运用骨小梁分数评价腹型肥胖对骨质量的影响

Effect of abdominal obesity on bone quality assessed by trabecular bone score

目的研究腹型肥胖对骨质量、骨量的影响。方法本研究纳入2013年7月至2016年4月在南京医科大学第一附属医院老年内分泌科检查的中老年男性及绝经后女性,共计466人,排除其他影响骨代谢的疾病及药物。将男性腰围≥90 cm、女性腰围≥85 cm,入选为腹型肥胖组,其余为对照组。男性腹型肥胖组共136名,年龄相当的男性对照组129名;女性腹型肥胖组共95名,年龄、绝经年龄、绝经年限相当的对照组106人。运用双能X线吸收检测法(dual energy X-ray absorptiometry,DXA)测定其股骨颈、全髋、腰椎骨密度(bone mineral density,BMD),采用TBS Insight软件测定其腰椎骨小梁分数(trabecular bone score,TBS),并测量身高、体质量、腰围及臀围,计算腰臀比(waist-to-hip ratio,WHR)、体质量指数(body mass index,BMI)。分析腹型肥胖组和对照组TBS、BMD的差异。结果中老年男性腹型肥胖组的股骨颈及全髋BMD均高于对照组[(0.79±0.11)g/cm^2vs.(0.76±0.12)g/cm^2、(0.94±0.14)g/cm^2vs.(0.90±0.12)g/cm^2,t=-2.021、-2.087,P=0.004、0.038)],腰椎BMD无变化(t=-0.703,P=0.483),而腰椎TBS低于对照组(1.27±0.09 vs.1.33±0.07,t=5.675,P<0.001)。与对照组相比,绝经后女性腹型肥胖组的股骨颈、全髋部及腰椎BMD差异均无统计学意义(t=-1.209、-1.367、-0.550,P=0.228、0.173、0.583),而腰椎TBS下降(1.22±0.09 vs.1.27±0.09,t=4.154,P<0.001)。结论腹型肥胖对中老年男性及绝经后女性骨量的影响存在性别、部位的差异,但对骨质量均产生不利影响。

Objective To investigate the effects of abdominal obesity on bone quality and bone mass.Methods A total of 466 participants were enrolled from July 2013 to April 2016.They were divided into 4 groups： male abdominal obesity group （n = 136,waist circumference≥90 cm,aged ≥40 years）,male control group （n = 129）,female abdominal obesity group （n = 95,waist circumference≥85 cm,postmenopausal women） and female control group （n = 106）.Secondary osteoporosis was excluded.Bone mineral density （BMD） of the femoral neck,total hip,and lumbar spine was measured by dual-energy x-ray absorptiometry.Lumbar spine trabecular bone score （TBS） was measured by the TBS i Nsight software.Height,weight,waist circumference,hip circumference,waist-to-hip ratio,and body mass index were calculated.The differences of TBS and BMD between abdominal obesity groups and their control groups were analyzed.Results 1.BMD of the femoral neck and total hip was higher in male abdominal obesity group than in male control group[ （0.79±0.11） g/cm^2 vs （0.76 ± 0.12） g/cm^2, （0.94± 0.14） g/cm^2 vs.（0.90 ± 0.12） g/cm^2,t =-2.021,-2.087,P = 0.004,0.038],while the lumbar spine BMD was unchanged （t =-0.703,P = 0.483）.The lumbar spine TBS was significantly lower in male abdominal obesity group,compared with male control group （1.27 ± 0.09 vs 1.33 ±0.07,t = 5.675,P〈0.001）.2.Compared with female control group,the lumbar spine TBS was significantly lower in female abdominal obesity group （1.22±0.09 vs 1.27± 0.09,t = 4.154,P〈0.001）,whereas BMD of the femoral neck,total hip and lumbar spine was unchanged （t =-1.209,-1.367,-0.550,P = 0.228,0.173,0.583）.Conclusion The effect of abdominal obesity on bone mass varies by sex and the body parts,whereas abdominal obesity has a negative effect on bone quality in men aged ≥40 years and postmenopausal women.