骨量异常患者服药依从性和骨密度调查及各自影响因素研究

发布时间：2018-05-18 03:07

本文选题：骨量减少 + 骨质疏松症　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的调查2015年度在天津医科大学总医院内分泌科住院治疗的骨量异常患者使用钙剂、维生素D及双膦酸盐类药物治疗的依从性现状,了解影响依从性的因素。观察骨量异常患者骨密度随年龄及性别变化情况,探讨骨密度影响因素。方法以2015年度天津医科大学总医院内分泌科住院患者出院诊断为线索,筛选出骨量异常患者360例。查阅病历资料,记录人口学特征、实验室检查、影像学检查、双能X线骨密度检查、处方单等信息。对这360例患者逐一进行了电话访问,追溯骨量异常病程,钙剂、维生素D及双膦酸盐类药物用药方案及持续时间。以药物持有率(MPR)量化依从性,定义MPR"g80%为依从性好,MPR80%为依从性差。比较依从性好与依从性差两组间各参数的差异,采用多因素分析依从性影响因素。采用二分类变量,即有持续性患者人数占研究对象人数比例表示持续性。以天或周为用药频率的药物,定义间隔1月为无持续性;以月或年为用药频率的药物,定义间隔3个月为无持续性。分别以3月、6月为时间截点,分别计算钙剂、维生素D和双膦酸盐类药物服药持续性,比较不同类型药物持续性差异。住院期间行双能X线吸收法测定骨密度(BMD)检查患者326例,观察不同年龄、不同性别患者不同骨骼部位骨密度的差异。按照T/Z值分为骨量减少组和骨质疏松组,比较两组生化指标和骨密度的差异,并进行相关性分析。新诊断2型糖尿病患者54例,住院期间行口服葡萄糖耐量试验(OGTT),按照骨密度分为骨质疏松组和骨量减少组,比较两组血糖和胰岛素及相关指标的差异。住院期间行骨标三项检查患者77例,按照原发病分为2型糖尿病组、格雷夫斯病组、原发性甲状旁腺功能亢进组和原发性骨质疏松组,分析各组间骨代谢指标和骨标志物的差异。绝经后女性患者83例,分析垂体性腺轴激素水平与BMD相关性。结果1、骨量异常患者共计360例,得到完整信息274例。依从性好132例,占48.2%;依从性差142例,占51.8%。多因素分析显示,影响骨量异常患者服药依从性的因素有病程、糖皮质激素使用史、骨痛症状和吸烟史(P0.05)。2、钙剂和(或)维生素D补充组、双膦酸盐类药物组、联合治疗组三组间依从性差异有统计学意义(P0.05)。联合治疗组较补充组MPR及依从性均较好(P0.05)。各药物持续性均随时间推移而下降,6个月内累计停药率超过50%。3、男性患者L1-L4、股骨颈、全髋、全身骨密度均高于女性(P0.05)。随年龄增长,骨密度整体呈下降趋势。股骨颈部位骨量异常检出率最高。4、骨量减少组与骨质疏松组两组年龄、血白蛋白、血尿素氮、FSH、LH、合并脂肪肝患者比例有显著差异(P0.05)。Pearson相关性分析:L1-L4骨密度与体重、BMI、UA、E2正相关(P均0.05),与年龄、HDL、FSH、LH负相关(P均0.05);股骨颈骨密度与体重、BMI、血白蛋白、E2正相关(P均0.05),与年龄、BUN、FSH、LH负相关(P均0.05);全髋骨密度与体重、BMI、血白蛋白、E2正相关(P均0.05),与年龄、HDL、BUN、FSH、LH负相关(P均0.05)。5、骨量减少组和骨质疏松组,HbA1c%、FBG、FINS、LN(HOMA-B)无显著差异(P0.05)。骨质疏松组LN(HOMA-IR)低于骨量减少组(P0.05)。Pearson相关性分析,全髋及全身骨密度均与LN(HOMA-IR)正相关(P均0.05)。6、T2DM组、GD组、原发性甲状旁腺功能亢进组及原发性骨质疏松组之间,体重、尿钙、尿磷无显著差异(P均0.05)。GD组及原发甲旁亢组血钙、OC、CTX、PINP均高于T2DM组和OP组,两组间血钙无显著差异,GD组OC、CTX、PINP平均值均高于原发甲旁亢组。7、Pearson相关性分析,绝经后女性股骨颈骨密度与FSH、LH、FSH/LH、FSH/E2无相关性(P均0.05),与E2正相关(P0.05)。结论骨量异常患者使用钙剂、维生素D、双膦酸盐类药物的依从性和持续性均较差。随病程延长,患者对骨量异常的重视程度提高,服药依从性有所好转。糖皮质激素对骨骼负性影响的广泛认知以及每日饱受骨痛症状困扰,可以提高治疗的依从性,吸烟等不良生活习惯降低依从性。骨密度随年龄增长而降低,腰椎和全身骨密度存在假性升高。股骨颈骨密度对于诊断骨量异常敏感性较高,但影响因素较多。体重为骨密度保护因素,胰岛素水平升高可能是骨密度的保护因素。HDL水平升高可能导致骨密度降低。GD患者骨转换活跃,甲状腺激素导致骨密度降低。绝经后女性骨密度降低与雌激素水平下降有关。
[Abstract]:Objective to investigate the compliance status of calcium, vitamin D and bisphosphonates in patients with bone quantity abnormality hospitalized in Department of Endocrinology, General Hospital Affiliated to Tianjin Medical University in 2015, and to understand the factors affecting compliance. The influence factors of bone mineral density with age and sex were investigated. On the basis of the diagnosis of hospitalized patients in Department of endocrinology of General Hospital Affiliated to Tianjin Medical University in 2015, 360 cases of abnormal bone quantity were selected. The data of medical records were checked, the demographic characteristics, laboratory examination, imaging examination, double energy X-ray bone density examination and prescription information. The 360 patients were interviewed by telephone to trace bone mass. Regular course of disease, calcium, vitamin D and bisphosphonates medication program and duration. With drug holding rate (MPR) quantitative compliance, define the MPR "g80% for good compliance, MPR80% compliance poor, good compliance and poor compliance of the differences between the two groups, the use of multiple factors analysis of compliance factors. Two classification variables, that is, The number of persistent patients represented the ratio of the number of subjects in the study. Drugs defined at the frequency of day or week were not persistent at the interval of January; drugs at the frequency of month or year were defined for 3 months without continuity. In March and June, respectively, calcium, vitamin D and bisphosphonates were used to calculate the dosage of calcium, vitamin and bisphosphonates. The persistence of the drugs was compared with the continuous difference of different types of drugs. During hospitalization, 326 cases of bone mineral density (BMD) were measured by double energy X-ray absorptiometry. The bone mineral density of different skeletal sites in different ages and sexes were observed. The T/Z values were divided into bone mass reduction group and bone sparse group, and the differences of biochemical indexes and bone mineral density were compared between the two groups. An oral glucose tolerance test (OGTT) was performed in 54 cases of newly diagnosed type 2 diabetic patients. The bone density was divided into osteoporosis group and bone mass reduction group according to bone mineral density. The difference between two groups of blood glucose and insulin and related indexes was compared. 77 cases were examined in three cases of bone mark during hospitalization, and were divided into type 2 diabetes according to the primary disease. Group, Graves's disease group, primary hyperparathyroidism group and primary osteoporosis group, analysis of the difference of bone metabolism index and bone marker between each group. 83 postmenopausal women patients, analysis of pituitary gonadal axis hormone level and BMD correlation. Results 1, 360 cases of abnormal bone mass, 274 cases of complete information. Good compliance 132. For example, 48.2%, 142 cases of poor compliance and 51.8%. multivariate analysis showed that the factors affecting the compliance of the patients with abnormal bone mass were the course of disease, the history of the use of glucocorticoids, the symptoms of bone pain and the history of smoking (P0.05).2, the calcium and (or) vitamin D supplementation group, the group of biphosphonate salts, and the differences of compliance between the three groups of the combined treatment group were statistically significant (P0 .05). The MPR and compliance of the combined group were better than that of the supplemental group (P0.05). The duration of each drug decreased with time, and the cumulative drug withdrawal rate was more than 50%.3 in 6 months. The male patients were L1-L4, the neck of the femur, the whole hip and the whole body density were higher than that of the women (P0.05). The highest rate of.4, the age of two groups of bone mass reduction group and osteoporosis group, blood albumin, blood urea nitrogen, FSH, LH, the proportion of patients with fatty liver was significantly different (P0.05).Pearson correlation analysis: L1-L4 bone density and weight, BMI, UA, E2 positive correlation (P 0.05), and age, HDL, FSH, negative correlation (0.05); femoral neck bone density and weight, blood white E2 positive correlation (P 0.05), negative correlation with age, BUN, FSH, LH (P 0.05); total hip bone density and weight, BMI, serum albumin, E2 (P 0.05), and age, HDL, BUN, FSH, and osteoporosis group. The P0.05.Pearson correlation analysis showed that the total hip and total bone mineral density were positively correlated with LN (HOMA-IR) (P 0.05).6, T2DM group, GD group, primary hyperparathyroidism group and primary osteoporosis group, body weight, urinary calcium and urine phosphorus (P 0.05).GD group and primary hyperparathyroidism group blood calcium, OC, CTX, and CTX. In group OP, there was no significant difference in blood calcium between the two groups. The average value of OC, CTX and PINP in group GD was higher than that of primary hyperparamidonic group.7, Pearson correlation analysis. The femur neck bone density in postmenopausal women had no correlation with FSH, LH, FSH/LH, FSH/E2 (P are 0.05). As the duration of the disease increased, the patient's attention to the bone mass was increased and the compliance of the drug was improved. The extensive cognition of the negative effects of glucocorticoid on the bone and the daily suffering of the symptoms of bone pain could improve the compliance of the treatment, and reduce the compliance of the bad living habits such as smoking. Bone density increased with age. Decrease, there is a false rise in the bone density of the lumbar vertebrae and the whole body. The bone density of the femoral neck is more sensitive to the diagnosis of bone mass, but the factors affecting the bone mineral density are more. The body weight is the factor of bone mineral density protection, the increase of insulin level may be the protective factor of bone density, the increase of.HDL level may lead to the reduction of bone turnover activity in.GD patients and thyroid hormone. The decrease in bone mineral density is associated with decreased bone mineral density in postmenopausal women.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R580

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