健康体检人群中非吸烟女性肺通气功能与骨密度关系的研究

Relationship between lung function and bone mineral density in nonsmoking healthy women

目的：探讨健康体检人群中非吸烟女性肺通气功能与骨密度（BMD）的关系。方法2013年6月至2014年3月到武警总医院健康医学中心体检的女性，通过调查问卷及进一步检查，纳入508例研究对象，平均年龄（49.33±8.66）岁。通过双能X线吸收测定仪测得腰椎BMD，根据WHO推荐标准，将研究对象分为骨量正常组、骨量减少组、骨质疏松组。通过调查问卷、人体成分分析仪、肺功能测定仪了解体检者一般情况、体质指数（BMI）及肺通气功能。方差分析比较各组的年龄、BMI、肺通气功能各指标与腰椎BMD、腰椎骨面积（BA），Pearson相关分析及多元线性逐步回归分析探讨肺通气功能各指标与腰椎BMD及BA的相关性。结果3组的BMI、第1秒用力呼气容积占用力肺活量百分比（FEV1/FVC%）差异无统计学意义（F值分别为0.192，0.296；P均〉0.05）；其他肺通气功能指标包括用力肺活量（FVC）、用力肺活量占预计值百分比（FVC%）、第1秒用力呼气量（FEV1）、第1秒用力呼气量占预计值百分比（FEV1%）、峰值呼气流速（PEF），骨质疏松组较骨量正常组、骨量减少组降低，差异有统计学意义（F值分别为15.313，5.508，18.890，5.440，6.763；P均〈0.01）；骨质疏松组及骨量减少组的各腰椎BMD及腰椎BA明显下降，3组差异均有统计学意义（F值分别为169.053，205.660，224.567，201.086，276.927，3.550；P均〈0.05）。Pearson相关性分析显示：FVC、FVC%、FEV1、FEV1%、PEF与年龄负相关（r值分别为-0.420，-0.187，-0.510，-0.199，-0.282，P均〈0.01）；FVC、FVC%与BMI负相关（r值分别为-0.081，-0.169，P均〈0.05），FEV1/FVC与BMI正相关（r=0.100，P〈0.05）；FVC与各腰椎BMD及腰椎BA正相关（r值分别为0.361，0.286，0.247，0.261，0.190，0.156，P均〈0.01），FEV1与各腰椎BMD及腰椎BA正相关（r值分别为0.298，0.297，0.246，0.257，0.196，0.135；P均〈0.01）。多元线性逐步回归显示年龄、BMI、BA与FVC、FVC%、FEV1、FEV1/FVC相关（P均〈0.01）。结论健康非吸烟女性，年龄、BMI、BA为肺通气功能的主要影响因素；骨质疏松组除FEV1/FVC外的其他肺通气功能指标均下降。

Objective To explore the relationship between lung function and bone mineral density （BMD） in nonsmoking women. Method The healthy women who came to our hospital for physical examination from June 2013 to March 2014 were chosen. Totally 508 cases, average age 49.33±8.66 years , were included through the questionnaire and further examination. The lumbar BMD was measured with dual energy X-ray absorption, the subjects were divided into normal bone mass group, osteopenia group, and osteoporosis group according to the diagnostic criteria of WHO. Through questionnaires, the human body composition analyzer, pulmonary function test apparatus were used to acquire their general information, body mass index （BMI） and pulmonary ventilation function. The data were compared by analysis of variance, Pearson correlation analysis and multiple linear stepwise regression analysis were applied to explore the relationship among the pulmonary ventilation function and bone mineral density of lumbar spine and lumbar bone area （BA）. Result BMI, forced vital capacity rate of one second （FEV1/FVC） were not significantly different among the three groups （F values were 0.192, 0.296;All P〉0.05）;the other indicators of pulmonary function including forced vital capacity （FVC）,FVC percent predicted （FVC%）, forced expiratory volume in first second（FEV1）, FEV1 percent predicted（FEV1%）,peak expiratory flow rate（PEF）decreased markedly in osteoporosis group compared with normal group and osteopenia group （F=15.313, 5.508, 18.890, 5.440, 6.763;all P〈0.05）. The lumbar spine BMD and lumbar BA declined significantly in osteoporosis group and＆amp;nbsp;osteopenia group comparing with normal group（F=169.053, 205.660, 224.567, 201.086, 276.927, 3.550;all P〈0.05）. Pearson correlation analysis showed that FVC, FVC%, FEV1, FEV1%, PEF were negatively correlated with age （all P〈0.01）;FVC, FVC%were negatively correlated with BMI （all P〈0.05） , FEV1/FVC was positively correlated with BMI P〈0.05）;FVC was positively correlated with lumbar BMD and lumbar BA （P〈0.01）. FEV1 were positively correlated with lumbar BMD and lumbar BA（all P〈0.01）. Multiple regression showed that age, BMI, and lumbar BA were correlated with FVC, FVC%, FEV1, FEV1/FVC（All P〈0.01）. Conclusion In healthy nonsmoking women, age, BMI, and lumbar BA are the main influencing factors of pulmonary function;except for FEV1/FVC, the other indicators of pulmonary function decreased markedly in osteoporosis group.