老年脑梗死后偏瘫患者骨密度及骨代谢指标变化与骨质疏松症的关系分析

Relationship of bone mineral density and bone metabolism indicators with osteoporosis in elderly patients with post-stroke hemiplegia

目的探究老年脑梗死后偏瘫患者骨密度及骨代谢指标变化与骨质疏松症的关系。方法选取2018年2月至2021年2月内蒙古包钢医院收治的老年脑梗死后偏瘫患者197例,按照性别、偏瘫病程、病情严重程度分析患者骨密度和骨代谢指标,根据病情严重程度分为轻度组(112例)、中度组(62例)、重度组(23例)。结果197例患者中83例(42.13%)患有骨质疏松症。男性股骨近端骨密度、血清骨碱性磷酸酶(BALP)和骨钙素水平均高于女性,血清Ⅰ型胶原羧基端前肽(CICP)、Ⅰ型胶原交联羧基端肽(CTXI)水平低于女性(P<0.01,P<0.05)。与3~6个月患者比较,7~12、13~24个月患者大转子、全髋骨密度和BALP、骨钙素水平显著降低,CICP、CTXI水平升高(P<0.05)。与轻度组比较,中度组、重度组大转子、全髋骨密度和BALP、骨钙素水平显著降低,CICP、CTXI水平升高(P<0.05);与中度组比较,重度组股骨颈、转子间、全髋骨密度显著降低(P<0.05)。股骨颈、大转子、转子间、全髋骨密度分别与CICP水平(r=-0.458、r=-0.403、r=-0.355、r=-0.482,P<0.01)、CTXI水平(r=-0.305、r=-0.291、r=-0.273、r=-0.384,P<0.05,P<0.01)呈负相关,与骨钙素水平(r=0.476、r=0.428、r=0.386、r=0.518,P<0.01)呈正相关。结论老年脑梗死后偏瘫患者骨质疏松症发病率较高,存在不同程度的骨密度降低及骨代谢异常,其变化水平与性别、偏瘫病程及病情严重程度有关。

Objective To explore the relationship of changes in bone mineral density and bone me-tabolism indicators with osteoporosis in elderly patients with hemiplegia after cerebral infarction.Methods A total of 197 elderly patients suffering post-stroke hemiplegia admitted to our hospital were enrolled between February 2018 and February 2021.Their bone mineral density and bone metabolism indicators were analyzed based on gender,disease course and hemiplegia severity.According to disease severity,they were divided into mild group(112 cases),moderate group(62 cases)and severe group(32 cases).Results Among the 197 elderly patients,83(42.13%)had osteoporosis.The males had significantly higher bone mineral density of proximal femur and levels of bone alkaline phosphatase(BALP)and osteocalcin,and lower levels of serum type 1 collagen(CICP)and C-terminal telopeptides of type 1 collagen(CTX1)than the females(P<0.01,P<0.05).Compared with the patients with hemiplegia course for 3-6 months,bone mineral density values of greater trochanter and total hip,and levels of BALP and osteocalcin were obviously de-creased,whde levels of C1CP and CTX1 were notably increased in those with the course of 7-12 months and 13-24 months(P<0.05).Compared with the mild group,bone mineral density val-ues of greater trochanter and total hip,and levels of BALP and osteocalcin were significantly decreased,whiCe levels of C1CP and CTXI were significantly increased in moderate group and severe group(P<0.05).Compared with the moderate group,bone mineral density values of greater tro-chanter,intertrochanteric site and total hip were significantly decreased in the severe group(P<0.05).The bone mineral density of above parts was negatively correlated with CICP levels(r=-0.458,r=-0.403,r=-0.355,r=-0.482,P<0.01)and CTX1 levels(r=-0.305,r=-0.291,r=-0.273,r=-0.384,P<0.05,P<0.01),whde positively correlated with BGP level(r=0.476,r=0.428,r=0.386,r=0.518,P<0.01).Conclusion The incidence of osteoporosis is quite higher in the elderly patients with post-stroke hemiplegia.There exist bone mineral density decline and abnormal bone metabolism,and their changes are related to gender,course and severi-ty of hemiplegia.