围绝经期及绝经后期女性腰椎骨密度与生殖特点及性激素浓度的相关分析

Correlation analysis of lumbar bone mineral density with reproductive characteristics and sex hormone levels in perimenopausal and postmenopausal women

目的探讨围绝经期及绝经后期女性腰椎骨密度(bone mineral density,BMD)与生殖特点及性激素浓度之间的关系,进一步分析此时期女性骨量减少的影响因素。方法选择2021年10月至2023年2月于首都医科大学附属北京妇产医院内分泌科就诊的围绝经期及绝经后期女性328例为研究对象。采用定量电子计算机断层扫描技术(quantitative computed tomography,QCT)测量腰椎骨密度,根据测量结果分为骨量正常组和骨量减少组。采用更年期症状全面评估量表采集所有研究对象的年龄、初潮年龄、绝经状态、孕产史、哺乳时长,采用全自动化学发光免疫法测定血清卵泡刺激素(follicle stimulating hormone,FSH)、黄体生成素(luteinizing hormone,LH)、雌二醇(estradiol,E 2)、孕酮(progesterone,P)及总睾酮(testosterone,T)浓度。采用单因素方差分析比较骨量正常组和骨量减少组的生殖特点及性激素浓度之间的差异性,采用多因素Logistic回归分析探讨骨量减少的危险因素。结果绝经后期女性的骨密度显著低于围绝经期女性(P<0.05)。骨量减少组女性年龄、初潮年龄、产次、哺乳时长、绝经后期占比、FSH浓度均显著高于骨量正常组(P<0.05),而血清E 2浓度显著低于骨量正常组(P<0.05)。多因素Logistic回归分析结果显示,年龄大(OR=1.088)、哺乳时间长(OR=1.057)、绝经后期(OR=5.716)是骨量减少的危险因素(P<0.05)。结论与围绝经期女性相比,绝经后期女性骨密度明显降低,围绝经期及绝经后期女性腰椎骨密度与生殖特点及性激素浓度密切相关。建议临床医生关注此时期女性的骨密度变化,以便通过及时合理的治疗来改善她们的生活质量,预防骨质疏松的发生。

Objective To explore the relationship between lumbar bone mineral density(BMD)and reproductive characteristics and sex hormone levels in perimenopausal and postmenopausal women,and to further analyze the influencing factors of bone loss in women during this period.Methods A total of 328 perimenopausal and postmenopausal women who visited Beijing Obstetrics and Gynecology Hospital,Capital Medical University from October 2021 to February 2023 were selected as subjects.Quantitative computed tomography(QCT)was used to measure lumbar bone density.According to the measurement results,the patients were divided into normal bone mass group and less bone mass group.The age,menarche age,menopausal status,pregnancy history and lactation duration of all subjects were collected with the comprehensive assessment scale of menopausal symptoms.The levels of serum follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E 2),progesterone(P)and total testosterone(T)were measured with automatic chemiluminescence immunoassay.Univariate analysis was used to compare the differences in reproductive characteristics and sex hormone levels between the normal bone mass group and the osteopenia group.Multivariate Logistic regression analysis was used to explore the risk factors of osteopenia.Results The BMD of postmenopausal women was significantly lower than that of perimenopausal women(P<0.05).Univariate analysis showed that the age,menarche age,number of deliveries,lactation duration,postmenopause ratio and FSH level of women in the less bone mass group were significantly higher than those in the normal bone mass group(P<0.05).The serum E 2 level was significantly lower than that in the normal bone mass group(P<0.05).Multivariate Logistic regression analysis showed that older age(OR=1.088),longer lactation duration(OR=1.057),and postmenopause(OR=5.716)were risk factors for bone loss(P<0.05).Conclusion Compared with perimenopausal women,postmenopausal women have significantly lower BMD;The BMD in perimenopausal and postmenopausal women is closely related to reproductive characteristics and sex hormone levels.It is suggested that clinicians should pay attention to the changes of BMD in women during this period,so as to improve their quality of life and prevent the occurrence of osteoporosis(OP)through timely and reasonable treatment.