脑卒中偏瘫患者骨密度变化及继发骨质疏松症的特点

The change of bone mineral density and osteoporosis after stroke in elderly people

目的:探讨脑卒中患者肢体瘫痪对其骨密度(BMD)和骨质疏松(OP)患病率的影响。方法:102例广东省佛山地区常住的脑卒中患者(脑卒中组),男46例,女56例,年龄55—85岁(平均72.8±9.2岁),使用美国Hologic公司双能X线骨密度仪对正位腰椎(L1-L4)、双侧前臂远端和股骨近端进行BMD测定,并与352例本地区健康人(对照组)进行BMD及OP患病率的比较。结果:脑卒中组的偏瘫侧前臂、股骨颈、Ward′s区的BMD值明显低于健侧(0.444±0.11 vs 0.478±0.09,0.716±0.16 vs 0.757±0.16,0.373±0.15 vs 0.407±0.15,P<0.05),偏瘫侧股骨颈、Ward′s区和腰椎BMD明显低于对照组(0.716±0.16 vs 0.844±0.12,0.373±0.15 vs 0.495±0.13,0.768±0.18 vs 0.831±0.13,P<0.05)。病程≥3个月的患者的偏瘫侧前臂、股骨颈和腰椎BMD明显低于病程<3个月的患者(0.415±0.10 vs 0.474±0.11,0.672±0.16 vs 0.751±0.16,0.722±0.14 vs 0.802±0.19,P<0.05),且病程≥3个月的患者的健侧BMD也低于病程<3个月的患者,但差异没有显著性(P>0.05)。女性脑卒中患者各部位的BMD明显低于男性(P<0.05)。脑卒中组偏瘫侧股骨的OP患病率高于健侧(P<0.05),男性腰椎和股骨、女性股骨的OP患病率高于对照组(P<0.05)。结论:脑卒中后偏瘫患者患侧前臂、股骨近端和腰椎BMD度低于健康人和健侧;女性患者BMD低于男性患者,病程越长,BMD越低。患侧肢体OP患病率高于健侧,脑卒中患者股骨的OP患病率高于健康人。

Objective：To investigate the change of bone mineral density（BMD） and osteoporosis（OP） prevalence rate after stroke in elderly people of Foshan district of Guangdong Provice.Method：The BMD of lumbar（L1-L4） ,distal of forearm and proximal femur were measured by Hologic DelphiTM dual energy X-ray absorptiometry in 102 stroke patients with hemiplegia and 352 healthy people.In the stroke group,there were 46 males and 56 females,with an age ranging from 55 to 85 years old,in average 72.8±9.2 years old and having a course of diseases for 4.1 months.Result：The BMD of forearm,proximal femur and Ward＇s area in hemiplegic side was significantly lower than the intact side（0.444±0.11 vs 0.478±0.09,0.716±0.16 vs 0.757±0.16,0.373±0.15 vs 0.407±0.15,P〈0.05） .The BMD of proximal femur,Ward＇s area in hemiplegic side and lumbar in stroke patients was significantly lower than in healthy people（0.716±0.16 vs 0.844±0.12,0.373±0.15 vs 0.495±0.13,0.768±0.18 vs 0.831±0.13,P〈0.05） .The BMD of distal of forearm,proximal femur in hemiplegic side and lumbar of the patients with more-than-3-month course was significantly lower than the patients with less-than-3-month course（0.415±0.10 vs 0.474±0.11,0.672±0.16 vs 0.751±0.16,0.722±0.14 vs 0.802±0.19,P〈0.05） .The BMD of female patients was significantly lower than male patients（P〈0.05） .Osteoporosis prevalence in proximal femur of hemiplegic side was significantly higher than in intact side（P〈0.05） ,and the male patient＇s lumbar and proximal femur of hemiplegic side,female patients＇s proximal femur of hemiplegic side was significantly higher than normal subjects（P〈0.05） .Conclusion：The BMD of lumbar,distal of forearm and proximal femur decrease significantly in stroke patients,in hemiplegic side,in long course of diseases and in females.Osteoporosis prevalence in stroke patients and in hemiplegic side is higher than in normal subjects and in intact side.