本文選題：骨質(zhì)疏松癥 + 高鈣尿癥�。� 參考：《第二軍醫(yī)大學(xué)》2017年碩士論文

【摘要】：目的探討女性絕經(jīng)后骨質(zhì)疏松癥的相關(guān)因素,并分析尿鈣量對(duì)女性絕經(jīng)后骨質(zhì)疏松癥患者骨轉(zhuǎn)換及腎小管功能的影響。方法選取2014年7月至2016年12月期間,至長(zhǎng)海醫(yī)院腎內(nèi)科及風(fēng)濕免疫科門診就診的患者,通過調(diào)查問卷的形式,收集并記錄患者一般資料,比如性別、年齡、身高、體重、有無絕經(jīng)、絕經(jīng)年限、生育個(gè)數(shù)、第一次妊娠年齡、既往病史、手術(shù)史、運(yùn)動(dòng)鍛煉情況、日照時(shí)間、服用藥物、骨折史、吸煙及飲酒史、生活方式及營(yíng)養(yǎng)狀況等,排除影響骨代謝的其他疾病后,通過雙能X線測(cè)定骨密度,按照骨質(zhì)疏松疏松癥的診斷標(biāo)準(zhǔn),分為正常骨量組與骨質(zhì)疏松組,記錄就診者的骨密度檢測(cè)結(jié)果、血生化、尿生化、尿常規(guī)、骨代謝標(biāo)志物,收集患者空腹尿液標(biāo)本,測(cè)定空腹尿鈣/尿肌酐、尿微量蛋白等。通過各暴露指標(biāo)與骨質(zhì)疏松癥的單因素分析,再通過多因素條件下Logistic回歸分析,得到女性絕經(jīng)后骨質(zhì)疏松癥危險(xiǎn)因素與保護(hù)因素。接下來對(duì)于骨質(zhì)疏松組,分析該組研究對(duì)象的骨密度(BMD)、空腹尿鈣/肌酐、尿N-乙酰-β-葡萄糖苷酶(NAG)、堿性磷酸酶(ALP)及尿β2-微球蛋白(尿β2-MG)之間的關(guān)系,以及骨質(zhì)疏松伴泌尿系結(jié)石組與非結(jié)石組,各項(xiàng)指標(biāo)的對(duì)比分析,從而分析尿鈣對(duì)女性絕經(jīng)后骨質(zhì)疏松癥患者骨轉(zhuǎn)換及腎小管功能的影響。結(jié)果研究對(duì)象共有290名,其中骨質(zhì)疏松的140名,骨量正常的150名,70歲以上的骨質(zhì)疏松的患病率明顯高于60歲以下的(P㩳0.01);研究發(fā)現(xiàn)經(jīng)常運(yùn)動(dòng)鍛煉是骨質(zhì)疏松的保護(hù)性因素(OR=0.457 95%CI0.236-0.887);食鹽攝入量、蛋白攝入量、生育次數(shù)及尿鈣/尿肌酐的值是絕經(jīng)后骨質(zhì)疏松的危險(xiǎn)性因素(OR1)。骨質(zhì)疏松組中,空腹尿鈣/肌酐與尿NAG(P0.01 r=0.721)、尿β2-MG(P0.01r=0.553)、ALP(P0.01 r=0.886)成正相關(guān);而骨質(zhì)疏松伴泌尿系結(jié)石組的尿鈣/肌酐、尿NAG、尿β2-MG及ALP均高于非結(jié)石組(P㩳0.05)。結(jié)論控制食鹽及動(dòng)物蛋白攝入量,積極進(jìn)行運(yùn)動(dòng)鍛煉,加強(qiáng)絕經(jīng)后骨質(zhì)疏松癥的健康宣教;骨質(zhì)疏松組骨吸收高于骨量正常組,空腹尿鈣/肌酐可以作為絕經(jīng)后骨質(zhì)疏松的危險(xiǎn)因素以及預(yù)測(cè)骨吸收的標(biāo)志物之一。在絕經(jīng)后骨質(zhì)疏松患者中,根據(jù)空腹尿鈣/肌酐值可以預(yù)測(cè)骨轉(zhuǎn)換、腎小球及腎小管功能,也可以預(yù)測(cè)腎結(jié)石發(fā)生的風(fēng)險(xiǎn)。
[Abstract]:Objective to investigate the related factors of postmenopausal osteoporosis and to analyze the effect of urine calcium content on bone turnover and renal tubular function in postmenopausal women with osteoporosis. Methods from July 2014 to December 2016, patients attending Department of Renal Medicine and Department of Rheumatology and Immunology, Changhai Hospital, were selected to collect and record general data of patients, such as gender, age, height, weight, by questionnaire. Menopause, years of menopause, number of births, age of first pregnancy, past medical history, history of surgery, exercise, sunshine time, medication, history of fracture, history of smoking and drinking, lifestyle and nutritional status, etc. After excluding other diseases affecting bone metabolism, bone mineral density (BMD) was measured by dual energy X-ray. According to the diagnostic criteria of osteoporosis, it was divided into normal bone mass group and osteoporosis group. The results of bone mineral density, blood biochemistry and urine biochemistry were recorded. Urine routine, bone metabolism markers, fasting urine samples were collected, fasting urine calcium / creatinine, urine trace protein were determined. The risk factors and protective factors of postmenopausal osteoporosis were obtained by univariate analysis of exposure indexes and osteoporosis and Logistic regression analysis under multivariate conditions. Then, for the osteoporosis group, the relationship between bone mineral density (BMD), fasting urine calcium / creatinine, urine N-acetyl- 尾 -glucosidase (NAGN), alkaline phosphatase (ALP) and urine 尾 _ 2-microglobulin (尾 _ 2-MG) was analyzed. The effects of urinary calcium on bone turnover and renal tubule function in female postmenopausal osteoporosis patients were analyzed. Results there were 290 subjects, 140 of whom were osteoporosis. The prevalence of osteoporosis in 150 patients over 70 years of age with normal bone mass was significantly higher than that in patients under 60 years of age. The study found that regular exercise is the protective factor for osteoporosis. Fertility frequency and urinary calcium / urinary creatinine were risk factors of postmenopausal osteoporosis. In osteoporosis group, fasting urinary calcium / creatinine was positively correlated with urinary NAG(P0.01 rr 0.721, urinary 尾 2-MGG P0.01rU 0.553P 0.01 rn 0.886), while urinary calcium / creatinine, urinary nag, urinary 尾 2-MG and ALP were significantly higher in osteoporosis with urolithiasis than those without urinary calculi. Conclusion to control the intake of salt and animal protein, to exercise actively, to strengthen the health education of postmenopausal osteoporosis, the bone resorption of osteoporosis group is higher than that of normal bone mass group. Fasting urine calcium / creatinine can be used as a risk factor for postmenopausal osteoporosis and a marker for predicting bone resorption. In postmenopausal patients with osteoporosis, fasting urinary calcium / creatinine levels can predict bone turnover, glomerular and tubular function, and predict the risk of renal calculi.
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R580

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