云南省德宏州傣族人群骨质疏松症流行病学调查及相关影响因素研究分析

发布时间：2018-05-12 22:35

  本文选题：云南省德宏州傣族 + 跟骨定量超声　； 参考：《昆明医科大学》2016年硕士论文

【摘要】：目的：1.调查云南省德宏州傣族人群骨质疏松症的患病率并探讨相关危险因素。2.通过跟骨定量超声技术测定云南省德宏州傣族人群跟骨骨量参数,建立峰值骨量数据库并探讨其变化规律。3.运用OSTA系统和FRAX评分对目标人群的骨质疏松症及其骨质疏松性骨折进行自我诊断及风险预测并验证其有效性及实用性。4.通过测定云南省德宏州傣族40岁以上人群血清骨代谢标志物测定,了解其一定的变化规律。方法：1.采用随机抽样法,抽取云南省德宏州傣族160人,其中男性49例,女性111例,年龄从20岁-77岁,分组标准为按10岁为一个年龄段,将人群分为6组。进行跟骨定量超声检测(包括跟骨BMD值、T值、SI值)、基本体征测量、骨质疏松相关因素问卷调查,整合后计算患者OSTA指数、FRAX评分,将问卷数据量化后进行统计学分析。2.采用随机抽样法,抽取目标人群40岁以上人群104人,年龄40-77岁,按年龄段分为4组,用ELISA法检测25-(OH)Vit D3、甲状旁腺激素PTH、骨钙素BGP及降钙素CT,骨碱性磷酸酶、总I型胶原氨基端延长肽(NTX)对检测结果进行统计分析。结果：1.在160名受试者中,20-29岁年龄段人群BMD及SI值处于最高值,分别为BMD=0.57±0.10 g/cm3SI=108.87±24.17,之后骨量逐步下降,到达60-69岁年龄段骨量达到最低点,其中30-39、50-59、60-69年龄段BMD及SI丢失最为迅速且具有统计学意义。2.160名德宏傣族受试人群中,23人患骨质疏松症,患病率(PR)为14.4%,其中PR男性:12.2%:PR女性:15.3%;63人存在骨量减少,占总人数的39.4%。性别对受试人群的0P患病率有直接影响,傣族女性较男性0P患病率高,傣族女性的骨量丢失也要大于男性。对于各年龄段0P发生率进行统计学分析后结果为：男女性均在50-59、60-69这个年龄段发病率远远高于其他年龄段,且这两个年龄段骨量丢失率比其他各年龄段高。3.年龄、身高、腰围这三项与BMD、SI、T值呈负相关,而BMI、OSTA指数值呈正相关,其余臀围和体重进行相关性检验和SI无统计学意义,B MD、SI、T但和BMD、T值呈负相关。4.OSTA风险等级与0P患病率存在正相关关系,人群OSTA风险等级越高,0P的患病率就越高。5.影响骨质疏松相关因素中发生脆性骨折的优势比0R为19.49,即：既往发生过脆性骨折史的傣族人群发生骨质疏松症的可能性比无既往脆性骨折史的人要高出19.49倍。其余因素无统计学意义。6.160名受试者中40岁以上受试者为137人,未来10年内预测发生全身性骨质疏松性骨折的概率为4.54±2.15%,发生髋部骨折的概率为0.72±1.11%。50-59岁组,60-69岁的女性发生骨质疏松性骨折概率均明显高于其他组,60-69岁组男性发生骨质疏松性骨折的概率高于其他年龄组,有统计学意义。7.云南省德宏州傣族40岁以上人群平均25-(0H)Vit D。含量为：平均PTH为：325.67ng/ml,平均BGP为：6.53ng/ml,平均CT为：7.19pg/ml,平均N41.91pg/ml,其中,60-69岁年龄段男女间NTX含量对TX:59.75ng/ml,比存在统计学差异；70-79岁年龄段男性及女性25-(OH)Vit D。含量较上一年龄段比较下降最为明显,有统计学差异,60-69岁年龄段男女间CT含量对比有统计学差异。结论：1.本组云南省德宏州傣族目标人群总体及女性的峰值骨量出现在20-29岁(但本组男性20-29岁年龄段数据缺失),该结果与全国大部分地区研究的结论类似,但平均骨量均低于全国其他地区, 其中在50～59岁、60-69岁两个年龄段丢失最为迅速。2.云南省德宏州傣族人群的0P患病率高于全国水平,表明德宏州是云南省及全国骨质疏松症的高发地区,男性患病率最高的年龄段为60-69岁,女性患病率为70-79岁,结果可能与德宏傣族所特有的民俗、饮食习惯和生活方式等有关,是未来骨质疏松防治的重点地区之一；3.年龄、BMI都是骨质疏松的影响因素之一；脆性骨折系云南省德宏州傣族人群骨质疏松症发病的重要相关因素,出现脆性骨折后应注意骨质疏松症的防范。4.OSTA系统对于BMD值与SI值具有良好的实用性及相关性,可用于对德宏傣族人群骨质疏松的初步筛查,其对于较偏远的山区,没有骨密度检查条件的地方是一种初步筛查手段。只需要简单的几个生理指标便可以达到对于少数民族欠发达地区的骨质疏松症进行初步筛查。5.FRAX评分对德宏傣族40岁以上人群未来10年进行预测后发现,德宏州傣族在50-59岁、60-69岁发生脆性骨折和髋部骨折概率较高。6.对云南傣族地区40岁以上人群血清标志物测定结果进行分析后我们得出以下结论：(1)随年龄的增加,目标人群男性、女性血清中25-(OH)Vit D。的含量是在逐步下降的。甲状旁腺激素水平逐步上升,但在50-59岁年龄段出现波动。(2)血清中降钙素的含量随年龄增长呈下降趋势,NTX则成上升趋势,其中NTX在各年龄组间及50-59、60-69岁年龄段男女间比较有明显的差异,(3)其余检测指标没有发现明显的组间差异和组内差异。我们可以推测对于德宏傣族人群,NTX作为一项新兴的敏感指标,是有明显的指导意义的,可以将NTX的检测进一步推广到骨代谢标志物的检测方法当中,以进一步对骨质疏松症的诊断、治疗和预后有一定的帮助作用和指导意义。
[Abstract]:Objective: 1. to investigate the prevalence of osteoporosis in Dai people in Dehong, Yunnan, and to explore the related risk factors for the determination of the bone mass parameters of the calcaneus in Dai people in Dehong, Yunnan province by calcaneus quantitative ultrasound technique, and establish the peak bone mass database and explore its change rule.3. using OSTA system and FRAX score for the bone thinning of the target population. The self diagnosis and risk prediction of the osteoporosis and its osteoporotic fracture and its risk prediction and its validity and practicability.4. are determined by measuring the serum bone metabolic markers in the Dai people over 40 years old in Dehong, Yunnan province. Methods: 1. the 160 people of Dai nationality in Dehong, Yunnan Province, were selected by random sampling, among them, male 49 cases, 111 women, age from 20 years old -77 years old, group standard was divided into 6 groups according to the age of 10 years old. Quantitative ultrasound examination of calcaneus (including calcaneus BMD value, T value, SI value), basic physical measurement, osteoporosis related factors questionnaire survey, integrated calculation of the patient OSTA index, FRAX score, the questionnaire data were quantified after statistics. A random sampling method was used to detect 104 people over 40 years of age over 40 years old in the target population, 40-77 years old, and divided into 4 groups according to age. The ELISA method was used to detect 25- (OH) Vit D3, parathyroid hormone PTH, osteocalcin BGP and calcitonin CT, bone alkaline phosphatase, and total I collagen amino end lengthening peptide (NTX). The results were 1. in 16 Among the 0 subjects, the values of BMD and SI in the 20-29 age group were at the highest value, respectively, BMD=0.57 + 0.10 g/cm3SI=108.87 + 24.17, and then the bone mass decreased gradually, and the bone mass reached the lowest point at the age of 60-69, of which the 30-39,50-59,60-69 age BMD and SI lost the fastest and statistically significant Dehong Dai subjects. Of the 23 patients with osteoporosis, the prevalence rate (PR) was 14.4%, of which PR men were 12.2%: 12.2%: PR women: 15.3%; 63 people had bone loss, and the 39.4%. sex of the total number had a direct impact on the prevalence of 0P in the subjects. The Dai women had a higher incidence of 0P than men, and the loss of bone mass in the Dai women was greater than that of men. The incidence of 0P in all ages was carried out. The results of statistical analysis were that the incidence of male and female in the 50-59,60-69 age was much higher than that of other age groups, and the rate of bone loss in these two ages was higher than that of other age groups, and the three items of height and waist circumference were negatively correlated with BMD, SI and T, while BMI, OSTA index was positively correlated, and the rest of hip circumference and body weight were examined by correlation. The test and SI were not statistically significant, B MD, SI, T but BMD, and the negative correlation.4.OSTA risk level was positively correlated with the 0P prevalence, the higher the OSTA risk level was, the higher the 0P prevalence rate was, the greater the odds ratio of the brittle fracture associated with the osteoporosis related factors was 19.49, that is, the Dai people who had had a history of brittle fracture. The possibility of osteoporosis was 19.49 times higher than that of people without the history of brittle fracture. The remaining factors were not statistically significant in 137 subjects of.6.160 subjects over 40 years old. The probability of predicting systemic osteoporotic fractures in the next 10 years was 4.54 + 2.15%, and the probability of hip fracture was 0.72 + 1.11%.50-59 years old. The probability of osteoporotic fracture in 60-69 year old women was significantly higher than that of other groups. The probability of osteoporotic fracture in 60-69 year old men was higher than that of other age groups. The average 25- (0H) Vit D. in the Dai people over 40 years old in Dehong, Yunnan Province, was: 325.67ng/ml, and the average BGP was 6.53ng/ml, flat. The average CT was 7.19pg/ml and average N41.91pg/ml. Among them, there was a statistical difference in NTX content between men and women at the age of 60-69 years. The 25- (OH) Vit D. content of men and women at the age of 70-79 years was the most significantly lower than that in the previous age group. There were statistical differences. There was a statistically significant difference in the comparison of CT content between men and women at 60-69 years of age. Conclusion: 1. the total and female peak bone mass of the Dai target population in Dehong, Yunnan Province, was 20-29 years old (but the data of the 20-29 year old age group was missing in this group). The results were similar to those in most areas of the country, but the average bone mass was lower than that of the rest of the country, of which 50~59, 60-69 years and two age segments lost the most. The prevalence rate of 0P in Dai people of.2. Yunnan province is higher than that of the national level. It shows that Dehong state is the high incidence area of Yunnan province and National Osteoporosis. The highest prevalence rate of male is 60-69 years old and the female prevalence rate is 70-79 years. The result may be related to the folk custom, eating habits and lifestyle of the Dai people in Dehong. It is one of the key areas for the prevention and control of osteoporosis in the future; 3. age, BMI is one of the factors affecting osteoporosis; fragile fracture is an important related factor for the pathogenesis of osteoporosis in Dai people in Dehong, Yunnan Province, and the prevention of osteoporosis after brittle fracture should be paid attention to the BMD value and the value of SI. The use of sex and correlation can be used to screen the osteoporosis of the Dai people in Dehong. It is a preliminary screening method for the remote mountain areas, where there is no bone density examination. Only a few simple physiological indexes can be used to screen the.5.FRAX evaluation of osteoporosis in the less developed minority areas. After the forecast of the Dai people over 40 years of age over the next 10 years in Dehong, it was found that the probability of brittle fracture and hip fracture in the Dai nationality in Dehong was higher than that of the 50-59 years old and 60-69 years old. The results of the determination of serum markers in the Dai people over 40 years old in Yunnan were analyzed. (1) the following conclusions were obtained: (1) the target population was male with the increase of age. The level of 25- (OH) Vit D. in the female serum is gradually decreasing. The level of parathyroid hormone rises gradually, but it fluctuates at the age of 50-59 years. (2) the content of calcitonin in the serum is decreasing with age, and NTX is on the rise, and there is a significant difference between NTX in all age groups and between women and men in the 50-59,60-69 age group. (3) there is no obvious difference between group and group. We can speculate that for the Dai people of Dehong, NTX is a new sensitive index, and it has obvious guiding significance. We can further promote the detection of NTX to the detection methods of bone metabolic markers, so as to further the osteoporosis. Diagnosis, treatment and prognosis are helpful and instructive.

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R580
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本文编号：1880436