老年女性代谢综合征患者骨密度与心血管危险因素的研究

The relationship between bone mineral density and cardiovascular risk factors in elderly women with metabolic syndrome

目的探讨老年女性代谢综合征患者心血管危险因素对骨密度影响及其相关性。方法老年女性代谢综合征患者168例，年龄71～91岁，分为骨质疏松组68例、骨量低下组70例和骨量正常组30例。测定血压、血糖、血脂及骨代谢相关生化指标等，应用双能X线骨密度仪测定腰椎及髋关节骨密度。结果骨质疏松组、骨量低下组、骨量正常组比较，身高、体质量、体质指数、亚洲人骨质疏松自我筛查工具（OSTA）、脉压、空腹血糖（FPG）、尿酸、糖化血红蛋白（HbA1c）、三酰甘油（TG）、总胆固醇、低密度脂蛋白胆固醇（LDL—C）、骨钙素N-端中分子片段（N—MIDOs）、p胶原降解产物（B-CROSS）、总I型胶原氨基端前肽（T-PINP）差异有统计学意义（P〈0．05）。与骨量正常组比较，骨量低下组脉压、FPG、HbA1c、LDL—C、N—MIDOs、0-CROSS、T—P工NP升高（P〈0．05），体质量、体质指数、总胆固醇降低（P〈0．05）；与骨量低下组比较，骨质疏松组脉压、FPG、TG、LDL-C、N—MIDOs、8-CROSS、T-PINP升高（P〈0．05），体质量、体质指数、尿酸降低（P〈0．05）。Pearson相关分析结果显示，腰椎骨密度与尿酸、体质量、体质指数呈正相关（r值分别为0．45、0．40、0．42，P〈0．05），与脉压、FPG、HbA。c、LDL-C、N—MIDOs、B-CROSS、T-PINP呈负相关（r值分别为-0．19、-0．25、-0．25、-0．39、-0．22、-0．25、-0．27，P〈0．05）。髋关节骨密度与尿酸、体质量、体质指数、TG呈正相关（r值分别为0．35、0．35、0．34、0．15，P〈0．05），与脉压、FPG、HbAlC、LDL-C、N—MIDOs、8-CROSS、T—PINP呈负相关（r值分别为-0．28、-0．19、-0．23、-0．29、-0．28、-0．22，-0．29，P〈0．05）。结论老年女性代谢综合征患者骨密度与体质指数、血压、血糖、血脂密切相关，合理控制心血管危险因素有利于骨质疏松症的防治。

Objective To investigate the relationship between bone mineral density and cardiovascular risk factors in elderly women with metabolic syndrome. Methods We analyzed the clinical data of 168 female with metabolic syndrome aged 71-91 years. All the participants were divided into 3 groups..osteoporosis group （MO group, n=68）, osteopenia group （ML group, n^70）, normal mineral density group （MN group, n= 30）. Blood pressure, blood glucose, serum lipid and bone metabolism-related biochemical indicators were determined. The bone mineral density of lumbar spine and hip joint were detected by dual-energy X-ray absorptiometry. Results The height, weight, body mass index （BMI）, Osteoporosis self-assessment tool for Asians（OSTA） index, pulse pressure, fasting blood glucose （FBG）, uric acid （UA）, hemoglobin A1 c （HbA1 c）, triglyceride （TG）, total cholesterol （TC）, low density lipoprotein cholesterol （LDL-C）, N-MID osteocalein （N-MIDOs）, serum beta-collagen degradation （p-CROSS）, total N-terminal pro-peptide of type I collagen （T-P I NP）had significantly statistical differences among MO, ML and MN groups （all P〈0.05）. Compared with MN group, the pulse pressure, FPG, HbAlc, LDL-C, N-MIDOs, B-CROSS, and T-P I NP were significantly increased （all P〈0.05）, and weight, BMI, and TC were significantly decreased （all P 〈0.05） in ML group. The pulse pressure, FPG, TG, LDL-C, N-MIDOs, β-CROSS, and T-P I NP were higher in MO group than in ML group （all P〈0. 05）, while the weight and UA were lower in MO group than in ML group （both P〈0.05）. Pearson correlation analysis showed that bone mineral density of lumber spine was positively correlated with UA, weight and BMI （r=0.45, 0.40, 0.42, respectively, all P〈0.05）, and negatively correlated with pulse presstkre, FPG, HbA1c, LDL-C, N-MIDOs, 13-CROSS, and T-P I NP （r=-0. 19, -0.25, -0.25, -0, ag, -0.22, -0.25, --0.27, respectively, all P%0.05）. The bone mineral density of hip joint had a positive correlation with UA, weight, BMI, and TG （r=0.35, 0.35, 0.34, 0.15, respectively, all P〈0.05）, while had a negative correlation with pulse pressure, FPG, HbA1c, LDL-C, N-MIDOs,13-CROSS, and T-PINP （r=-0.28, -0.19, -0.23, -0.29, -0.28,-0,22,-0.29, respectively, all P〈0.05）. Conclusions The bone mineral density in elderly women with metabolic syndrome is closely correlated with BMI, blood pressure, blood glucose, and serum lipid. The reasonable control of cardiovascular risk factors is in favor of the prevention and treatment of osteoporosis.