呼和浩特地区老年髋部骨折流行病学调查及其相关研究

发布时间：2018-05-06 06:40

本文选题：雌激素受体 + 骨质疏松症　；参考：《北京中医药大学》2010年博士论文

【摘要】： 老年人髋部骨折是一个世界性的公共卫生难题,因其高花费、高死亡率、高致残率而成为骨质疏松性骨折中最严重的一种。随着人口老龄化加剧,其带来的社会问题也更加严峻。现今,呼和浩特地区老年髋部骨折相关研究资料仍然很匮乏。本课题试图通过以下三部分研究来完善本地区老年髋部骨折的流行病学资料,并探讨髋部骨折与中医体质分型及雌激素受体基因多态性的关系。第一部分呼和浩特地区老年髋部骨折住院患者的回顾性研究目的：通过对呼和浩特地区老年人髋部骨折病例的回顾性研究,揭示本地区老年髋部骨折患者的发病特点,为老年人髋部骨折的防治提供理论依据。方法：收集2005年1月至2008年12月老年髋部骨折986例,设计调查表进行相关因素的登记,对老年人髋部骨折的流行特征及4年发生情况进行动态分析。同时对髋部骨折患者骨质疏松的诊断、治疗情况进行分析。结果：(1)老年髋部骨折发病例数有逐年递增趋势,女性发生例数明显多于男性(男性372例,女性614例),70至89岁是老年髋部骨折的高发年龄(该年龄段患者占总数的70.18%),呼和浩特老年髋部骨折有地区特点。(2)老年髋部骨折伴骨质疏松症诊断例数有逐年递增趋势(分别为10.19%、10.82%、18.36%、26.86%),但仍有大量漏诊。虽然抗骨质疏松治疗病例逐年增加,但有明显的盲目性和随意性。结论：(1)应针对呼和浩特地区老年髋部骨折特点,加强本地区人群髋部骨折,尤其是跌倒和骨质疏松的预防工作。(2)呼和浩特地区骨科医生骨质疏松诊疗水平存在不足,需要加强骨科医生的继续教育,进而采取更积极的态度,选择合理的抗骨质疏松治疗方案。第二部分老年髋部骨折患者中医体质类型及其与骨密度关系研究目的：通过研究呼和浩特地区老年髋部骨折患者中医体质的分布规律及其与骨密度的关系,为筛选老年髋部骨折相对高危人群提供理论依据,从而给予适当的干预措施以防止骨折的发生。方法：对156例老年髋部骨折患者和156例非老年髋部骨折患者进行病例对照研究,体质判定标准采用《中医体质分类判定》标准,并对其腰椎的骨密度进行测量。结果：按照中医体质分型,两组人群的体质构成比有统计学差异(P0.05),老年髋部骨折患者气虚质、阳虚质、阴虚质、血瘀质、痰湿质的构成比高于正常人群,分别为21.15%,14.74%,15.39%,16.03%,16.67%。髋部骨折患者腰椎骨密度明显低于正常人群。结论：气虚质、阳虚质、阴虚质、血瘀质、痰湿质是呼和浩特地区老年髋部骨折患者的主要体质影响因素,中医体质类型与骨密度关系密切。第三部分老年男性骨质疏松性髋部骨折患者ERα基因多态性的病例对照研究目的：研究呼和浩特地区汉族老年男性髋部骨折患者雌激素受体基因多态性与骨质疏松症的关系。方法：收集老年男性髋部骨质疏松性骨折128例,按年龄配比选取汉族男性健康体检者128名,进行病例对照研究。所有受试者均行骨密度检查,并进行雌激素受体基因多态性检测。结果：骨质疏松组雌激素受体PvuⅡ基因型PP、Pp及pp频率分别为7.8%,42.2%和50.0%；对照组雌激素受体PvuⅡ基因型PP、Pp及pp频率分别为13.3%,53.9%和32.8%,卡方检验提示,骨质疏松组和对照组之间Pp, pp, PP三种基因型的频率分布差异有显著性意义(P0.05)。骨质疏松组雌激素受体XbaⅠ基因型XX、Xx及xx频率分别为4.7%,44.5%和50.8%；对照组雌激素受体PvuⅡ基因型XX、Xx及xx频率分别为3.1%,39.1%和57.8%,卡方检验提示,骨质疏松组和对照组之间XX、Xx及xx三种基因型的频率分布差异无显著性意义(P0.05)。结论：雌激素受体基因型分布频率均符合Hardy-Weinberg定律,呼和浩特地区老年男性ERα基因基因PvuⅡ酶切位点与原发性骨质疏松症存在相关性。老年髋部骨折与雌激素受体基因多态性可能存在相关性。
[Abstract]:Hip fracture in the elderly is a worldwide public health problem. Because of its high cost, high mortality and high disability rate, it has become one of the most serious types of osteoporotic fractures. With the aging of the population, the social problems are becoming more severe. Nowadays, the research data of hip fracture in the Hohhot area are still scarce. This topic attempts to improve the epidemiological data of hip fracture in the elderly by the following three parts, and to explore the relationship between hip fracture and TCM Constitution and the polymorphism of estrogen receptor gene.
The first part is a retrospective study of elderly patients with hip fracture in Hohhot.
Objective: to provide a theoretical basis for the prevention and treatment of hip fracture in the elderly, through a retrospective study of the cases of hip fracture in the elderly in Hohhot, and to reveal the characteristics of the elderly hip fracture in the local area.
Methods: 986 cases of hip fracture in the aged from January 2005 to December 2008 were collected, and the questionnaire was designed to register the related factors. The epidemiological characteristics and 4 years of the hip fracture in the elderly were analyzed dynamically. The diagnosis and treatment of the osteoporosis in the patients with hip fracture were analyzed. Results: (1) the cases of hip fracture in the elderly. The number of cases increased year by year, the number of female cases was more than men (372 men, 614 women), 70 to 89 years old is the age of hip fracture in the elderly (70.18% of the age group), and the hip fracture in Hohhot has regional characteristics. (2) the number of elderly hip fractures with osteoporosis is increasing year by year (respectively) For 10.19%, 10.82%, 18.36%, 26.86%, there is still a large number of missed diagnosis. Although the treatment of osteoporosis has increased year by year, it has obvious blindness and randomness.
Conclusion: (1) should strengthen the hip fracture characteristics of the elderly in Hohhot, strengthen the prevention of hip fracture in the local population, especially the fall and osteoporosis. (2) there is a shortage of diagnosis and treatment of osteoporosis in the Department of orthopedics in the Department of orthopedics. It is necessary to strengthen the continuing education of doctors in the Department of orthopedics, and take a more positive attitude, and choose a reasonable choice. The treatment of anti osteoporosis.
The second part is the relationship between TCM Constitution Types and bone mineral density in elderly hip fracture patients.
Objective: To study the distribution of TCM Constitution and the relationship with bone mineral density in the elderly hip fracture patients in Hohhot, and to provide the theoretical basis for screening the elderly hip fracture relative high risk population, so as to give appropriate intervention measures to prevent the fracture.
Methods: 156 cases of hip fracture in the elderly and 156 cases of non aged hip fracture were studied. The standard of constitution classification was determined by TCM constitution classification, and the bone mineral density of the lumbar spine was measured.
Results: according to the constitution of traditional Chinese medicine, the constitution ratio of the two groups was statistically different (P0.05). The constitution ratio of the elderly hip fracture patients with Qi deficiency, Yang deficiency, yin deficiency, blood stasis, blood stasis, and phlegm wet quality was 21.15%, 14.74%, 15.39%, 16.03%, respectively, and the lumbar bone density of the patients with hip fracture was significantly lower than that of the normal group.
Conclusion: Qi deficiency, Yang deficiency, yin deficiency, blood stasis and phlegm moisture are the main factors affecting the physique of the elderly patients with hip fracture in Hohhot, and the type of Chinese medicine is closely related to the bone mineral density.
The third part is a case control study of ER alpha polymorphism in elderly male patients with osteoporotic hip fracture.
Objective: To study the relationship between estrogen receptor gene polymorphism and osteoporosis in elderly male patients with hip fracture in Hohhot area.
Methods: 128 elderly male hip osteoporotic fractures were collected and 128 Han men were selected according to age ratio, and a case control study was carried out. All the subjects were examined with bone mineral density, and the polymorphism of estrogen receptor gene was detected.
Results: the frequency of estrogen receptor Pvu II genotype PP, Pp and PP were 7.8%, 42.2% and 50%, respectively, and the frequency of Pp and PP in the control group was 13.3%, 53.9% and 32.8%, respectively. The frequency distribution of Pp, PP, PP three genotypes between the osteoporosis group and the control group was significantly different. P0.05. The frequency of estrogen receptor Xba I genotype XX, Xx and XX were 4.7%, 44.5% and 50.8% in the osteoporosis group, and the Pvu II genotype XX, Xx and XX frequencies in the control group were 3.1%, 39.1% and 57.8% respectively. The chi square test suggested that there was no significant difference in the frequency distribution of XX, Xx and XX three genotypes between the osteoporosis group and the control group. Meaning (P0.05).
Conclusion: the distribution frequency of estrogen receptor genotypes conforms to Hardy-Weinberg's law. There is a correlation between the Pvu II enzyme cutting site of ER alpha gene gene and primary osteoporosis in elderly men in Hohhot, and there may be a correlation between the age of hip fracture and the polymorphism of estrogen receptor gene.

【学位授予单位】：北京中医药大学
【学位级别】：博士
【学位授予年份】：2010
【分类号】：R683;R181.3

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