绝经后骨量减少妇女的骨组织计量学研究

Bone Histomorphomety Study in Post-menopausal Women With Osteopenia

本研究对２９３例绝经后骨量减少的妇女的髂后嵴骨标本，经塑料包埋，不脱钙染色，用计算机进行骨组织计量学测定。结果：骨标本小梁骨面积平均为１０．６％±５．４７％，低于正常低值（１５％）的２９．３％。其中１８６例（６３．５％）组织学类型属正常转化型，７５例（２５．６％）属高转化型，３２例属低转化型。与正常转化型比较，高转化型的破骨细胞数、校正矿化率及骨形成率增高（Ｐ＜０．０１），矿化时间缩短（Ｐ＜０．０１）；低转化型则相反（Ｐ＜０．０５～０．０１）。按５１～６０、６１～７０及＞７０岁３个年龄组进行比较。矿化的小梁骨面积和未矿化的骨前质面积，随年龄的增长而减少；骨转化状态在５１～６０岁组即已出现高、低两种异常转化，６１～７０岁组高、低转化型所占比例最高，在＞７０岁组转化趋于正常。提示：骨组织活检可鉴别骨量减少与骨软化，确定转化类型，并指导治疗。

bjectives To investigate the histological features of bone,the turnover status of bone remodeling in postmenopausal women with osteopenia. To observe the in fluence of age on the changes of bone turnover. Methods Two hundred ninety three bone biopsies were obtained from posterior iliac crests of post- menopausal White women with osteopenia after taking fluorescence-labelled tetracyclin,All these speci- mens were embedded in methacrylate,the nondecalcified sections were stained routinely and measured by computerized histomorphometry. Results The mean trabecular bone volume was 10.6%±5.47%,which is 29.3% less than the low limit of normal range(15%)established in our laboratory.There were 186 cases(63.5%)in normal turnover status,75 cases(25.6%)in high turnover,and 32 cases(10.9%)in low turnover.In com- parison with the normal turnover group,the osteoclast number,eorrected bone mineralization rate and bone formation rate were elevated and mineralization lag time was reduced in the high turnover group(P<0.01).In contrary,all the above pararneters in the low turnover group were on the opposite(P< 0.05～0.01).Comparison of three age groups(51～60, 61～70,> 70 years)showed that the bone volume and osteoid volume decreased as the age increased.The proportion of high and low turnover types began to increase in the 51～60 age group,peaked in the 61～70 agegroup and dropped to nadir in the > 70 age group。Conclusions Bone histomorphometry examination is not only valuable in distinguishing osteoporosis from osteomalacia,but also beneficial for determination of the bone turnover status and,therefore、is useful for the direction of clinical treatment in patients with postmenopausal osteopenia.