【摘要】：目的探討體重、體脂與絕經后女性骨密度的關系。通過分析骨代謝指標與骨密度的關系以及OSTA、FRAX評估工具識別骨質疏松風險的能力,為絕經后女性骨質疏松癥的早期診斷及治療提供指導。方法選取2014年5月至2014年8月在安徽醫(yī)科大學第一附屬醫(yī)院體檢中心體檢的健康絕經后女性131例,平均年齡(63.96±7.60)歲,自然絕經,絕經時間大于1年,平均絕經年限(14.50±8.71)年。采集受試者年齡、身高、體重、腰圍、絕經年限、母親骨折史等資料,計算體重指數(BMI),測定血鈣(Ca)、血磷(P)、堿性磷酸酶(ALP)、25羥-維生素D3(25(OH)D3)、雌激素(E2)、骨鈣素(BGP)、抗酒石酸酸性磷酸酶(TRACP)等生化指標,采用雙能X線骨密度儀檢測腰椎L2-4、股骨頸、wards三角、大轉子骨密度及全身體脂百分比,結合相關資料,計算出每位受試者亞洲人骨質疏松自我篩查工具(OSTA)指數和骨折風險因子評估工具(不含骨密度模型FRAX)的10年髖部骨折風險(HF)和主要骨質疏松性骨折風險(MO)。依據BMI值24為切點將受試者分為體重正常組和超重及肥胖組,通過t檢驗比較兩組間骨密度、骨代謝指標、骨折風險概率。根據骨密度分為骨質疏松組及非骨質疏松組,通過t檢驗比較兩組間體重、體脂百分比、骨代謝指標、骨折風險概率。運用相關分析探討骨密度的相關影響因素。分析OSTA、FRAX工具識別骨質疏松風險的ROC曲線特征。結果1.超重及肥胖組的腰椎L2-4骨密度、股骨頸骨密度、大轉子骨密度較正常體重組高,而絕經年限較對照組短,差異有統計學意義(均P0.05);兩組的年齡、身高、Wards三角骨密度、BGP、TRACP、E2、25(OH)D3、ALP、Ca、P差異無統計學意義。2.骨質疏松組的年齡、絕經年限、BGP、TRACP、ALP較對照組高,而身高、體重、BMI、體脂百分比、E2、25(OH)D3較對照組低,差異有統計學意義(均P0.05)。兩組的腰圍、ALP、Ca、P差異無統計學意義。3.相關分析顯示腰椎L2-4骨密度、股骨頸骨密度、大轉子骨密度、Wards三角骨密度與BMI、體脂百分比、體重、OSTA評分、E2呈正相關,與年齡、絕經年限、MO、HF、BGP、TRACP呈負相關,與腰圍、25(OH)D3、ALP、Ca、P相關性較弱或無相關性。4.OSTA指數識別骨質疏松風險的ROC曲線下面積為0.754,FRAX工具計算出的HF、MO識別骨質疏松風險的ROC曲線下面積分別為0.890、0.888。結論1.健康的絕經后女性適量增加體重和體脂可以增加骨密度從而早期預防骨質疏松癥;2.測定骨代謝指標對骨質疏松癥的早期診斷提供指導;3.OSTA及FRAX工具均可用于識別絕經后女性骨質疏松風險,且OSTA簡單、經濟、易與推廣。
[Abstract]:Objective to investigate the relationship between body weight, body fat and bone mineral density in postmenopausal women. The relationship between bone metabolism and bone mineral density (BMD) and the ability of OSTA-FRAX to identify the risk of osteoporosis were analyzed in order to provide guidance for early diagnosis and treatment of osteoporosis in postmenopausal women. Methods 131 postmenopausal women (mean age (63.96 鹵7.60) years) who were examined in the physical examination Center of the first affiliated Hospital of Anhui Medical University from May 2014 to August 2014 were selected. The menopausal period was more than one year and the average menopausal period was (14.50 鹵8.71) years. The subjects' age, height, weight, waist circumference, menopausal age, history of the mother's fracture and so on were collected. Body mass index (BMI),) was used to measure serum calcium, (Ca), serum phosphorus, (P), (P), alkaline phosphatase (ALP) 25 hydroxy-vitamin D 3 (25 (OH) D 3), estrogen (E2), osteocalcin (BGP), tartrate resistant acid phosphatase (TRACP) and so on. Lumbar spine L2-4 and femoral neck bursa triangle were detected by dual energy X-ray absorptiometry. Bone mineral density of trochanter and percentage of body fat, combined with relevant data, Calculate 10 year hip fracture risk (HF) and major osteoporosis fracture risk (MO). For each Asian self-screening tool (OSTA) index and fracture risk factor assessment tool (excluding bone mineral density model FRAX) The subjects were divided into normal weight group and overweight and obesity group according to the BMI value of 24. Bone mineral density, bone metabolism index and fracture risk probability were compared between the two groups by t test. Bone mineral density was divided into osteoporosis group and non-osteoporosis group. T test was used to compare the weight, percentage of body fat, bone metabolism index and fracture risk probability between the two groups. Correlation analysis was used to investigate the related factors of bone mineral density (BMD). The ROC curve features of OSTA-FRAX tool for identifying osteoporosis risk were analyzed. Result 1. L2-4 bone mineral density (BMD), femoral neck bone density (BMD) and greater trochanter bone density (BMD) in overweight and obese group were higher than those in normal weight group, but the menopausal period was shorter than that in control group (P0.05). There was no significant difference in bone mineral density (BGP) between two groups. The age and menopausal age of Osteoporosis group were higher than that of the control group, but the body height, body weight and body fat percentage were significantly lower than those in the control group (P0.05). There was no significant difference in the waist circumference between the two groups. Correlation analysis showed that lumbar L2-4 bone mineral density, femoral neck bone density, greater trochanter bone mineral density and BMIs, percentage of body fat, weight and OSTA score E _ 2 were positively correlated, but negatively correlated with age, menopausal age and BGPCP. The area under the ROC curve of Osta index to identify the risk of osteoporosis was 0.754m FRAX tool. The area under the ROC curve calculated by FRAX tool was 0.890 鹵0.8880.The area under the ROC curve calculated by FRAX tool was 0.890 ~ 0.8880.The area under the ROC curve calculated by FRAX was 0.890 ~ 0.888. Conclusion 1. Healthy postmenopausal women gain weight and body fat in moderation to increase bone mineral density and prevent osteoporosis early. Osta and FRAX tools can be used to identify osteoporosis risk in postmenopausal women, and OSTA is simple, economical, easy and popularized.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R580
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本文編號：2142155