高海拔地区西宁市藏汉老年骨质疏松的危险因素分析

Analysis of Risk Factors for Osteoporosis in Tibetan and Han Elderly in Xining City in High Altitude Area

目的分析高海拔地区西宁市藏汉老年骨质疏松(OP)的影响因素。方法选择2018年1月—2020年1月于青海省西宁市3家省市级三甲医院老年患者678例,根据患者民族分为藏族组(n=123)及汉族组(n=555)。应用美国LUNARPRODIGY双能X线骨密度检测仪计算所有患者T值。采集所有患者入院24 h内的空腹静脉血,采用全自动生化分析仪检测HbA1c、Ca、TG、LDL-C、HDL-C、红细胞、血红蛋白、中性粒细胞及淋巴细胞水平,计算中性粒细胞计数与淋巴细胞计数的比值(NLR)。调查并记录所有患者的年龄、性别、民族、BMI、吸烟、饮酒、喝牛奶、经常运动、室外工作、缺氧环境工作、慢性阻塞性肺病、高血压及糖尿病等资料。采用多因素Logistics回归分析老年患者发生OP的影响因素。结果藏族组受检者各关节T值高于汉族组,差异有统计学意义(P<0.05)。两组患者各关节T值随年龄的增加而降低,且同时间点,藏族组受检者各关节T值高于汉族组,差异有统计学意义(P<0.05)。藏族组受检者白细胞、NLR及Ca含量高于汉族组,HbA1c水平低于汉族组,藏族组患者高血压、吸烟、饮酒、室外工作比例低于汉族组,藏族组患者喝牛奶、运动比例高于汉族组,同族患者中,OP组患者吸烟、饮酒、高血压、慢性阻塞性肺病、糖尿病比例明显高于非OP组,喝牛奶、经常运动及室外工作比例明显低于非OP组,Ca水平明显低于非OP组,HbA1c水平高于非OP组,差异有统计学意义(P<0.05)。采用多因素Logistics回归分析得知,汉族、年龄、高血压、NLR、慢性阻塞性肺病等均是老年人群发生OP的危险因素,而喝牛奶、经常运动及Ca含量均是保护因素(P<0.05)。结论高海拔地区西宁市汉族人群骨密度较藏族人群低,且随年龄的增加而降低,高血压、喝牛奶、运动、NLR、慢性阻塞性肺病、Ca含量也是影响老年人群发生OP的影响因素,早期干预或可预防老年OP的发生。

Objective To analyze the influencing factors of osteoporosis(OP)in Tibetan and Han elderly people in Xining city in high altitude area.Methods From January 2018 to January 2020,678 elderly patients in three provincial and municipal class III hospitals in Xining City,Qinghai Province were selected and divided into Tibetan group(n=123)and Han group(n=555)according to their nationalities.The T value of all patients was calculated by the American LUNARPRODIGY dual-energy X-ray absorptiometry.Fasting venous blood was collected from all patients within 24 hours of admission,and the levels of HbA1c,Ca,TG,LDL-C,HDL-C,red blood cells,hemoglobin,neutrophils and lymphocytes were detected by automatic biochemical analyzer.The ratio of neutrophil count to lymphocyte count(NLR)was calculated.Investigate and record the age,gender,ethnicity,BMI,smoking,drinking,drinking milk,regulow exercise,outdoor work,hypoxic work,chronic obstructive pulmonary disease,hypertension and diabetes of all patients.Multivariate logistic regression was used to analyze the influencing factors of OP in elderly patients.Results The T value of each joint in the Tibetan group was higher than that in the Han group,the difference was statistically significant,the difference was statistically significant(P<0.05).The T value of each joint in the two groups decreased with the increase of age,and at the same time point,the T value of each joint in the Tibetan group was higher than that in the Han group,the difference was statistically significant,the difference was statistically significant(P<0.05).The contents of white blood cells,NLR and Ca in the Tibetan group were higher than those in the Han group,and the level of HbA1c was lower than that in the Han group.The proportions of hypertension,smoking,drinking and outdoor work in the Tibetan group were lower than those in the Han group.The proportion of patients in the Tibetan group drinking milk and exercising was higher than that in the Han group.Among the patients of the same race,the proportions of smoking,drinking,hypertension,chronic obstructive pulmonary disease and diabetes in the OP group were significantly higher than those in the non-OP group.The proportion of drinking milk,regular exercise and outdoor work was significantly lower than that of the non-OP group,the Ca level was significantly lower than that of the non-OP group,and the HbA1c level was higher than that of the non-OP group,the difference was statistically significant(P<0.05).Multivariate logistic regression analysis showed that Han nationality,age,hypertension,NLR,and chronic obstructive pulmonary disease were all risk factors for the occurrence of OP in the elderly,while drinking milk,regular exercise and Ca content were protective factors(P<0.05).Conclusion The bone mineral density of the Han population in Xining City at high altitude is lower than that of the Tibetan population,and it decreases with the increase of age.Hypertension,drinking milk,exercise,NLR,chronic obstructive pulmonary disease,and Ca content are also factors that affect the occurrence of OP in the elderly,and early intervention may prevent the occurrence of OP in the elderly.