不同中医证型及维生素D受体基因BsmⅠ多态性与绝经后骨质疏松症患者骨密度的关系

Bsm I polymorphism of vitamin D receptor gene and traditional Chinese medicine differentiation type in relation to bone mineral density in female patients with postmenopausal osteoporosis

目的:观察维生素D受体基因BsmⅠ多态性及中医证型与绝经后骨质疏松症患者骨密度的相关性,分析影响骨密度的自身因素。方法:①选择2003-01/2004-04福建省中医药研究院骨科门诊绝经后骨质疏松症患者180例,年龄45～70岁,绝经年龄40～58岁。均对检测项目知情同意。肾阴虚118例、肾阳虚42例、肾阴阳两虚20例。②用美国Hologic(4500W)型双能X线骨密度仪检测正位第2～4腰椎、左侧股骨颈、大转子和Ward’s区骨密度。③记录患者自身因素:年龄、绝经年龄、绝经年限、身高、体质量和体质量指数。④应用聚合酶链反应检测维生素D受体基因BsmⅠ多态性。⑤计量资料两组比较正态分布用t检验,非正态分布用Wilcoxon秩和检验,用Bivariate分析患者自身因素与骨密度的相关关系。结果:纳入绝经后骨质疏松症者180例,均进入结果分析。①不同维生素D受体基因型与不同中医证型骨质疏松症患者骨密度比较,3种维生素D受体基因型骨质疏松症患者骨密度差异不明显(P>0.05);3种中医证型骨质疏松症患者骨密度差异也不明显(P>0.05)。②在维生素D受体基因bb型中,肾阴阳两虚患者第2～4腰椎骨密度明显低于肾阴虚型(P<0.05),其他证型间差异不明显(P>0.05)。③在肾阴虚型骨质疏松症患者中,bb型与Bb型骨密度相近(P>0.05)。④在相关性因素中,年龄和绝经年限与4个部位的骨密度呈显著负相关(r=-0.206～-0.441,P<0.05～0.01);身高与腰椎、股骨颈、大转子的骨密度呈显著正相关(r=0.171～0.222,P<0.05～0.01);体质量与股骨颈呈显著正相关(r=0.188,P<0.05);绝经年龄、体质量指数与骨密度无明显相关性(r=0.032～0.158,P>0.05);年龄与腰椎、股骨颈骨密度均呈显著负相关(r=-0.345,-0.427,P<0.05),而绝经年龄、绝经年限、身高、体质量、体质量指数与骨密度无明显相关性(r=-0.018～-0.246,P>0.05)。结论:①维生素D受体基因BsmⅠ多态性及中医证型分类与绝经后骨质疏松症骨密度存在相关性。②年龄、绝经年限、身高、体质量是影响维生素D受体基因bb型患者骨密度的因素。年龄是影响维生素D受体基因Bb型患者骨密度的因素。

AIM： To study the relationship between the Bsm Ⅰ polymorphism of vitamin D receptor （VDR） gene uniting traditional Chinese medicine （TCM） differentiation type and bone mineral density （BMD） in temale postmenopausal osteoporosis （POP）. METHODS： ① The 180 patients with postmenopausal osteoporoses aged 45-70 years and menopausal age of 40-58 years were investigated through random sampling method in the Department of Orthopaedics of Fujian Academy of Chinese Medicine during January 2003 to April 2003,. They all knew the fact and accepted. There were 118 patients of kidney-yindeficiency, 42 of kidney-ycatg-deficiency and 20 of kidney-yin-yangdeficiency. ② The BMD of the 2^th and 4^th lumbar vertebrae, left upper femur, greater troehanter and Ward＇s area was measured with dual energy X-ray absorptiometry （4 500 W, Hologic, USA）.③ Self-factor of patients： Age, menopausal age, menopausal duration, height, body mass and body mineral index were recorded. ④ The Bsm Ⅰ polymorphism of VDR gene was detected by polymerase chain reaction. ⑤ Normal data were compared with t test, no normal data were compared with Wilcoxon rank sum test, and relationship between self-factors and BMD were analyzed with Bivariate method. RESULTS： Totally 180 POP patients were entered the final analysis.①BMD of POP patients with 3 kinds VDR was not significantly different from that of patients with various TCM differentiation types （P 〉 0.05）, and differences among 3 kinds of TCM differentiation types were not significant （P 〉 0.05）, ② In bb genotype, BMD of the 2^th and 4^th lumbar vertebrae in patients was significantly lower than that in kidney-y/n-deficiency patients （P 〈 0.05）, but there were no significant differences among other TCM differentiation types （P 〉 0.05）. ③ bb genotypos were similar to Bb genotype of POP patients in kidney-yindeficiency （P 〉 0.05）. ④ Among relative factors, age and menopausal duration were negative correlation with BMD at four sites （r=-0.206 to -0.441, P 〈0.05-0.01）; height was positive correlation with BMD in lumbar vertebrae, neck of femur and greater trochanter （r=0.171-0.222, P 〈 0.05-0.01）; body mass was positive correlation with neck of femur （r=0.188, P 〈 0.05）; menopausal age and body mass index were no correlation with BMD （r=0.032-0.158, P 〉 0.05）; age was negative correlation with BMD in lumbar vertebrae and neck of femur （r=-0345, -0.427, P 〈 0.05）; menopausal age, menopausal duration, height, body mass and body mass index were no correlation with BMD （r= -0.018 to -0246, P 〉 0.05）. CONCLUSION： ① Bsm I polymorphism of VDR gene uniting TCM differentiation type is correalted with BMD in POP. ② Self-factors such as age, menopausal duration, height and body mass can affect BMD in bb genotype of VDR, and age can also affect BMD in Bb genotype of VDR.