【作者】 单鹏飞；

【导师】 廖二元；

【作者基本信息】 中南大学 ， 内分泌学， 2006， 博士

【副题名】附：女性2型糖尿病患者骨密度及低骨量与骨质疏松症发病率的研究

【摘要】 第一章 长沙女性血清骨源性碱性磷酸酶、骨钙素、Ⅰ型胶原N-末端肽、尿脱氧吡啶啉和骨密度随年龄及绝经的变化 目的 观察895例20～80岁长沙女性的骨转换水平和骨密度随年龄及绝经的变化规律，探讨骨转换水平和骨密度(BMD)之间的关系。 对象和方法 应用测定的四个生化指标(血清B-ALP、OC、NTX和尿DPD／Cr)评价骨转换水平，其中血清B-ALP和OC用于反映骨形成水平，血清NTX和尿DPD／Cr用于反映骨吸收水平。采用双能X线骨密度吸收仪(DXA)测定腰椎(L1～L4)、左侧髋部和远端前臂骨密度(g／cm~2)。 结果 在10种拟合数学模型中，以三次回归模型拟合血清B-ALP、OC、NTX、尿DPD／Cr和BMD随年龄变化的决定系数最大(R~2=0.060～0.340，P=0.000)。女性骨转换水平在20～29岁缓慢降低，30～39岁达最低水平，同时达到腰椎峰值骨量；40～59岁的骨转换水平显著增加，伴多个骨骼部位BMD的降低，随后骨转换维持于较高水平。与绝经前女性相比，围绝经期女性的血清B-ALP、OC、NTX和尿DPD／Cr升高，腰椎和髋部BMD降低。绝经后，血清B-ALP、OC和NTX继续升高，BMD降低。经年龄、身高、体重和体质指数校正后的偏相关分析显示：血BAP、OC、NTX及尿DPD／Cr和腰椎、髋部及前臂BMD呈负相关(r=-0.096～-0.357，P=0.005～0.000)。三次回归模型、复合模型和幂回归模型拟合的血BAP、OC、NTX及尿DPD随各骨骼部位BMD变化的模型较优(R~2=0.008～0.275，P=0.007～0.000)。多元线性逐步回归显示：年龄、血清OC和BAP是BMD的负性决定因素，BMI是BMD的正性决定因素。 结论 以上研究表明，中国长沙女性骨转换水平和BMD随年龄和绝经变化而变化，BMD的年龄相关性变化与骨转换水平密切相关。血清BAP、OC和年龄及体质指数是骨密度的决定因素。更多还原

【Abstract】 Chapter one Age- and menopause-dependent changes of serum bone alkaline phosphatase, osteocalcin, cross-linked N-telopeptides of type I collagen, urinary deoxypyridinoline and bone mineral densityin Changsha femalesObjective To determine how the biochemical markers as serum bone alkaline phosphatase(B-ALP), osteocalcin(OC), cross-linked N-telopeptides of type I collagen(NTX), urinary deoxypyridinoline(DPD), and BMD are varied with age and menopause, and to evaluate the correlationship between them in 895 Changsha women aged 20～80 years.Subjects and Methods Bone turnover level was assessed by measuring B-ALP, OC, NTX, and DPD. Serum B-ALP and OC were used to evaluate the bone formation status; while serum NTX and urinary DPD were used to detect the status of bone resorption. Dual-energy x-ray absorptiometry (DXA) was used to measure BMD at the lumbar spine from L1-L4, hip and distal end of radius and ulna. Results It was found that a cubic regression model provided the best fit for serum B-ALP, OC, NTX and urinary DPD (R~2=0.060～0.340, p=0.000) to various ages in women as compared with other 9 regression models. Bone turnover status reached a minimal level in the age range of 30～39 years, when a peak bone mass was acquired at posteroanterior spine. During the age range of 40～59 years, the level of bone turnover increased significantly, accompanied by a decrease in BMD at multiple skeletal regions. Compared with premenopausal women, perimenopausal women were associated with increased levels of serum B-ALP, OC, NTX, and urinary DPD and decreased values of BMD at several skeletal regions including lumber spine and hip (P=0.004～0.000). After menopause, the serum B-ALP, OC, and NTX were increased while BMD at most skeletal regions including lumber spine, hip, and distal end of radius and ulna were further dereased (P=0.027～0.000). With the correction for age, height, body weight and body mass index (BMI), the values of serum B-ALP, OC, NTX and urinary DPD were correlated更多还原