中老年男性雄激素部分缺乏综合征患者的骨密度改变及其影响因素的研究

Study of bone mineral density and its influential factors in partial androgen deficiency in aging male patients

目的 探讨中老年男性雄激素部分缺乏综合征（partial androgen deficiency in the aging male,PADAM）患者的骨密度（bone mineral density,BMD）特点及其影响因素.方法 采用双能X线骨密度仪（dual energy X-ray absorptiometry,DEXA）测定186例中老年PADAM患者和125例年龄、体重指数（body mass index,BMI）相匹配的健康中老年人的腰椎及股骨颈骨密度,收集相关生化、性激素及骨代谢指标,并对其与年龄、身高、体重、BMI、性激素水平及部分骨代谢指标进行多元逐步回归分析.结果 （1）PADAM组患者腰椎BMD与健康对照组差异无统计学意义（P＞0.05）,但股骨颈各部位BMD均较健康对照组明显降低[Neck：（0.831±0.136）g/cm2 vs（0.954±0.143）g/cm2,Ward＇s：（0.712±0.127）g/cm2 vs（0.811±0.149）g/cm2,Troch：（0.697±0.124）g/cm2 vs（0.764±0.131）g/cm2,P＜0.05）].（2）PADAM组及健康对照组骨量减少的发生率分别为48.9%、36%,骨质疏松的发生率分别为33.3%、20.8%.（3）PADAM患者腰椎BMD与BMI呈正相关;而股骨颈各部位BMD均与年龄呈负相关,与BMI、雄激素水平呈正相关（P＜0.05）.结论 PADAM患者股骨颈各部位骨密度明显降低.高龄、低体重指数和低雄激素水平为PADAM患者BMD降低的危险因素.

Objective To explore the characteristics and its influential factors of bone mineral density （BMD） changes in partial androgen deficiency in aging male patients.Methods 186 aging male patients with partial androgen deficiency and 125 healthy persons were selected, and their BMD in the first to fourth lumber spine and the proximal left femur was measured with the dual-energy X BMD measuring instrument.The biochemical and bone metabolic markers and sexual hormones were collected, and the relationship between changes of BMD in the patients with partial androgen deficiency, age, BMI, sexual hormones and bone metabolic markers were observed by multivariate stepwise regression analysis.Results There was no significant difference in BMD at the lumbar spine between two groups（ P ＞ 0.05 ）, but BMD in PADAM group was lower than control groups at the hip[Neck： （0.831 ±0.136） g/cm2 vs （0.954 ±0.143） g/cm2,War＇s： （0.712 ± 0.127 ） g/cm2 vs （ 0.811 ± 0.149 ） g/cm2,Troch： （ 0.697 ± 0.124 ） g/cm2 vs （ 0.764 ±0.131 ）g/cm2, P ＜ 0.05 ）].The incidence of PADAM and control group with osteopenia were 48.9% and 36%, and the osteoporosis was 33.3% and 20.8%, respectively.The bone mineral density was positively correlated to BMI at the first to fourth lumber spine and the proximal left femur in the patients with PADAM and negatively correlated to age and serum level of androgen.Conclusion BMD in PADAM group was significantly decreased, and age and low BMI and androgen deficiency wwere the risk factors of low BMD in PADAM patients.