再妊娠妇女妊娠中晚期及产褥期骨代谢状况研究

Study of bone metabolism in second and third trimesters of pregnancy and puerperal period in re-pregnant women

目的 探讨再妊娠妇女妊娠中晚期及产褥期的骨代谢变化情况,为再妊娠妇女的孕期和哺乳期的补钙提供参考。方法 纳入定期产检孕妇,并根据其产次分为再妊娠组(100例)及初妊娠组(100例),每组按年龄段分3个层次(25~30岁、31~35岁、36~40岁)。比较2组研究对象妊娠中晚期及产褥期的骨代谢指标、不同年龄段再妊娠妇女妊娠骨代谢情况,并于产褥期测定再妊娠妇女骨密度(BMD),比较不同骨代谢孕妇的妊娠并发症情况。结果 再妊娠组在妊娠中晚期、产褥期的β-胶原降解产物(β-CTX)水平高于初妊娠组,Ⅰ型前胶原羧基端前肽(PICP)水平低于初妊娠组(P <0.05)。不同年龄段再妊娠妇女妊娠中期、晚期及产褥期的血清甲状旁腺激素(PTH)、骨钙素N端中分子片段(N-MID)、β-CTX、PICP水平比较差异均无统计学意义(P均> 0.05);25~30岁年龄段再妊娠妇女在妊娠中晚期、产褥期的25-羟维生素D3[25(OH)D3]水平均较高(P均<0.05)。再妊娠妇女中骨量异常者的妊娠期亚临床甲状腺功能减退、妊娠期糖尿病发生率均高于骨量正常者(P均<0.05)。结论 再妊娠妇女妊娠中晚期及产褥期的β-CTX水平高于初妊娠妇女,PICP水平低于初妊娠妇女。年龄、产次可影响部分骨代谢指标水平,且骨量异常者妊娠期并发症发生率较高。

Objective To investigate the changes of bone metabolism in the second and third trimesters of pregnancy and puerperal period in re-pregnant women,aiming to provide reference for calcium supplementation during pregnancy and lactation in re-pregnant women.Methods Pregnant women who underwent regular obstetric examination were enrolled and divided into the repregnant group(n=100)and first pregnant group(n=100)according to their self-reported birth frequency.Patients in each group were divided into three subgroups according to age(25-30 years old,31-35 years old and 36-40 years old).Bone metabolism indexes in the second and third trimesters of pregnancy and puerperal period were compared between two groups.Bone metabolism in pregnant women of different ages was also compared.Bone mineral density(BMD)was measured in the puerperal period,and the pregnancy complications of pregnant women with different bone metabolism were compared.Results Theβ-collagen degradation product(β-CTX)level in the second and third trimesters of pregnancy and puerperal period in the re-pregnant group was higher,whereas the level of carboxy-terminal propeptide(PICP)of type I procollagen was lower than those in the first pregnant group(both P<0.05).There were no significant differences in the serum parathyroid hormone(PTH),N-terminal fragment of osteocalcin(N-MID),β-CTX and PICP levels in pregnant women of different ages during the second and third trimesters of pregnancy and puerperal period(all P>0.05).The levels of 25-hydroxyvitamin D3(25(OH)D3)in the second and third trimesters of pregnancy and puerperal period were the highest in re-pregnant women aged 25-30 years(all P<0.05).The incidence of hypothyroidism and gestational diabetes mellitus in patients with abnormal bone mass during pregnancy was higher than that in those with normal bone mass(both P<0.05).Conclusions Theβ-CTX levels in the second and third trimesters and puerperal period of re-pregnant women are higher,whereas the PICP levels are lower compared with those in first pregnant women.Age and parity can affect partial bone metabolism indexes,and women with abnormal bone mass have a higher incidence of pregnancy complications.