老年人骨密度测定在颈动脉硬化随访观察中的意义

The significance of bone mineral density detection in the follow-up of the carotid arteriosclerosis in senile patients

目的研究老年人骨质疏松与颈动脉粥样硬化的相关性,给出颈动脉内中膜厚度(IMT)、粥样斑块直径与骨密度T值之间联系。方法研究对象为第二人民医院老年科门诊和住院患者100例,采用双能X线吸收法(DXA)测定腰椎骨和股骨区的骨密度(BMD);同时采用彩超探查颈总及颈内动脉IMT及粥样斑块的情况。根据颈动脉病变程度分为3组:A组(无病变组)、B组(轻度病变组)和C组(中重度病变组)。结果 C组甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、骨碱性磷酸酶(BALP)水平明显低于A组,总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)明显高于A组,差异均有统计学意义(P<0.05)。B组BALP水平明显低于A组,差异有统计学意义(P<0.05)。C组BALP水平明显低于B组,差异有统计学意义(P<0.05)。C组第2-4腰椎及股骨颈BMD水平均明显低于A组,C组股骨颈BMD水平明显低于B组,B组股骨颈BMD水平亦明显低于A组,差异均有统计学意义(P<0.01)。结论老年颈动脉粥样硬化病变程度严重者,骨密度较正常及轻度者偏低。对有颈动脉粥样硬化的老年人随访及体检时加强骨密度检测可能有积极意义。

Objective To investigate the correlation between osteoporosis and carotid atherosclerosis in the elderly, and to find out the relationship among the carotid artery intima-media thickness （IMT） , the diameter of atherosclerotic plaque, and the T-value of the bone mineral density （BMD）. Methods One hundred senile patients from the Out-patient and In-patient Department of Geriatrics in the Second People＇ s Hospital were selected. BMD of the lumbar vertebrae and the femur was detected using dual energy X-ray absorptiometry （DXA）. At the same time, color Doppler ultrasound was applied to detect the IMT of the common carotid artery and the internal carotid artery. The condition of atherosclerotic plaque was also detected. According to the degree of carotid artery lesions, patients were divided into 3 groups： Group A （no-lesion group）, Group B （minor lesion group）, and Group C （moderate lesion group）. Results The serum levels of TG, HDL-C, and BALP in Group C were significantly lower than those in Group A, while the levels of TC and LDL-C were significantly higher than that in Group A （P 〈 0. 05 ）. The serum level of BALP in Group B was significantly lower than that in Group A （P 〈 0. 05）. And the serum level of BALP in Group C was significantly lower than that in Group B （P 〈 0.05 ）. BMD of the lumbar vertebrae （ L2-4 ） and the femoral neck in Group C was significantly lower than that in Group A, and BMD of the femoral neck in Group C was significantly lower than that in Group B, while BMD of the femoral neck in Group B was significantly lower than that in Group A （P 〈 0. 01 ）. Conclusion The elderly patients with severe carotid atherosclerosis have a lower BMD, compared with the patients with no-lesions or minor lesions. Enhanced BMD detection during the follow-up and physical examination of the elderly patients with carotid atherosclerosis may have positive significance.