萧山某社区孕产妇骨密度筛查及骨量下降影响因素分析

Analysis of bone mineral density screening and influencing factors of bone mass decline in pregnant women in a community in Xiaoshan

目的研究萧山某社区产妇骨密度现状筛查结果并分析骨量下降的影响因素.方法采用随机整群抽样方法抽取2022年1月-2022年12月萧山某社区进行孕期检查且自愿进行骨密度检测的400例怀孕女性作为样本人群,对所有目标人群进行骨密度检测,观察其骨密度水平.孕16周及孕24周采用美国CUBA公司生产的定量超声骨密度测定仪测定受检孕妇足跟部骨密度超声衰减度及T值,并根据T值结果(T=-0.1为界值,骨量正常:T≥-1.0;骨量减少:-2.5≤T<-1.0;骨质疏松:T<-2.5.骨质疏松与骨量减少均认为骨量下降)将产妇分为骨量正常组及骨量下降组,收集两组临床资料,采用多因素Logistic回归分析影响骨量下降的因素.结果400名孕产妇中,共395名孕产妇完整完成了骨密度测量及调查问卷填写.初次测量结果显示,调查群体中骨量正常312例(78.99%),骨量减少74例(18.73%),骨质疏松9例(2.28%).第二次共370名完成了骨密度测量,失访25名,结果显示,骨量正常253例(68.38%),骨量下降117例(31.62%);单因素分析显示,两组间有无骨质疏松家族史、脆性骨折家族史、日常活动时间、补钙+维生素对比,有统计学意义(P<0.05);进行多因素Logistic回归分析,骨质疏松家族史(OR=3.555,95%CI=1.848-6.819)、脆性骨折家族史(OR=3.476,95%CI=1.763-6.853)是发生骨量下降的危险因素,补钙+维生素(OR=0.117,95%CI=0.061-0.227)、日常活动时间(OR=0.893,95%CI=0.867-0.919)是发生骨量下降的保护因素(P<0.05).结论萧山某社区孕产妇骨量下降发生率较高,骨质疏松家族史、脆性骨折家族史是孕产妇发生骨量下降的危险因素,日常活动时间长、补钙+维生素是发生骨量下降的保护因素.

Objective To study the status of maternal bone mineral density screening and the influencing factors of bone mass decline in a community in Xiaoshan.Methods A random cluster sampling method was used to select 400 pregnant women who underwent pregnancy examination and voluntary bone mineral density testing in a community in Xiaoshan from January 2022 to December 2022 as the sample population.All the target population were tested for bone mineral density and their bone mineral density levels were observed.At 16 weeks and 24 weeks of gestation,ultrasonic attenuation and T value of heel bone mineral density of pregnant women were measured by quantitative ultrasonic bone densimeter produced by CUBA Company,USA.According to the T value results(T=-0.1 as the boundary value,normal bone mass:T≥-1.0;Decreased bone mass:-2.5≤T<-1.0;Osteoporosis:T<-2.5.Both osteoporosis and osteopenia are considered bone mass loss)the parturients were divided into normal bone mass group and decreased bone mass group.The clinical data of the two groups were collected and the factors affecting decreased bone mass were analyzed by multivariate Logistic regression.Results Among the 400 pregnant women,395 of them completed the BMD measurement and questionnaire.The first measurement results showed that 312 cases(78.99%)had normal bone mass,74 cases(18.73%)had decreased bone mass,and 9 cases(2.28%)had osteoporosis.A total of 370 patients completed the BMD measurement in the second time,and 25 lost follow-up.The results showed that 253 patients(68.38%)had normal bone mass and 117 patients(31.62%)had decreased bone mass.Univariate analysis showed that there was statistical significance in osteoporosis,family history of fragility fracture,daily activity time and calcium+vitamin supplementation between the two groups(P<0.05).Multivariate Logistic regression analysis showed that family history of osteoporosis(OR=3.555,95%CI=1.848-6.819)and family history of fragility fracture(OR=3.476,95%CI=1.763-6.853)were risk factors for bone mass loss.Calcium+vitamin supplementation(OR=0.117,95%CI=0.061-0.227),daily activity time(OR=0.893,95%CI=0.867-0.919)was the protective factor for bone mass loss(P<0.05).Conclusion There is a high incidence of bone mass loss in pregnant women in a community in Xiaoshan.Family history of osteoporosis and fragility fracture are risk factors for bone mass loss.Long daily activity time and calcium+vitamin supplementation are protective factors for bone mass loss.