女性绝经后骨质疏松症危险因素分析及尿钙对其骨转换及肾小管功能的影响

发布时间：2018-05-14 23:01

本文选题：骨质疏松症 + 高钙尿症　；参考：《第二军医大学》2017年硕士论文

【摘要】：目的探讨女性绝经后骨质疏松症的相关因素,并分析尿钙量对女性绝经后骨质疏松症患者骨转换及肾小管功能的影响。方法选取2014年7月至2016年12月期间,至长海医院肾内科及风湿免疫科门诊就诊的患者,通过调查问卷的形式,收集并记录患者一般资料,比如性别、年龄、身高、体重、有无绝经、绝经年限、生育个数、第一次妊娠年龄、既往病史、手术史、运动锻炼情况、日照时间、服用药物、骨折史、吸烟及饮酒史、生活方式及营养状况等,排除影响骨代谢的其他疾病后,通过双能X线测定骨密度,按照骨质疏松疏松症的诊断标准,分为正常骨量组与骨质疏松组,记录就诊者的骨密度检测结果、血生化、尿生化、尿常规、骨代谢标志物,收集患者空腹尿液标本,测定空腹尿钙/尿肌酐、尿微量蛋白等。通过各暴露指标与骨质疏松症的单因素分析,再通过多因素条件下Logistic回归分析,得到女性绝经后骨质疏松症危险因素与保护因素。接下来对于骨质疏松组,分析该组研究对象的骨密度(BMD)、空腹尿钙/肌酐、尿N-乙酰-β-葡萄糖苷酶(NAG)、碱性磷酸酶(ALP)及尿β2-微球蛋白(尿β2-MG)之间的关系,以及骨质疏松伴泌尿系结石组与非结石组,各项指标的对比分析,从而分析尿钙对女性绝经后骨质疏松症患者骨转换及肾小管功能的影响。结果研究对象共有290名,其中骨质疏松的140名,骨量正常的150名,70岁以上的骨质疏松的患病率明显高于60岁以下的(P㩳0.01);研究发现经常运动锻炼是骨质疏松的保护性因素(OR=0.457 95%CI0.236-0.887);食盐摄入量、蛋白摄入量、生育次数及尿钙/尿肌酐的值是绝经后骨质疏松的危险性因素(OR1)。骨质疏松组中,空腹尿钙/肌酐与尿NAG(P0.01 r=0.721)、尿β2-MG(P0.01r=0.553)、ALP(P0.01 r=0.886)成正相关;而骨质疏松伴泌尿系结石组的尿钙/肌酐、尿NAG、尿β2-MG及ALP均高于非结石组(P㩳0.05)。结论控制食盐及动物蛋白摄入量,积极进行运动锻炼,加强绝经后骨质疏松症的健康宣教;骨质疏松组骨吸收高于骨量正常组,空腹尿钙/肌酐可以作为绝经后骨质疏松的危险因素以及预测骨吸收的标志物之一。在绝经后骨质疏松患者中,根据空腹尿钙/肌酐值可以预测骨转换、肾小球及肾小管功能,也可以预测肾结石发生的风险。
[Abstract]:Objective to investigate the related factors of postmenopausal osteoporosis and to analyze the effect of urine calcium content on bone turnover and renal tubular function in postmenopausal women with osteoporosis. Methods from July 2014 to December 2016, patients attending Department of Renal Medicine and Department of Rheumatology and Immunology, Changhai Hospital, were selected to collect and record general data of patients, such as gender, age, height, weight, by questionnaire. Menopause, years of menopause, number of births, age of first pregnancy, past medical history, history of surgery, exercise, sunshine time, medication, history of fracture, history of smoking and drinking, lifestyle and nutritional status, etc. After excluding other diseases affecting bone metabolism, bone mineral density (BMD) was measured by dual energy X-ray. According to the diagnostic criteria of osteoporosis, it was divided into normal bone mass group and osteoporosis group. The results of bone mineral density, blood biochemistry and urine biochemistry were recorded. Urine routine, bone metabolism markers, fasting urine samples were collected, fasting urine calcium / creatinine, urine trace protein were determined. The risk factors and protective factors of postmenopausal osteoporosis were obtained by univariate analysis of exposure indexes and osteoporosis and Logistic regression analysis under multivariate conditions. Then, for the osteoporosis group, the relationship between bone mineral density (BMD), fasting urine calcium / creatinine, urine N-acetyl- 尾 -glucosidase (NAGN), alkaline phosphatase (ALP) and urine 尾 _ 2-microglobulin (尾 _ 2-MG) was analyzed. The effects of urinary calcium on bone turnover and renal tubule function in female postmenopausal osteoporosis patients were analyzed. Results there were 290 subjects, 140 of whom were osteoporosis. The prevalence of osteoporosis in 150 patients over 70 years of age with normal bone mass was significantly higher than that in patients under 60 years of age. The study found that regular exercise is the protective factor for osteoporosis. Fertility frequency and urinary calcium / urinary creatinine were risk factors of postmenopausal osteoporosis. In osteoporosis group, fasting urinary calcium / creatinine was positively correlated with urinary NAG(P0.01 rr 0.721, urinary 尾 2-MGG P0.01rU 0.553P 0.01 rn 0.886), while urinary calcium / creatinine, urinary nag, urinary 尾 2-MG and ALP were significantly higher in osteoporosis with urolithiasis than those without urinary calculi. Conclusion to control the intake of salt and animal protein, to exercise actively, to strengthen the health education of postmenopausal osteoporosis, the bone resorption of osteoporosis group is higher than that of normal bone mass group. Fasting urine calcium / creatinine can be used as a risk factor for postmenopausal osteoporosis and a marker for predicting bone resorption. In postmenopausal patients with osteoporosis, fasting urinary calcium / creatinine levels can predict bone turnover, glomerular and tubular function, and predict the risk of renal calculi.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R580

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