老年人血浆总同型半胱氨酸与骨矿密度的关系

Relation of Plasma Total Homocysteine and Bone Mineral Density

目的探讨老年人血浆总同型半胱氨酸(tHcy)与骨矿密度(BMD)的关系。方法测定177例老年人(60～93岁)血钙、血磷、碱性磷酸酶(ALP)、肌酐和tHcy。用双能X线骨密度仪测定腰椎(L2～4)、股骨颈、大转子及Ward’s三角区BMD。结果女性骨质疏松组年龄均大于低骨量组和正常骨量组(均P<0.05);女性骨质疏松组tHcy水平均高于低骨量组和正常骨量组(均P<0.05),低骨量组tHcy水平高于正常骨量组(P<0.05);女性tHcy分别与腰椎正位总体(r=-0.231,P<0.05)和股骨总体BMD均呈负相关(r=-0.194,P<0.05);多元逐步回归分析发现股骨总体BMD的影响因子是年龄(回归系数b1=-0.203,P=0.029)和tHcy(回归系数b7=-0.003,P=0.025)。男性骨质疏松组年龄均大于低骨量组和正常骨量组(均P<0.05);男性血浆tHcy水平与腰椎正位总体(r=-0.052,P>0.05)和股骨总体BMD均无相关性(r=-0.008,均P>0.05)。结论老年女性高水平tHcy可能与低BMD有关,老年男性tHcy水平与BMD无相关性。tHcy可能是老年女性骨质疏松潜在的危险因素。

Objective To investigate the association between plasma total homocysteine （tHcy） and bone mineral density （BMD） in older persons. Methods Serum calcium, phosphate, alkaline phosphatase （ALP）, creatinine and tHcy were measured in older persons （n=177） aged 60 years and older. BMD was measured at the femoral neck and lumbar spine （L24） using dual energy X-ray absorptiometry. Results Compared with low bone mass and normal bone mass in elderly women, age was higher in osteoporotic subjects （all, P〈0.05）. Compared with low bone mass and normal hone mass in elderly women, plasma tHey level was higher in osteoporotic subjects （all, P〈0.05）. Compared with normal bone mass in elderly women, plasma tHey level was higher in low mass （P〈0. 05）. BMD at total hip and lumbar spine was negative correlated with they for elderly women in the bivariate sis （r=-0. 231, r= -0. 194; all, P〈0.05）. A multiple stepwise regression analysis showed that age and tHey were risk factors for BMD of total hip in elderly women, with regression coefficients bl =-0. 203 and br =-0. 003, respectively. Compared with low bone mass and normal bone mass in elderly men, age was higher in osteoporotic subjects （all, P〈0.05）. Plasma tHey level was not related to BMD at total lumbar spine （r=-0. 052, P〉0.05） and hip among men （r= -0. 008; P〉0.05）. Conclusion Elevated tHey may be associated with low BMD in elderly women but not in elderly men. This shows that they may be a potential risk factor for osteoporosis in elderly women.