偏瘫患者全身骨量和骨密度变化分析

Changes of Total Body Bone Mass and Bone Mineral Density in Patients with Hemiplegia

目的探讨偏瘫患者骨量和骨密度的变化规律及影响因素。方法采用双能X线骨密度仪测定366例单侧偏瘫患者(脑血管病313例、脑外伤53例)的全身骨密度、骨量、瘦体组织和脂肪组织,并记录每位患者的一般临床资料。结果患侧上、下肢及躯干的骨量明显低于健侧(P<0.01);三部位患、健侧骨量变化百分比随病程呈下降趋势,差异有非常显著性意义(P<0.01);多元逐步回归分析结果显示,全身骨量和骨密度均与年龄和病程呈明显负相关(P<0.01),与体重指数呈正相关(P<0.05～0.01);全身骨密度还与全身瘦体质量及日常生活活动(ADL)评分呈正相关(P<0.05～0.01)。结论偏瘫患者偏瘫侧骨量较健侧明显下降,并随病程呈加重趋势;年龄、病程和体重指数对全身骨密度和骨量有影响;全身骨密度亦与ADL评分及全身瘦体组织含量相关。

Objective To investigate the changes of bone mineral density （BMD） and bone mass and the influencing factors in patients with hemiplegia. Methods The total BMD, bone mass, lean mass and fat mass of 366 patients （313 stroke cases and 53 TBI eases） with hemiplegia were tested by dual-energy X-ray absorptiometry, as well as the clinical features of all patients, were studied. Results The bone masses in the paretie side （upper limb, lower limb and trunk） decreased significantly compared with nonparetie side （ P 〈0.01） ; the differences of bone masses （%） in upper limb, lower limb and trunk between paretie and nonparetie side decreased with duration of disease or trauma （ P 〈0.01）. The muhivariable stepwise regression analyses showed that the total bone mass and total BMD were negatively correlated with age and duration of disease significantly （all P 〈 0.01）, and positively correlated with body mass index （BMI） significantly （ P 〈0.01）, the total BMD was also positively correlated with lean mass （ P 〈0.01） and ADL level （ P 〈0.05）. Conclusion The bone mass deceases in the paretic side significantly, and gets worse with the duration of disease. Age, duration of disease or trauma and BMI influence total BMD and bone mass; in addition, total BMD is correlated with total lean mass and ADL level.