妇女围绝经期雌激素水平与骨质疏松发生的临床分析

Clinical analysis of estrogen levels and osteoporosis in perimenopausal women

目的探讨妇女在围绝经期雌激素水平的变化及对骨质疏松发生的影响。方法选择解放军第180医院120例围绝经期妇女,年龄在45～55岁,检测所有患者的雌二醇（E2）及骨代谢指标水平,如Ⅰ型羧基末端肽（CTX）、氨基酸中段骨钙素（NMID）、Ⅰ型前胶原氨基端前肽（PINP）,以及患者骨密度值（BMD）,比较并分析患者体内雌激素水平和骨代谢及骨质疏松之间的关系。结果 45～50岁组的患者E2水平显著高于51～55岁组,差异具有统计学意义（t=22.89,P〈0.05）,同时BMD值也显著高于51～55岁组,差异具有统计学意义（t=11.57,P〈0.05）。CTX、NMID、PINP值则显著低于51～55岁组,差异亦具有统计学意义（t值分别为12.37、10.52、8.93,均P〈0.05）;所有患者E2值与破骨CTX、NMID、PINP浓度具有负相关性（r值分别为-0.321、-0.582、-0.507,均P〈0.05）,同时与骨密度具有显著正相关性（r=0.398,P〈0.05）。结论围绝经期女性雌激素的降低,可引起破骨信号通路的激活,促进骨组织的吸收,导致最终的骨密度下降及骨质疏松的发生。可通过检测雌激素水平的变化来预测围绝经期女性骨质疏松的发生,也为其治疗提供依据。

Objective To explore and analyze the impact of estrogen level on osteoporosis in perimenopausal women. Methods Totally 120 perimenopausal women ranging from 45- 55 years old treated in People＇s Liberation Army 180 Hospital were selected,and E2 levels,bone metabolism indexes such as CTX,NMID and PINP levels,and BMD were tested to analyze the correlation of estrogen levels and bone metabolism as well as osteoporosis. Results E2 level and BMD of patients in 45- 50 years old group were significantly higher than those in51- 55 years old group（ t value was 22. 89 and 11. 57,both P〈0. 05）,but CTX,NMID and PINP were lower than those in 51- 55 years old group with statistically significant differences（ t value was 12. 37,10. 52 and 8. 93,respectively,all P〈0. 05）. E2 was negatively correlated with CTX,NMID and PINP in all patients（ r value was- 0. 321,- 0. 582 and- 0. 507,respectively,all P〈0. 05） but positively correlated with BMD（ r = 0. 398,P〈0. 05）. Conclusion The decrease of estrogen levels of perimenopausal women can activate signal pathway of osteoclast activity,promote the absorption of bone and result in osteoporosis. Osteoporosis situation of perimenopausal women can be predicted by testing E2 level,and it also provides theoretical basis for therapy.