原发性醛固酮增多症患者腹部内脏脂肪与腰椎骨密度的相关性

Correlation Between Abdominal Visceral Fat and Lumbar Vertebral Bone Mineral Density in Patients with Primary Aldosteronism

目的探讨原发性醛固酮增多症(PA)患者腹部内脏脂肪分布与骨密度(BMD)的相关性。方法回顾性分析2017年1月至2021年2月因“高血压查因”于郑州大学第一附属医院确诊为PA的54例患者,利用定量CT(QCT)测量腰1~3椎体的BMD值,测量腰2椎体层面的腹部总脂肪面积(TFA)、腹部内脏脂肪面积(VFA)及腹部皮下脂肪面积(SFA)。按照BMD值将患者分为两组:A组(骨量减少及骨质疏松组,24例)、B组(骨量正常组,30例)。结果与B组相比,A组年龄、VFA、总胆固醇及立位的血浆醛固酮浓度(PAC)与肾素活性(PRA)的比值增高,立位的血浆肾素水平降低(P<0.05);相关分析显示BMD与年龄(r=-0.521、P<0.05)、VFA(r=-0.373,P<0.05)呈负相关;多元线性回归分析显示,校正年龄后,VFA是BMD的独立影响因素(P<0.05);进一步研究显示内脏脂肪增多较非内脏脂肪增多的PA患者BMD值降低(P<0.05)。结论内脏脂肪增多的PA患者更容易表现为低骨量,VFA增高可能是PA患者BMD降低的危险因素。

Objective To explore the relationship between abdominal visceral fat distribution and bone mineral density(BMD)of lumbar spine in patients with primary aldosteronism(PA).Methods A total of 54 PA patients who diagnosed in the First Affiliated Hospital of Zhengzhou University from January 2017 to February 2021 were analyzed retrospectively.Quantitative CT(QCT)was used to measure the BMD value of L 1-3.The total abdominal fat area(TFA),subcutaneous fat area(SFA)and visceral fat area(VFA)at the level of L 2 were measured as well.According to the BMD value,the patients were divided into two groups:group A(osteopenic and osteoporosis group,24 cases)and group B(normal bone mass group,30 cases).Results Compared to group B,age,VFA,triglyceride and the ratio of orthostatic plasma aldosterone concentration(PAC)to plasma renin activity(PAC)was higher in group A,while orthostatic plasma renin levels was lower(P<0.05).The correlation analysis showed that BMD of lumbar spine was negatively correlated with age(r=-0.521,P<0.05)and VFA(r=-0.373,P<0.05).Multiple linear regression analysis showed that VFA was still negatively correlated with VFA after controlling for age(P<0.05).Further research showed that PA patients with increased VFA had lower BMD than the non-increased VFA(P<0.05).Conclusion PA patients with increased VFA are more likely to present with low bone mass,and increased VFA may be a risk factor for decreased BMD in PA patients.