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  本文選題：骨量減少 + 骨質疏松癥�。� 參考：《天津醫(yī)科大學》2017年碩士論文

【摘要】：目的調查2015年度在天津醫(yī)科大學總醫(yī)院內分泌科住院治療的骨量異�；颊呤褂免}劑、維生素D及雙膦酸鹽類藥物治療的依從性現(xiàn)狀,了解影響依從性的因素。觀察骨量異常患者骨密度隨年齡及性別變化情況,探討骨密度影響因素。方法以2015年度天津醫(yī)科大學總醫(yī)院內分泌科住院患者出院診斷為線索,篩選出骨量異常患者360例。查閱病歷資料,記錄人口學特征、實驗室檢查、影像學檢查、雙能X線骨密度檢查、處方單等信息。對這360例患者逐一進行了電話訪問,追溯骨量異常病程,鈣劑、維生素D及雙膦酸鹽類藥物用藥方案及持續(xù)時間。以藥物持有率(MPR)量化依從性,定義MPR"g80%為依從性好,MPR80%為依從性差。比較依從性好與依從性差兩組間各參數(shù)的差異,采用多因素分析依從性影響因素。采用二分類變量,即有持續(xù)性患者人數(shù)占研究對象人數(shù)比例表示持續(xù)性。以天或周為用藥頻率的藥物,定義間隔1月為無持續(xù)性;以月或年為用藥頻率的藥物,定義間隔3個月為無持續(xù)性。分別以3月、6月為時間截點,分別計算鈣劑、維生素D和雙膦酸鹽類藥物服藥持續(xù)性,比較不同類型藥物持續(xù)性差異。住院期間行雙能X線吸收法測定骨密度(BMD)檢查患者326例,觀察不同年齡、不同性別患者不同骨骼部位骨密度的差異。按照T/Z值分為骨量減少組和骨質疏松組,比較兩組生化指標和骨密度的差異,并進行相關性分析。新診斷2型糖尿病患者54例,住院期間行口服葡萄糖耐量試驗(OGTT),按照骨密度分為骨質疏松組和骨量減少組,比較兩組血糖和胰島素及相關指標的差異。住院期間行骨標三項檢查患者77例,按照原發(fā)病分為2型糖尿病組、格雷夫斯病組、原發(fā)性甲狀旁腺功能亢進組和原發(fā)性骨質疏松組,分析各組間骨代謝指標和骨標志物的差異。絕經(jīng)后女性患者83例,分析垂體性腺軸激素水平與BMD相關性。結果1、骨量異常患者共計360例,得到完整信息274例。依從性好132例,占48.2%;依從性差142例,占51.8%。多因素分析顯示,影響骨量異�；颊叻幰缽男缘囊蛩赜胁〕�、糖皮質激素使用史、骨痛癥狀和吸煙史(P0.05)。2、鈣劑和(或)維生素D補充組、雙膦酸鹽類藥物組、聯(lián)合治療組三組間依從性差異有統(tǒng)計學意義(P0.05)。聯(lián)合治療組較補充組MPR及依從性均較好(P0.05)。各藥物持續(xù)性均隨時間推移而下降,6個月內累計停藥率超過50%。3、男性患者L1-L4、股骨頸、全髖、全身骨密度均高于女性(P0.05)。隨年齡增長,骨密度整體呈下降趨勢。股骨頸部位骨量異常檢出率最高。4、骨量減少組與骨質疏松組兩組年齡、血白蛋白、血尿素氮、FSH、LH、合并脂肪肝患者比例有顯著差異(P0.05)。Pearson相關性分析:L1-L4骨密度與體重、BMI、UA、E2正相關(P均0.05),與年齡、HDL、FSH、LH負相關(P均0.05);股骨頸骨密度與體重、BMI、血白蛋白、E2正相關(P均0.05),與年齡、BUN、FSH、LH負相關(P均0.05);全髖骨密度與體重、BMI、血白蛋白、E2正相關(P均0.05),與年齡、HDL、BUN、FSH、LH負相關(P均0.05)。5、骨量減少組和骨質疏松組,HbA1c%、FBG、FINS、LN(HOMA-B)無顯著差異(P0.05)。骨質疏松組LN(HOMA-IR)低于骨量減少組(P0.05)。Pearson相關性分析,全髖及全身骨密度均與LN(HOMA-IR)正相關(P均0.05)。6、T2DM組、GD組、原發(fā)性甲狀旁腺功能亢進組及原發(fā)性骨質疏松組之間,體重、尿鈣、尿磷無顯著差異(P均0.05)。GD組及原發(fā)甲旁亢組血鈣、OC、CTX、PINP均高于T2DM組和OP組,兩組間血鈣無顯著差異,GD組OC、CTX、PINP平均值均高于原發(fā)甲旁亢組。7、Pearson相關性分析,絕經(jīng)后女性股骨頸骨密度與FSH、LH、FSH/LH、FSH/E2無相關性(P均0.05),與E2正相關(P0.05)。結論骨量異常患者使用鈣劑、維生素D、雙膦酸鹽類藥物的依從性和持續(xù)性均較差。隨病程延長,患者對骨量異常的重視程度提高,服藥依從性有所好轉。糖皮質激素對骨骼負性影響的廣泛認知以及每日飽受骨痛癥狀困擾,可以提高治療的依從性,吸煙等不良生活習慣降低依從性。骨密度隨年齡增長而降低,腰椎和全身骨密度存在假性升高。股骨頸骨密度對于診斷骨量異常敏感性較高,但影響因素較多。體重為骨密度保護因素,胰島素水平升高可能是骨密度的保護因素。HDL水平升高可能導致骨密度降低。GD患者骨轉換活躍,甲狀腺激素導致骨密度降低。絕經(jīng)后女性骨密度降低與雌激素水平下降有關。
[Abstract]:Objective to investigate the compliance status of calcium, vitamin D and bisphosphonates in patients with bone quantity abnormality hospitalized in Department of Endocrinology, General Hospital Affiliated to Tianjin Medical University in 2015, and to understand the factors affecting compliance. The influence factors of bone mineral density with age and sex were investigated. On the basis of the diagnosis of hospitalized patients in Department of endocrinology of General Hospital Affiliated to Tianjin Medical University in 2015, 360 cases of abnormal bone quantity were selected. The data of medical records were checked, the demographic characteristics, laboratory examination, imaging examination, double energy X-ray bone density examination and prescription information. The 360 patients were interviewed by telephone to trace bone mass. Regular course of disease, calcium, vitamin D and bisphosphonates medication program and duration. With drug holding rate (MPR) quantitative compliance, define the MPR "g80% for good compliance, MPR80% compliance poor, good compliance and poor compliance of the differences between the two groups, the use of multiple factors analysis of compliance factors. Two classification variables, that is, The number of persistent patients represented the ratio of the number of subjects in the study. Drugs defined at the frequency of day or week were not persistent at the interval of January; drugs at the frequency of month or year were defined for 3 months without continuity. In March and June, respectively, calcium, vitamin D and bisphosphonates were used to calculate the dosage of calcium, vitamin and bisphosphonates. The persistence of the drugs was compared with the continuous difference of different types of drugs. During hospitalization, 326 cases of bone mineral density (BMD) were measured by double energy X-ray absorptiometry. The bone mineral density of different skeletal sites in different ages and sexes were observed. The T/Z values were divided into bone mass reduction group and bone sparse group, and the differences of biochemical indexes and bone mineral density were compared between the two groups. An oral glucose tolerance test (OGTT) was performed in 54 cases of newly diagnosed type 2 diabetic patients. The bone density was divided into osteoporosis group and bone mass reduction group according to bone mineral density. The difference between two groups of blood glucose and insulin and related indexes was compared. 77 cases were examined in three cases of bone mark during hospitalization, and were divided into type 2 diabetes according to the primary disease. Group, Graves's disease group, primary hyperparathyroidism group and primary osteoporosis group, analysis of the difference of bone metabolism index and bone marker between each group. 83 postmenopausal women patients, analysis of pituitary gonadal axis hormone level and BMD correlation. Results 1, 360 cases of abnormal bone mass, 274 cases of complete information. Good compliance 132. For example, 48.2%, 142 cases of poor compliance and 51.8%. multivariate analysis showed that the factors affecting the compliance of the patients with abnormal bone mass were the course of disease, the history of the use of glucocorticoids, the symptoms of bone pain and the history of smoking (P0.05).2, the calcium and (or) vitamin D supplementation group, the group of biphosphonate salts, and the differences of compliance between the three groups of the combined treatment group were statistically significant (P0 .05). The MPR and compliance of the combined group were better than that of the supplemental group (P0.05). The duration of each drug decreased with time, and the cumulative drug withdrawal rate was more than 50%.3 in 6 months. The male patients were L1-L4, the neck of the femur, the whole hip and the whole body density were higher than that of the women (P0.05). The highest rate of.4, the age of two groups of bone mass reduction group and osteoporosis group, blood albumin, blood urea nitrogen, FSH, LH, the proportion of patients with fatty liver was significantly different (P0.05).Pearson correlation analysis: L1-L4 bone density and weight, BMI, UA, E2 positive correlation (P 0.05), and age, HDL, FSH, negative correlation (0.05); femoral neck bone density and weight, blood white E2 positive correlation (P 0.05), negative correlation with age, BUN, FSH, LH (P 0.05); total hip bone density and weight, BMI, serum albumin, E2 (P 0.05), and age, HDL, BUN, FSH, and osteoporosis group. The P0.05.Pearson correlation analysis showed that the total hip and total bone mineral density were positively correlated with LN (HOMA-IR) (P 0.05).6, T2DM group, GD group, primary hyperparathyroidism group and primary osteoporosis group, body weight, urinary calcium and urine phosphorus (P 0.05).GD group and primary hyperparathyroidism group blood calcium, OC, CTX, and CTX. In group OP, there was no significant difference in blood calcium between the two groups. The average value of OC, CTX and PINP in group GD was higher than that of primary hyperparamidonic group.7, Pearson correlation analysis. The femur neck bone density in postmenopausal women had no correlation with FSH, LH, FSH/LH, FSH/E2 (P are 0.05). As the duration of the disease increased, the patient's attention to the bone mass was increased and the compliance of the drug was improved. The extensive cognition of the negative effects of glucocorticoid on the bone and the daily suffering of the symptoms of bone pain could improve the compliance of the treatment, and reduce the compliance of the bad living habits such as smoking. Bone density increased with age. Decrease, there is a false rise in the bone density of the lumbar vertebrae and the whole body. The bone density of the femoral neck is more sensitive to the diagnosis of bone mass, but the factors affecting the bone mineral density are more. The body weight is the factor of bone mineral density protection, the increase of insulin level may be the protective factor of bone density, the increase of.HDL level may lead to the reduction of bone turnover activity in.GD patients and thyroid hormone. The decrease in bone mineral density is associated with decreased bone mineral density in postmenopausal women.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R580

【參考文獻】

相關期刊論文 前10條

1 賀麗英;孫蘊;要文娟;潘克h，

本文編號：1904085