血骨代谢指标及骨密度与骨组织钙、磷及金属微量元素含量的相关性

Relationship among bone metabolic markers,bone mineral density and calcium,phosphorus,metal elements contents in bone tissue

目的研究血骨代谢指标及髋部骨密度(bone mineral density,BMD)值与骨组织不同区域骨钙、磷及金属元素含量的相关性,明确骨矿物质元素与骨质疏松的关系。方法对2015年9月至2016年9月在复旦大学附属华东医院骨科接受手术治疗的62例股骨粗隆间骨折老年患者进行骨组织取材,运用X线聚焦荧光能谱仪检测骨组织皮质骨区域、松质骨区域及交界区域的钙、磷、锰、铁、铜、锌元素含量比重,控制年龄、性别、体质量指数(body mass index,BMI)等因素,运用偏相关分析研究血骨代谢指标和BMD与骨钙磷及金属元素含量的相关性。结果 25羟维生素D3[25 hydroxy vitamin D3,25(OH)D3)]与松质骨区域的骨铜和锌含量呈正相关(r=0.589、0.494,P=0.002、0.012);血甲状旁腺素(parathyroid hormone,PTH)与交界区域的骨钙、铁、锌含量呈正相关(P=0.009、0.011、0.025),相关系数分别为0.568、0.554、0.498,而与骨磷含量呈负相关(r=-0.582,P=0.007)。全髋BMD值与骨铁含量可能存在负相关性(r=-0.472,P=0.089),大粗隆BMD值与松质骨区域的骨钙含量呈负相关性(r=-0.621,P=0.031),与骨磷含量呈正相关性(r=0.690,P=0.013)。结论充足的维生素D3可能促进机体锌和铜元素的吸收以提高BMD和增加骨量。大粗隆部BMD值的下降可能与松质骨区域骨钙含量比重上升导致金属微量元素含量比重下降有关。

Objective To investigate the effect of bone metabolic markers and bone mineral density（ BMD） on bone calcium,phosphorus,and metal elements contents in geriatric patients with intertrochanteric fractures,and determine the relationship between bone mineral elements and osteoporosis. Methods Sixty two geriatric patients suffered from intertrochanteric fractures and received surgical treatment were harvested bone tissues during the operation from September 2015 to September 2016. Energy dispersive X-ray fluorescence（ EDX） was used to examine the bone inorganic element contents of calcium,phosphorus,manganese,iron,copper,and zinc in cortical bone zone,cancellous bone zone and interfacing zone between cortical bone and cancellous bone. Partial correlation analysis was performed to definite the correlation between bone metabolic markers,BMD and bone calcium,phosphorus and metal elements contents by controlling the influence of age, sex and BMI. Results The partial correlation analysis suggested that the level of serum 25 hydroxy vitamin D3[25（ OH） D3]was positively correlated to bone copper and zinc contents in cancellous bone zone（ r = 0. 589,0. 494,P = 0. 002,0. 012）. Besides,the level of parathyroid hormone（ PTH） was positively correlated to bone calcium,iron,and zinc contents（ P =0. 009,0. 011,0. 025） whose coefficient r were 0. 568,0. 554 and 0. 498 respectively but negatively correlated to bone phosphorus contents（ r =-0. 582,P = 0. 007） in the interfacing zone between cortical bone and cancellous bone. Total hip BMDs may be negatively correlated to contents（ r =-0. 472,P = 0. 089）. Additionally,the BMDs in the trochanter exhibited significantly positive correlation to bone calcium contents（ r =-0. 621,P = 0. 031） but significantly negativly correlated to bone phosphorus contents（ r = 0. 690,P = 0. 013）. Conclusions Sufficient vitamin D3 might be beneficial to absorb zinc and copper,which could improve bone density and increase bone mass.The deceased trochanter BMDs might be correlated to the deceased bone metal trace-elements contents due to the increment of bone calcium contents in cancellous bone zone.