体重、体重指数与绝经后妇女骨丢失率的相关性研究

Correlation between body mass,body mass index and biochemical markers of bone turnover in postmenopausal women

目的评价体重、体重指数对绝经后妇女骨转换率的影响。方法对1042名门诊体检的健康绝经后妇女测定身高、体重,计算体重指数(BMI),DXA骨密度仪测定腰椎和股骨部位骨密度(BMD),同时留取血液和尿液测定骨转换指标,如血清骨钙素(SM-BGP)、血清骨特异性碱性磷酸酶(S-BALP)、血I型前胶原C端肽(S-PICP),和骨吸收指标,如尿吡啶啉(U-PYD)、尿脱氧吡啶啉(U-DPD)、尿I型胶原羧基端肽(U-CTX)、尿I型胶原氨基端肽(U-NTX)、尿钙(U-Ca)、尿肌酐(U-Cr)以及可以反映骨代谢的血完整甲状旁腺素(S-PTH)。结果U-CTX/Cr(r=-0.233,P=0.000)、U-NTX/Cr(r=-0.110,P=0.016)和SM-BGP(r=-0.193,P=0.027)与BMI呈负相关。根据体重指数将受试对象分为三组:BMI≤24kg/m(2正常组),24kg/m2<BMI<27kg/m2(超重组),27kg/m2≤BMI(肥胖组),U-CTX/Cr在三组的水平分别为:287.73±98.47;239.37±85.26;204.14±79.91,各组间差异均有统计学意义;U-NTX/Cr在三组的水平分别为:61.77±29.83;54.45±20.37;49.53±19.81,只在组1和组3间差异有统计学意义;SM-BGP在三组的水平分别为:26.16±12.75;24.57±10.98;20.82±7.99,组3与组1、组2间差异有统计学意义。多元逐步回归分析,BMI、腰椎BMD和年龄是影响绝经后妇女U-CTX/Cr、U-NTX/Cr、SM-BGP的主要因素。结论BMI与骨转换率呈负相关,对于绝经后妇女,随着BMI的升高其骨形成(SM-BGP)或骨吸收(U-CTX、U-NTX)均有降低的趋势。

Objective To evaluate the influence of body mass and body mass index （BMI） on bone turnover markers of postmenopausal women. Methods Calculated were BMI, spinal and femoral bone mineral density and bone turnover markers of bone formation （serum osteocalcin （SM-BGP）, serum procollagen type I propeptide （S-PICP）, serum bone-specific alkalin phosphatase （S-BALP）） and bone resorption markers （urine pyridinoline （U-PYD）, urine deoxypyridinoline （U-DPD）, urine N- and C-terminal cross-linking telopeptide of type 1 collagen （U-NTX and U-CTX）） and serum PTH in 1,042 healthy postlnenopausal women. Results U-CTX/Cr （r=-0.233, P=0.000）, U-NTX/Cr（ r=-0.110, P=0.016 ）and SM-BGP（ r=-0.193, p=0.027 ） were negatively correlated with BMI. According to their BMI, the women were grouped into normal group （BMI≤ 24 kg/m^2）, overweight group （24 kg/m^2〈BMI〈27 kg/m^2）, and obese group （27 kg/m^2≤ BMI）. U-CTX/Cr of the three groups was 287.73 ±98.47, 239.37 ± 85.26 and 204.14 ± 79.91 respectively（P=0.000）, the difference being significant between them; U-NTX/Cr was 61.77± 29.83, 54.45 ± 20.37 and 49.53 ± 19.81 respectively, the difference being significant between normal group and obese group; SM-BGP was 26.16 ± 12.75, 24.57 ±10.98 and 20.82 ± 7.99 respectively, the difference being significant between obese group and normal and overweight groups. Multivariate successive regression analysis showed that BMI, BMDLI-4 and age were the main t＇actors affecting bone turnover markers of U-CTX/Cr, U-NTX/Cr and SM-BGP. Conclusions In postmenopausal women BMI is inversely associated with levels of bone formation markers and bone resorption markers.