POI患者激素治疗前后骨密度情况及影响因素分析

Observation on Bone Mineral Density of POI before and after Hormone Therapy and Analysis of the Influencing Factors

目的观察早发性卵巢功能不全(POI)患者性激素治疗前后骨密度情况并分析其疗效影响因素。方法接受治疗的POI患者共133例,调查患者一般情况、治疗方案及疗程、治疗前后腰椎(L 1~L 4)及左右股骨颈骨密度(g/cm ^2),求变化百分比。治疗前骨密度行随机区组方差分析,据其结果选取第1腰椎(L 1)及左股骨颈骨密度变化情况进行χ2检验及Logistic回归分析其疗效影响因素。结果治疗前L 1及左右股骨颈骨密度均低于L 2~L 4(P<0.05),左股骨颈骨密度低于右股骨颈(P<0.05);L 1及左股骨颈骨密度平均变化百分比分别为7.14%±9.29%、4.62%±8.11%,差异有统计学意义(P<0.05);治疗前Z值低、产次多、绝经时间长、超重使腰椎骨密度增加的可能性下降,运动锻炼使其升高;年龄大、治疗前Z值低使左股骨颈骨密度增加的可能性下降,长期使用其增加的可能性升高。结论POI患者L 1及左股骨颈骨密度较低;相对股骨颈,激素治疗可显著提高腰椎骨密度;早诊断尽早且长期激素治疗,并保持正常体型、坚持运动锻炼对改善骨密度至关重要;应注重股骨颈,早发现骨丢失,预防骨质疏松。

Objective To observe the bone mineral density(BMD)before and after hormone replacement therapy(HRT)in patients with POI and analyze the influencing factors.Methods Totally 133 cases of POI were treated with hormone.The general situation,treatment course and the before and after treatment BMD of lumbar spine(L 1-L 4)and left and right femoral neck(g/cm 2)were collected.The BMD before treatment was conducted by the analysis of variance of random area group,and the influencing factors were analyzed by chi square test and multivariate Logistic regression analysis.Results The BMD of L 1 and left and right femoral neck were lower than L 2-L 4(P<0.05).The left femoral neck was lower than right femoral neck(P>0.05).The average changes of L 1 and left femoral neck were 7.14%±9.29%,4.62%±8.11%,respectively(P<0.05),Low Z value,multiple births,long menopause time and overweight decreased the possibility of increasing lumbar BMD,and increased the possibility of exercise.The possibility of increasing BMD of left femoral neck decreased of old age and low Z value,and increased after long-term use.Conclusion The BMD of L 1 and Left femoral neck is low.Compared with the femoral neck,HRT can significantly improve the BMD of lumbar spine.Timely diagnosis and long-term use of HRT are important.We should pay more attention to femoral neck and the early occurrence of bone loss,prevention of osteoporosis.