基于定量CT对绝经后无症状冠心病患者腰椎骨密度与冠脉钙化的相关研究

The study of association between bone mineral density of the lumbar spine and calcified coronary plaque in postmenopausal women with asymptomatic coronary artery disease

目的探讨无症状绝经后老年冠心病患者腰椎骨密度改变与冠状动脉钙化的关系并分析相关因素。方法对112例绝经后无症状老年冠心病患者进行腰椎骨密度(BMD)的定量CT(QCT)测定,同时检测冠状动脉钙化积分(CS),并通过填写调查表了解患者的一般情况、生活习惯及其他影响冠状动脉钙化的因素。将所有患者骨密度T值分为骨量正常组、骨量减少组和骨质疏松组。采用方差分析法比较三组的临床数据及骨密度,用多元线性回归方法和多元相关分析有关因素与CS之间的关系。结果骨质疏松组较骨量减少组、骨量正常组的年龄增大,且差异有显著性(P<0.05),绝经年限在正常组与骨质疏松组比较中差异具有显著性(P<0.05),BMD、冠脉总钙化积分值(TCS)三组比较存在显著性的差异(P<0.05)。而血磷(P)、高密度脂蛋白(HDL)骨质疏松组虽然较骨量减少组、骨量正常组减低,但组间比较差异无显著性(P>0.05)。多元线性回归显示年龄、HDL、腰椎BMD、甘油三脂(TG)对TCS有影响且P<0.05,其中年龄、TG是冠状动脉钙化的危险因素,HDL、腰椎BMD是其保护因素,多元相关分析得出腰椎BMD与TCS存在负相关关系。结论绝经后无症状老年冠心病患者骨量异常者较正常者有较高发生冠状动脉钙化的危险性,且低骨量或骨质疏松可能会和传统的危险因素一样用来预测心血管疾病的发生、发展。

Objective To explore the association between bone mineral density （BMD） of the lumbar spine and coronary artery calcification in postmenopausa elderly women with asymptomatic coronary artery disease and to analyze its relative factors. Methods The quantitative CT （QCT） of the lumbar vertebral BMD of ll2 postmenopausal women with asymptomatic coronary artery disease was measured, and the total calcification score （TCS） was also measured at the same time. The general condition, lifestyle, and other risk factors for coronary artery calcification were analyzed with a questionnaire. All patients were divided into control, osteopenia, and osteoporosis group based on the T score of the lumbar spine BMD. The clinical data and BMD were compared among three groups using an analysis of variance （ ANOVA）. The association of relative factors and TCS was analyzed using the multiple regression method and multiple correlation analysis. Result Age in osteoporosis group was older than other two groups, and the difference was significant （P 〈 0. 05）. The difference of the time of menopause between the osteoporosis group and the control group was significant （P 〈 0. 05）. The differences of lumbar spine BMD and TCS among three groups were significant （P 〈 0. 05）. Serum P and high density lipoprotein （HDL） in ostenporosis group were lower than other twogroups, but the differences were not significant （P 〉 0.05）. Multiple regression analysis showed that age, HDL, and triglyceride （TG） had effects on TCS （P 〈0. 05）. Age and TG were risk factors for TCS. HDL and BMD of the lumbar spine were protective factors for TCS. Multiple regression analysis showed that lumber BMD was negatively associated with TSC. Conclusion The osteopenia patients have higher risk for coronary artery calcification than normal bone mass people of postmenopausal women with asymptomatic coronary artery disease. Low bone mass and osteoporosis can be used to predict the occurrence and progress of coronary artery disease as other traditional risk factors.