绝经后妇女不同骨量、骨代谢生化指标及其他相关因素的初步研究

A preliminary study of bone metabolic biochemical markers and other related factors in different bone mineral contents of healthy postmenopausal women

目的 观察绝经后妇女不同骨量、骨代谢生化指标及相关因素的变化，以探讨Ⅰ型骨质疏松（ＯＰ）的发病机制。方法 ７５ 例正常绝经后妇女按照宽波段超声衰减（ＢＵＡ） 分成骨量正常组（Ａ 组） 、骨量减少组（Ｂ组） 、骨质疏松组（Ｃ组）。用酶联免疫吸附法（ＥＬＩＳＡ） 法测定各种骨形成与骨吸收的生化标志，用放射免疫分析法（ＲＩＡ） 测定血清中雌二醇（Ｅ２）、卵泡刺激素（ＦＳＨ） 、黄体生成素（ＬＨ） ，此外还测量其身高、体重。结果 Ｂ、Ｃ组分别与Ａ 组相比，骨钙素（ＢＧＰ） 、吡啶酚（ＰＹＤ） 、脱氧吡啶酚（ＤＰＤ） 明显升高，而Ⅰ型胶原羧基端前肽（ＣＩＣＰ）仅在Ｃ组明显升高。Ｃ组分别与Ａ、Ｂ组相比，体重、体重指数（ＢＭＩ） 、Ｅ２ 明显下降，绝经年龄明显提前，且Ｅ２ 在Ｂ组即明显下降，Ｃ组与Ａ 组相比ＦＳＨ 明显升高。直线相关分析显示ＢＵＡ与体重、ＢＭＩ呈正相关（ｒ＝ ０ ．３３３ ，Ｐ＜０ ．０１；ｒ＝０ ．２９１ ，Ｐ＜ ０ ．０５） ，多元逐步回归分析显示ＢＵＡ 与绝经年龄、体重，Ｅ２ 相关（ Ｐ 值分别为０ ．００１ 、０ ．００１ 、０．０１９） 。结论 Ⅰ型ＯＰ的骨形成与骨吸收的生化标志均升高，属高转换型。雌激素下降是其主要发病机制，低体?

Objective To explore the relationship between bone metabolic biochemical markers and other rela ted factors in different bone mineral contents of healthy postmenopausal women. Methods 75 healthy postmenopausal women were divided into three groups, 20 with normal bone density (Group A), 20 with osteopenia (Group B) and 35 with osteoporosis (Group C), according to broadband ultrasound attenuation (BUA). Markers of bone formation and resorption were measured by enzyme linked immunosorbent assay (ELISA). The serum estradiol (E 2), lutinizing hormone (LH) and folliclular stimulating hormone (FSH) were measured by radioimmunoassay (RIA). Body height and weight were also measured. Results Osteocalcin (BGP), pyridinodine (PYD) and deoxypyridinoline (DPD) were significantly increased in Group C and B compared with A, but carboxyterminal propeptide of type Ⅰ collagen (CICP) was only apparently elevated in Group C. Weight, body mass index (BMI) and E 2 were significantly decreased in Group C compared with Group A and B. Menopausal age was also apparently younger in Group C. FSH was significantly increased in Group C compared with A. Linear regreassion analysis showed that BUA was positively correlated with body weight and BMI ( r=0.333, P<0.01; r=0.291, P<0.05). Multple stepwise regression analysis showed that BUA was correlated with menopausal age, weight and E 2 ( P =0.01, 0.01, 0.019 individually). Conclusion Bone formation and resorption markers were all elevated in type Ⅰ osteoporosis. The major pathogenetic mechanism may involve decreased estrogen and low body weight may be one of the risky factors in type Ⅰ osteoporosis. (Shanghai Med J, 2000, 23:102 104)