闭经患者雌激素与雄激素对骨密度的影响

The effect of estrogen and androgen on bone density in amenorrhea patients

为了解原发闭经和继发闭经患者的雌雄激素水平与骨密度的关系，收集了１８～５１岁原发闭经患者９０例，继发闭经患者２６０例，并以相同年龄正常月经１８０例为对照组。分别测定其血清雌二醇和睾酮水平，测量皮质骨和松质骨骨密度。结果：原发闭经和继发闭经患者的雌激素均低于正常对照组。２１－羟化酶缺乏患者的雌激素水平稍低但雄激素远高于其它各类闭经患者和正常对照组。各类原发闭经和继发闭经患者的皮质骨和松质骨骨密度均低于同年龄正常对照组，唯独２１－羟化酶缺乏患者骨密度不但未降低反而升高３．１％。多囊性卵巢综合征患者的骨密度降低较少，它与２１－羟化酶缺乏二者均有高雄激素的临床特征。总之，原发闭经患者骨密度低于继发闭经患者，松质骨的骨密度较皮质骨更低。结果表明雌激素和雄激素缺乏均可影响骨密度，雌、雄激素缺乏越早。

Objectives: To assess the bone density in patients with primary and secondary amenorrhea and to see the effect of estrogen and androgen on bone density. Design: A clinical trial. Setting: Outpatient clnic of Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, Peking Union Medical College Hospital. Subjects: A total of 350 patients, aged 18～51 years, with primary and secondary amenorrhea were recruited and 180 women with normal menstruation as controls. Methods: Serum estradiol (E 2) and testosterone (T) were determined by radioimmunoassay (RIA) and bone density measured by single photon absorptiometry (SPA) and quantitative computed tomography (QCT). Results: In patients with primary amenorrhea, all serum E 2 and T were lower than normal controls, except in congenital adrenal hyperplasia (CAH) with 21 hydroxylase deficiency patients they were much higher than controls. Bone density in primary amenorrhea patients was lower than normal controls, except in CAH with 21 hydroxylase deficiency it was higher than controls. In patients with secondary amenorrhea all serum E 2 and T were lower than normal controls, except in polycystic ovary syndrome(PCOS) patients T was slightly higher than normal controls. Bone density in all secondary amenorrhea patients were lower than normal controls, except in PCOS patients the bone density decrease is relatively small. Patients with CAH with 21 hydroxylase deficiency and PCOS both had manifestations of increased androgen. As a whole trabecular bone density is lower than cortical bone density and bone density in primary amenorrhea patients is lower than in secondary amenorrhea patients. Conclusion: Both estrogen and androgen are co related to bone dencity. The earlier the dificiency, the lower the bone density.