老年女性硫酸脱氢表雄酮水平及骨代谢指标与骨量的关系

Correlation between serum dehydroepiandrosterone sulfate level and bone mineral density in aged women

目的探讨老年女性的硫酸脱氢表雄酮（DHEAS）水平与骨密度及骨代谢指标之间的关系。方法采用化学发光法测定207例老年女性血清DHEAS、性激素、活性维生素D3、I型胶原羧基端肽β特殊序列（β—cTx）、骨钙素、总I型胶原氨基端延长肽（TPINP），并用DEXA测定腰椎正位和股骨颈的骨密度。根据骨密度诊断标准及血清DHEAS水平的四分位间距分组，按T〉-1．0s、-2．5s〈T≤-1．0s及≤-2．5s分为正常骨量组、低骨量组及骨质疏松组；同时根据DHEAS的水平，按四分位间距分为Q1、Q2、Q3和Q4组，比较各组DHEAS水平与骨密度和骨代谢指标间的关系。结果（1）按骨量分组，骨质疏松组的年龄大于其余2组，而体重指数低于正常骨量组，差异有统计学意义；骨质疏松组DHEAS较正常骨量组和低骨量组显著下降，组间两两比较均有统计学差异[（97．9±-5．O对183．2±8．9，139．3±10．4）μg／dl，均P〈0．01]，用协方差分别矫正年龄和体重指数后，差异仍有统计学意义；（2）Q2、Q3、Q4组的骨密度显著低于Ql组，Q4组的骨密度显著低于Q2、Q3组，差异均有统计学意义；（3）相关分析及多元回归分析发现，骨密度与年龄、绝经年龄、体重指数、雌二醇和DHEAS相关。结论血清DHEAS水平是老年女性骨量的一个独立危险因素，随访或补充DHEAS可能有助于骨质疏松的防治。

Objective To investigate the relationship between the serum dehydroepiandrosterone sulfate （DHEAS） level and bone mineral density （BMD） in aged women. Methods Two hundred and seven elderly women aged 60-84 years were enrolled in the study. Acquisition histories, including age, body mass index, and blood pressure were recorded. Serum steroid hormones （ DHEAS, testosterone, estradiol, and eortisol） and bone metabolic markers： βC-terminal telopeptide of type I collagen （βCTx）, osteocalcin, and total procollagen type I N propeptide （TPINP） were determined. The BMD was also determined. The enrolled subjects were divided into 3 groups according to T values （ T〉- 1.0 s, -2.5 s〈T ≤ 1.0 s, and T ≤ -2.5 s）, and divided into 4 groups according to the quartile of the DHEAS concentrations. The correlations between DHEAS with BMD and bone metabolic markers were analyzed. Results （ 1 ） Serum DHEAS level manifested significant differences among BMD groups [ （ 97.9± 5.0 vs 183.2 ± 8.9, 139.3 ±10.4） μg/dl, all P〈0.01 ], and it was negatively correlated with aging. After being adjusted by age and body mass index, partial regression analysis showed that DHEAS was still correlated with BMDs. （ 2 ） BMD in groups Q2-Q4 was lower than that in group Q1 ; BMD in group Q4 was lower than that in group Q2 and Q3, and the differences were statistically significant. （ 3 ） Stepwise linear regression analysis showed that age, body mass index, menopause age, estradiol, and DHEAS levels were correlated with BMD. Conclusions The decreased serum DHEAS level is an independent ＂risk factor＂ for BMD in aged woman. Monitoring serum DHEAS level as well as supplementation of DHEAS may contribute to the prediction and prevention of osteoprosis in aged women.