高促卵泡激素闭经患者低骨量的临床表现

The Profile of Low Bone Mass in Amenorrhea with Elevated Follicle Stimulating Hormone

目的了解高促卵泡激素（ＦＳＨ）卵巢性闭经患者低骨量的特点。方法对１８例高ＦＳＨ原发闭经（ＰＡ组）、１７１例高ＦＳＨ继发闭经（ＳＡ组）患者，采用放射免疫法测定血清雌二醇（Ｅ２）；生化法测定血清碱性磷酸酶（ＡＬＰ）、尿钙／肌酐（Ｃａ／Ｃｒ）比值；单光子吸收测量法测定右侧桡骨皮质骨骨密度（ＣＢＭＤ），定量计算机断层扫描法测定腰椎松质骨骨密度（ＴＢＭＤ）。以１８０例年龄匹配。月经正常妇女为对照（对照组）。结果闭经患者的平均Ｅ２水平＜１５０ｐｍｏｌ／Ｌ，ＡＬＰ与Ｃａ／Ｃｒ值显著升高。ＳＡ组ＣＢＭＤ为（６５５±６９）ｍｇ／ｃｍ２，显著低于对照组的（６７７±５６）ｍｇ／ｃｍ２（低３２％，Ｐ＜００１）；ＴＢＭＤ为（１４５±２６）ｍｇ／ｃｍ３，显著低于对照组的（１９２±２８）ｍｇ／ｃｍ３（低２４５％，Ｐ＜０００１）。ＰＡ组的ＣＢＭＤ与ＴＢＭＤ较对照组分别降低１１１％和３５７％。闭经患者的骨密度与闭经时间呈负相关。结论高ＦＳＨ卵巢性闭经患者性激素不足，骨转换增强，骨积累减少，松质骨量骤然下降，受累程度与卵巢功能低落开始的年龄及其持续时间有关。

Objective To observe the characteristics of low bone mass in amenorrhea with elevated follicle stimulating hormene(FSH). Methods Amenorrhea patients with elevated FSH: primary amenorrhea (PA) 18 cases, secondary amenorrhea (SA), 171 cases and age matched control with normal menstruation (Nor) 180 cases. The descriptive parameters were: estradiol (E 2), alkaline phosphatase (ALP), urinary excretion of calcium to creatinine ratio (Ca/Cr), the cortical bone mineral density (CBMD) at right radius measured by single photon absorptimetry (SPA) and the trabecular bone mineral density (TBMD) at lumbar vertebra body measured by quantitative computerized tomography (QCT). Results The experiment had shown the average E 2 level in amenorrhea patients to be <150 pmol/L. Significantly higher ALP and Ca/Cr values than the Nor group. In the SA group, the CBMD value was (655±69)mg/cm 2, which was significantly lower than the Nor group's value of (677±56)mg/cm 2 (3.2% lower, P <0.01). The TBMD value is (145±26) mg/cm 3, which is significantly lower than the Nor group's value of (192±28) mg/cm 3 (24.5%, P <0 001). The disparity with the Nor group was even greater in the PA group (11.1% and 35.7% lower, respectively). The BMD of the amenorrhea patients were negatively linearly correalted with their amenorrhea age.Conclusions The serum estradiol level in amenorrhea patients with high FSH was so low that their bone turnover was increased which led to the insufficient bone accumulation and dramatically dropping of TBMD. It's extent was related to the initial age and the duration of ovarian failure.