产后妇女骨量和骨代谢生化指标变化的研究

Changes of bone mass and biochemical markers of bone metabolism in postpartum women

目的 探讨产后妇女骨量和骨代谢生化指标的变化 ,同时明确年龄、身高、体重、身体指数和月经复潮时间对骨密度变化的影响。方法 对 2 4名健康产妇 (2 1～ 35岁 )在产后 6个月内进行了追踪观察。用双能X线吸收测量仪 (DEXA)分别在产后 3～ 5d ,4月初和 7月初测量了腰椎正、侧位和股骨颈BMD ,同时检测了血清骨钙素 ,ICTP ,雌二醇 (放射免疫方法 )及血钙、磷浓度。 2 0名非产妇的BMD值作为对照。结果 哺乳妇女腰椎正位和股骨颈BMD在产后 4月初和 7月初比产后 3～ 5d升高显著 (P <0 0 5 ) ,腰椎侧位BMD在产后 7月初比产后 4月初和产后 3～ 5d明显升高 (P <0 0 1) ,产后 6个月内腰椎和股骨颈的BMD均升高到非产妇组水平 ;血清骨钙素在产后 4月初和 7月初比产后 3～ 5d有明显升高 (P <0 0 1) ,而ICTP却有明显降低 (P <0 0 1) ;血钙在产后 3个月内升高明显 (P <0 .0 1) ,而血磷在产后 6个月内无明显变化 ,但两者都在正常范围 ;月经复潮时间对骨量增加有负性影响 ,而年龄、身高、体重及身体指数对骨量变化无明显影响。结论 在产后 6个月内哺乳妇女的骨量持续增加 ,达到非产妇组水平 ;骨转换增快 ,骨形成超过骨吸收 ;

Objective\ To study changes of bone mass and biochemical markers of bone metabolism in postpartum women, and to determine the effects of age, height, weight, body mass index and time of menses resumption on changes in BMD. Methods\ Twenty four healthy women(21 35yr) were followed longitudinally across 6 months postpartum. Lumbar spine BMD(including anteroposterior and lateral) and femoral neck BMD were measured by DEXA at 1 week, the beginning of 4 and 7 months postpartum. Serum osteocalcin, collagen type Ⅰ cross linking carboxy terminal telopeptide peptide(ICTP), estradiol,calcium and phosphorus were assayed at the same time. Results\ BMD of anteroposterior lumbar spine and femoral neck significantly increased at the beginning of 4 and 7 months postparturition, compared with that at 1 week postpartum( P <0 05), BMD of lateral lumbar spine also significantly increased at the beginning of 7 months postpartum, compared with that at 1 week and the beginning of 4 months postpartum( P <0.01); the serum level of osteocalcin increased significantly( P <0.01) at the beginning of 4 and 7 months postpartum compared with that at 1 week postpartum while the serum level of ICTP declined significantly( P <0.01); serum calcium concentration increased significantly( P <0.01) during 3 months postpartum while serum phosphorus concentration had no significant changes during the 6 months postpartum; and the time of menses resumption was negatively associated with increase in bone mass, whereas age, height, weight and bone mass index were not associated. Conclusion\ It is possible that bone mass increase continously during the 6 month postpartum period in lactating women, the process of bone turnover grows fast while the speed of bone formation exceeds that of bone absorption, and prolonged postpartum amenorrhea is unfavourable to increase in bone mass postpartum.