绝经后女性骨关节炎和骨质疏松患者血清性激素结合蛋白水平比较分析

Comparative analysis of serum sex hormone-binding globulin levels between postmenopausal female patients with osteoarthritis and osteoporosis

目的分析绝经后女性骨关节炎(OA)和骨质疏松(OP)患者血清雌二醇、性激素结合蛋白(SHBG)水平差异及其各自与股骨近端、腰椎骨密度及血清骨保护素(OPG)之间的相关性,探讨SHBG在这两种疾病中的作用机制。方法选取绝经后女性OA和OP患者各60例,用放射免疫法和ELISA法分别检测血清雌二醇、SHBG和OPG等。游离雌二醇指数(FEI)用血清雌二醇与SHBG的摩尔比率表示。结果 OA组患者的体质量、体质量指数、骨密度明显高于OP组患者。两组患者血清雌二醇水平差异无统计学意义(P=0.124),但OP组患者血清SHBG及OPG水平均高于OA组患者[SHBG:(74.98±8.90)nmol/L和(66.38±9.74)nmol/L,P<0.01;OPG:(6.94±1.18)pmol/L和(4.67±1.28)pmol/L,P<0.01],而FEI为OA组高于OP组(0.75±0.31和0.63±0.27,P<0.05)。两组患者血清SHBG和股骨近端、腰椎骨密度之间均有明显负相关性,而FEI与两个部位骨密度间均呈正相关。结论绝经后女性OA与OP患者血清SHBG水平的差异可能是引起活性雌激素水平差异、导致骨密度和骨微结构不同的重要因素。

Objective To compare the serum levels of estradiol and sex hormone-binding globulin(SHBG) between postmenopausal females patients with osteoarthritis(OA) and osteoporosis(OP),analyse their possible correlations with serum osteoprotegerin(OPG) and bone mineral densities(BMD) in the proximal femur and lumbar region,and explore the mechanism of SHBG in the development of OA and OP. Methods Sixty postmenopausal female patients with OA and 60 postmenopausal female patients with OP were selected.Anthropometric parameters were measured,and serum levels of estradiol,SHBG and OPG were quantified with radioimmunoassay or ELISA.Free estradiol index(FEI) was also calculated by the ratio of serum estradiol to SHBG. Results The body weight,body mass index and BMD in OA group were higher than those in OP group.There was no significant difference in serum estradiol level between two groups(P=0.124).SHBG and OPG levels in OP group were significantly higher than those in OA group [SHBG:(74.98±8.90) nmol/L vs(66.38±9.74) nmol/L,P<0.01;OPG:(6.94±1.18) pmol/L vs(4.67±1.28) pmol/L,P<0.01].FEI in OP group was significantly lower than that in OA group(0.63±0.27 vs 0.75±0.31,P<0.05).Serum SHBG negatively correlated,while FEI positively correlated with BMD in the proximal femur and lumbar region in both groups. Conclusion The differences in serum SHBG levels may determine the differences in active estradiol levels,and eventually result in the differences in BMD and bone micro-structures between postmenopausal female patients with OA and OP.