云南省大理州白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：2018-08-22 19:30

【摘要】：目的：1.通过定量超声技术测定云南省大理州白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。2.调查云南省大理州白族骨质疏松症的患病率并探讨相关危险因素。3.验证OSTA系统是否适用于目标人群的骨质疏松症自我诊断及预测,为云南省白族骨质疏松症的自我筛查提供参考依据。4.测定云南省大理州白族40岁以上人群血清骨代谢标志物,了解其变化规律。方法：1.采用整群抽样法,抽取云南省大理州剑川县白族人群200例,其中男性57例,女性143例,年龄从23岁～87岁,并按10岁为一年龄段,将人群分为7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,整合并量化检测及调查结果后进行统计分析。2.采用随机抽样法,抽取云南省大理州白族40岁以上人群103人,年龄40～87岁,按年龄段分为5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,并对检测结果进行统计分析。结果：1.云南省大理州白族人群男女BMD峰值均出现于20～29岁年龄段。男性SI峰值处于20～29岁；女性的SI峰值则出现在30～39岁。峰值过后BMD及SI均开始下降,女性于50～59岁、60～69岁两个年龄段BMD、SI的丢失最为迅速。2.总体骨质疏松症患病率PR总体为9.5%,其中男性骨质疏松症患病率PR男性：3.5%,女性骨质疏松症患病率PR女性：11.89%。女性于70～79岁、80-89岁患病率最高,且相对于其他年龄段具有统计学差异。年龄、女性孕、产次与骨量变化呈负相关关系,身高、体重与骨量变化呈正相关关系；脆性骨折在Logistic回归分析中优势比为11.86,系云南省大理州白族人群骨质疏松症发病的高危因素。3.OSTA风险等级与OP患病率存在正相关关系。OSTA等级的ROC曲线下面积AUC显示OSTA等级对受试人群骨质疏松症有预测价值。4.大理州白族40岁以上人群平均25-(OH)Vit D含量为：14.51ng/ml,平均PTH为：46.50pg/ml,平均BGP为：8.10ng/ml,平均PCT为：17.20pg/ml;其中,随年龄的增长,25-(OH)Vit D含量呈现下降趋势,60～69岁年龄段男性及女性25-(OH)Vit D含量下降最为明显；PTH含量随年龄增长出现上升趋势,且25-(OH)Vit D血清含量与PTH血清含量呈的负相关关系。25-(OH)Vit D含量与BMD、SI对比后无统计学意义,但通过与T值对比后发现25-(OH)Vit D含量与T值呈正相关关系。CT与BGP两项检测结果与年龄、BMD、SI、T值进行对比后未发现有统计学意义。结论：1.云南省大理州白族人群峰值骨量出现在20～29岁年龄段,与全国大部分地区一致,但骨量均值低于低海拔的平原及沿海地区；峰值年龄过后BMD开始逐渐下降,50～59岁、60-69岁两个年龄段丢失最为迅速,因此,预防骨量丢失的重点应放在50～69岁之间。2.骨质疏松症患病率低于全国水平,与沿海等经济发达地区相比较低；男性患病率最高为50～59岁,女性患病率最高为70～79岁、80～89岁两个年龄段,因此,白族骨质疏松症及并发症防治重点应放在上述年龄段。年龄、女性孕、产次与BMD变化呈负相关关系,身高、体重与BMD变化呈正相关关系；脆性骨折系云南省大理州剑川县白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。3.OSTA系统与云南省大理州白族人群骨质疏松患病情况之间具有良好的相关性及统计学意义,是适用于该地区该民族骨质疏松症自我检测的有效工具。4.大理州剑川县白族人群血清25-(OH)Vit D3含量与年龄呈负相关关系(于60～69岁年龄段下降最为迅速),与跟骨T值成正相关关系；血清PTH含量与年龄成正相关关系,与血清25-(OH)Vit D3含量呈负相关关系；血清骨钙素BGP、降钙素CT与年龄、BMD、T值以及其他两项血清骨代谢物对比后无明显统计学意义。对大理州剑川县白族人群进行血清25-(OH)Vit D3以及PTH含量的检测对该民族骨质疏松症患病情况有一定的指导意义。
[Abstract]:Objective: 1. To determine the calcaneal bone mass parameters of Bai ethnic group in Dali Prefecture of Yunnan Province by quantitative ultrasound, establish a peak bone mass database and explore its changing regularity. 2. To investigate the prevalence of osteoporosis in Bai ethnic group in Dali Prefecture of Yunnan Province and explore the related risk factors. The serum bone metabolic markers of the Bai nationality over 40 years old in Dali Prefecture of Yunnan Province were determined to understand the regularity of their changes. Methods: 1. 200 cases of Bai nationality in Jianchuan County, Dali Prefecture, Yunnan Province were selected by cluster sampling, including 57 males and 143 females. The population was divided into seven groups according to age from 23 to 87. Quantitative ultrasound examination of calcaneus (including BMD, T, SI), basic signs measurement, questionnaire survey of osteoporosis related factors were carried out. The results were integrated and quantified and analyzed statistically. 2. A random sampling method was used to select 40 Bai nationality from Dali Prefecture, Yunnan Province. 103 people over the age of 40-87 were divided into 5 groups according to their age. 25-(OH) Vit D3, parathyroid hormone PTH, osteocalcin BGP and calcitonin CT were detected by ELISA, and the results were statistically analyzed. Results: 1. BMD peaks of both men and women in Dali Bai nationality of Yunnan Province were in the age range of 20-29 years. After the peak, BMD and SI began to decrease, and the loss of SI was the fastest in women aged 50-59 and 60-69. 2. The overall prevalence of osteoporosis was 9.5%. The prevalence of osteoporosis was 3.5% in males and 11.89% in females. The prevalence rate of fragile fracture was the highest in women aged 70-79, and the difference was statistically significant between 80-89 and other age groups. The area under the ROC curve of OSTA showed that OSTA had predictive value for osteoporosis. 4. The average content of 25 - (OH) Vit D was 14.51ng/ml, and the average PTH was 46.50pg/ml, and the average BGP was 8.10n/ml. The average PCT was 17.20 pg/ml. The content of 25-(OH) Vit D decreased with age, and the content of 25-(OH) Vit D decreased most significantly in males and females aged 60-69. The content of PTH increased with age, and the serum content of 25-(OH) Vit D was negatively correlated with that of PTH. There was no significant difference between MD and SI, but there was a positive correlation between 25-(OH) Vit D and T. There was no significant difference between CT and BGP in BMD, SI and T. Conclusion: 1. The peak bone mass of Bai nationality in Dali Prefecture of Yunnan Province appeared in the age range of 20-29 years, which was the same as most of the country. BMD began to decrease gradually after the peak age, and the loss was most rapid in the two age groups of 50-59 and 60-69. Therefore, the focus of preventing bone loss should be placed between 50-69 years old. 2. The prevalence of osteoporosis is lower than the national level, and coastal and other economically developed areas. The highest morbidity rate of men is 50-59 years old, the highest morbidity rate of women is 70-79 years old, 80-89 years old two age groups, therefore, the prevention and treatment of osteoporosis and complications of the Bai nationality should focus on the above age groups. Osteoporosis is an important risk factor for the occurrence of osteoporosis in Bai nationality in Jianchuan County, Dali Prefecture, Yunnan Province. We should pay attention to the prevention of osteoporosis after fragile fracture. 3. There is a good correlation and statistical significance between OSTA system and the prevalence of osteoporosis in Bai nationality in Dali Prefecture, Yunnan Province. 4. Serum 25 - (OH) Vit D3 levels were negatively correlated with age (the lowest was in the 60-69 age group), and positively correlated with calcaneal T value; serum PTH levels were positively correlated with age, and negatively correlated with serum 25 - (OH) Vit D3 levels; serum bone marrow was positively correlated with calcaneal T value; serum PTH levels were negatively correlated with serum 25 - (OH) Vit D3 levels. Calcitonin BGP, calcitonin CT and age, BMD, T value and other two serum bone metabolites were not statistically significant. The serum 25 - (OH) Vit D3 and PTH levels of Bai nationality in Jianchuan County, Dali Prefecture were measured to have certain guiding significance for the prevalence of osteoporosis in this nationality.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R580

【参考文献】