)對檢測結(jié)果進(jìn)行統(tǒng)計(jì)分析。結(jié)果：1.在160名受試者中,20-29歲年齡段人群BMD及SI值處于最高值,分別為BMD=0.57±0.10 g/cm3SI=108.87±24.17,之后骨量逐步下降,到達(dá)60-69歲年齡段骨量達(dá)到最低點(diǎn),其中30-39、50-59、60-69年齡段BMD及SI丟失最為迅速且具有統(tǒng)計(jì)學(xué)意義。2.160名德宏傣族受試人群中,23人患骨質(zhì)疏松癥,患病率(PR)為14.4%,其中PR男性:12.2%:PR女性:15.3%;63人存在骨量減少,占總?cè)藬?shù)的39.4%。性別對受試人群的0P患病率有直接影響,傣族女性較男性0P患病率高,傣族女性的骨量丟失也要大于男性。對于各年齡段0P發(fā)生率進(jìn)行統(tǒng)計(jì)學(xué)分析后結(jié)果為：男女性均在50-59、60-69這個(gè)年齡段發(fā)病率遠(yuǎn)遠(yuǎn)高于其他年齡段,且這兩個(gè)年齡段骨量丟失率比其他各年齡段高。3.年齡、身高、腰圍這三項(xiàng)與BMD、SI、T值呈負(fù)相關(guān),而BMI、OSTA指數(shù)值呈正相關(guān),其余臀圍和體重進(jìn)行相關(guān)性檢驗(yàn)和SI無統(tǒng)計(jì)學(xué)意義,B MD、SI、T但和BMD、T值呈負(fù)相關(guān)。4.OSTA風(fēng)險(xiǎn)等級與0P患病率存在正相關(guān)關(guān)系,人群OSTA風(fēng)險(xiǎn)等級越高,0P的患病率就越高。5.影響骨質(zhì)疏松相關(guān)因素中發(fā)生脆性骨折的優(yōu)勢比0R為19.49,即：既往發(fā)生過脆性骨折史的傣族人群發(fā)生骨質(zhì)疏松癥的可能性比無既往脆性骨折史的人要高出19.49倍。其余因素?zé)o統(tǒng)計(jì)學(xué)意義。6.160名受試者中40歲以上受試者為137人,未來10年內(nèi)預(yù)測發(fā)生全身性骨質(zhì)疏松性骨折的概率為4.54±2.15%,發(fā)生髖部骨折的概率為0.72±1.11%。50-59歲組,60-69歲的女性發(fā)生骨質(zhì)疏松性骨折概率均明顯高于其他組,60-69歲組男性發(fā)生骨質(zhì)疏松性骨折的概率高于其他年齡組,有統(tǒng)計(jì)學(xué)意義。7.云南省德宏州傣族40歲以上人群平均25-(0H)Vit D。含量為：平均PTH為：325.67ng/ml,平均BGP為：6.53ng/ml,平均CT為：7.19pg/ml,平均N41.91pg/ml,其中,60-69歲年齡段男女間NTX含量對TX:59.75ng/ml,比存在統(tǒng)計(jì)學(xué)差異；70-79歲年齡段男性及女性25-(OH)Vit D。含量較上一年齡段比較下降最為明顯,有統(tǒng)計(jì)學(xué)差異,60-69歲年齡段男女間CT含量對比有統(tǒng)計(jì)學(xué)差異。結(jié)論：1.本組云南省德宏州傣族目標(biāo)人群總體及女性的峰值骨量出現(xiàn)在20-29歲(但本組男性20-29歲年齡段數(shù)據(jù)缺失),該結(jié)果與全國大部分地區(qū)研究的結(jié)論類似,但平均骨量均低于全國其他地區(qū), 其中在50～59歲、60-69歲兩個(gè)年齡段丟失最為迅速。2.云南省德宏州傣族人群的0P患病率高于全國水平,表明德宏州是云南省及全國骨質(zhì)疏松癥的高發(fā)地區(qū),男性患病率最高的年齡段為60-69歲,女性患病率為70-79歲,結(jié)果可能與德宏傣族所特有的民俗、飲食習(xí)慣和生活方式等有關(guān),是未來骨質(zhì)疏松防治的重點(diǎn)地區(qū)之一；3.年齡、BMI都是骨質(zhì)疏松的影響因素之一；脆性骨折系云南省德宏州傣族人群骨質(zhì)疏松癥發(fā)病的重要相關(guān)因素,出現(xiàn)脆性骨折后應(yīng)注意骨質(zhì)疏松癥的防范。4.OSTA系統(tǒng)對于BMD值與SI值具有良好的實(shí)用性及相關(guān)性,可用于對德宏傣族人群骨質(zhì)疏松的初步篩查,其對于較偏遠(yuǎn)的山區(qū),沒有骨密度檢查條件的地方是一種初步篩查手段。只需要簡單的幾個(gè)生理指標(biāo)便可以達(dá)到對于少數(shù)民族欠發(fā)達(dá)地區(qū)的骨質(zhì)疏松癥進(jìn)行初步篩查。5.FRAX評分對德宏傣族40歲以上人群未來10年進(jìn)行預(yù)測后發(fā)現(xiàn),德宏州傣族在50-59歲、60-69歲發(fā)生脆性骨折和髖部骨折概率較高。6.對云南傣族地區(qū)40歲以上人群血清標(biāo)志物測定結(jié)果進(jìn)行分析后我們得出以下結(jié)論：(1)隨年齡的增加,目標(biāo)人群男性、女性血清中25-(OH)Vit D。的含量是在逐步下降的。甲狀旁腺激素水平逐步上升,但在50-59歲年齡段出現(xiàn)波動。(2)血清中降鈣素的含量隨年齡增長呈下降趨勢,NTX則成上升趨勢,其中NTX在各年齡組間及50-59、60-69歲年齡段男女間比較有明顯的差異,(3)其余檢測指標(biāo)沒有發(fā)現(xiàn)明顯的組間差異和組內(nèi)差異。我們可以推測對于德宏傣族人群,NTX作為一項(xiàng)新興的敏感指標(biāo),是有明顯的指導(dǎo)意義的,可以將NTX的檢測進(jìn)一步推廣到骨代謝標(biāo)志物的檢測方法當(dāng)中,以進(jìn)一步對骨質(zhì)疏松癥的診斷、治療和預(yù)后有一定的幫助作用和指導(dǎo)意義。
[Abstract]:Objective: 1. to investigate the prevalence of osteoporosis in Dai people in Dehong, Yunnan, and to explore the related risk factors for the determination of the bone mass parameters of the calcaneus in Dai people in Dehong, Yunnan province by calcaneus quantitative ultrasound technique, and establish the peak bone mass database and explore its change rule.3. using OSTA system and FRAX score for the bone thinning of the target population. The self diagnosis and risk prediction of the osteoporosis and its osteoporotic fracture and its risk prediction and its validity and practicability.4. are determined by measuring the serum bone metabolic markers in the Dai people over 40 years old in Dehong, Yunnan province. Methods: 1. the 160 people of Dai nationality in Dehong, Yunnan Province, were selected by random sampling, among them, male 49 cases, 111 women, age from 20 years old -77 years old, group standard was divided into 6 groups according to the age of 10 years old. Quantitative ultrasound examination of calcaneus (including calcaneus BMD value, T value, SI value), basic physical measurement, osteoporosis related factors questionnaire survey, integrated calculation of the patient OSTA index, FRAX score, the questionnaire data were quantified after statistics. A random sampling method was used to detect 104 people over 40 years of age over 40 years old in the target population, 40-77 years old, and divided into 4 groups according to age. The ELISA method was used to detect 25- (OH) Vit D3, parathyroid hormone PTH, osteocalcin BGP and calcitonin CT, bone alkaline phosphatase, and total I collagen amino end lengthening peptide (NTX). The results were 1. in 16 Among the 0 subjects, the values of BMD and SI in the 20-29 age group were at the highest value, respectively, BMD=0.57 + 0.10 g/cm3SI=108.87 + 24.17, and then the bone mass decreased gradually, and the bone mass reached the lowest point at the age of 60-69, of which the 30-39,50-59,60-69 age BMD and SI lost the fastest and statistically significant Dehong Dai subjects. Of the 23 patients with osteoporosis, the prevalence rate (PR) was 14.4%, of which PR men were 12.2%: 12.2%: PR women: 15.3%; 63 people had bone loss, and the 39.4%. sex of the total number had a direct impact on the prevalence of 0P in the subjects. The Dai women had a higher incidence of 0P than men, and the loss of bone mass in the Dai women was greater than that of men. The incidence of 0P in all ages was carried out. The results of statistical analysis were that the incidence of male and female in the 50-59,60-69 age was much higher than that of other age groups, and the rate of bone loss in these two ages was higher than that of other age groups, and the three items of height and waist circumference were negatively correlated with BMD, SI and T, while BMI, OSTA index was positively correlated, and the rest of hip circumference and body weight were examined by correlation. The test and SI were not statistically significant, B MD, SI, T but BMD, and the negative correlation.4.OSTA risk level was positively correlated with the 0P prevalence, the higher the OSTA risk level was, the higher the 0P prevalence rate was, the greater the odds ratio of the brittle fracture associated with the osteoporosis related factors was 19.49, that is, the Dai people who had had a history of brittle fracture. The possibility of osteoporosis was 19.49 times higher than that of people without the history of brittle fracture. The remaining factors were not statistically significant in 137 subjects of.6.160 subjects over 40 years old. The probability of predicting systemic osteoporotic fractures in the next 10 years was 4.54 + 2.15%, and the probability of hip fracture was 0.72 + 1.11%.50-59 years old. The probability of osteoporotic fracture in 60-69 year old women was significantly higher than that of other groups. The probability of osteoporotic fracture in 60-69 year old men was higher than that of other age groups. The average 25- (0H) Vit D. in the Dai people over 40 years old in Dehong, Yunnan Province, was: 325.67ng/ml, and the average BGP was 6.53ng/ml, flat. The average CT was 7.19pg/ml and average N41.91pg/ml. Among them, there was a statistical difference in NTX content between men and women at the age of 60-69 years. The 25- (OH) Vit D. content of men and women at the age of 70-79 years was the most significantly lower than that in the previous age group. There were statistical differences. There was a statistically significant difference in the comparison of CT content between men and women at 60-69 years of age. Conclusion: 1. the total and female peak bone mass of the Dai target population in Dehong, Yunnan Province, was 20-29 years old (but the data of the 20-29 year old age group was missing in this group). The results were similar to those in most areas of the country, but the average bone mass was lower than that of the rest of the country, of which 50~59, 60-69 years and two age segments lost the most. The prevalence rate of 0P in Dai people of.2. Yunnan province is higher than that of the national level. It shows that Dehong state is the high incidence area of Yunnan province and National Osteoporosis. The highest prevalence rate of male is 60-69 years old and the female prevalence rate is 70-79 years. The result may be related to the folk custom, eating habits and lifestyle of the Dai people in Dehong. It is one of the key areas for the prevention and control of osteoporosis in the future; 3. age, BMI is one of the factors affecting osteoporosis; fragile fracture is an important related factor for the pathogenesis of osteoporosis in Dai people in Dehong, Yunnan Province, and the prevention of osteoporosis after brittle fracture should be paid attention to the BMD value and the value of SI. The use of sex and correlation can be used to screen the osteoporosis of the Dai people in Dehong. It is a preliminary screening method for the remote mountain areas, where there is no bone density examination. Only a few simple physiological indexes can be used to screen the.5.FRAX evaluation of osteoporosis in the less developed minority areas. After the forecast of the Dai people over 40 years of age over the next 10 years in Dehong, it was found that the probability of brittle fracture and hip fracture in the Dai nationality in Dehong was higher than that of the 50-59 years old and 60-69 years old. The results of the determination of serum markers in the Dai people over 40 years old in Yunnan were analyzed. (1) the following conclusions were obtained: (1) the target population was male with the increase of age. The level of 25- (OH) Vit D. in the female serum is gradually decreasing. The level of parathyroid hormone rises gradually, but it fluctuates at the age of 50-59 years. (2) the content of calcitonin in the serum is decreasing with age, and NTX is on the rise, and there is a significant difference between NTX in all age groups and between women and men in the 50-59,60-69 age group. (3) there is no obvious difference between group and group. We can speculate that for the Dai people of Dehong, NTX is a new sensitive index, and it has obvious guiding significance. We can further promote the detection of NTX to the detection methods of bone metabolic markers, so as to further the osteoporosis. Diagnosis, treatment and prognosis are helpful and instructive.

【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R580
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本文編號：1880436