【作者】 郑郑；

【导师】 李自成；

【作者基本信息】 暨南大学 ， 心血管， 2010， 硕士

【摘要】 【目的】在建立双能X线吸收法(DXA)骨密度测量的基础上,分析绝经后女性高血压病(EH)伴糖耐量减低(IGT)患者骨密度的变化,探讨绝经后女性糖耐量减低对骨密度的影响,并探讨其可能发病机制。[方法]连续入选2009年1月至2010年1月暨南大学附属第一医院心内科、内分泌科住院与门诊、及附属校门诊部绝经后女性患者(66.82±10.69岁),共107例,详细记录基础资料,常规检测三大常规、血脂、肝肾功能等。参照国际IGT、高血压诊断标准将其分为正常对照组55例、单纯IGT组28例、IGT合并EH组24例,均使用DXA测量全身、局部腰椎(腰椎L1-L4)和股骨近端(包括股骨颈、大转子和Ward’s三角)的骨密度(Bone Mineral Density,BMD)。使用SPSS13.0软件进行资料的统计分析。计数资料用均数±标准差表示；x2检验分别比较单纯IGT组和IGT合并EH组总骨质疏松(osteoporosis,OP)、腰椎OP、髋部OP的患病率,协方差分析各部位BMD的差别,使用独立样本t检验分别比较三组间实验室指标与各部位BMD,并使用多元回归方法及直线相关分析各部位BMD与相关危险因素之间的相关性。[结果]IGT组中,高血压组腰椎OP患病构成比显著高于非高血压组(P<0.05)；而全身OP、双侧股骨近端OP两组构成比无明显差别(P>0.05)。两组BMD比较,高血压组各部位的BMD均低于非高血压组,其中腰椎L1、L2、L3、L4的BMD显著低于非高血压组(P值分别为0.021、0.033、0.036、0.029),但在校正BMI及餐后2h C肽后P值显著变大,两组BMD均无统计学差异。IGT组(包括单纯IGT组和IGT合并EH组)与正常对照组比较,IGT组收缩压、舒张压、标准OGTT餐后2h血糖、HbAlc水平、C肽水平高于正常对照组(P<0.05)；而TC、TG、HDL-C、LDL-C等指标与正常对照组比较无显著差异(P>0.05)。IGT组腰椎L2、L3、L4、Ward’s三角区的BMD明显低于正常对照组(P值分别为0.031、0.026、0.034和0.039)；而全身、腰椎L1、股骨颈、大粗隆的BMD无显著差异(P值分别为0.329、0.374、0.085、0.432)。应用多元回归分析并进行相应的直线相关分析,绝经年限、OGTT餐后2h血糖、体重指数(BMI)和BMD有关系；而在有IGT基础上的高血压与BMD呈明显的负相关。[结论]绝经后糖耐量减低女性患者部分腰椎、Ward’s三角区的骨密度显著降低。对有糖耐量异常基础的绝经后女性,高血压使腰椎骨密度显著降低,而对Ward’s三角区的骨密度影响未见明显。骨密度和绝经年限、餐后血糖水平(PPG)、平均动脉压(MAP)呈直线负相关；与体重指数(BMI)呈正相关。更多还原

【Abstract】 [Objective]Based on the precision of the measurements of body composition and bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA), we analyzed changes of BMD in postmenopausal female patients with essential hypertension who is suffering impaied glucose tolerance on the purpose of investigating the effect of IGT on postmenopausal female patients, and exploring the possible mechanism.107 postmenopausal female patients from section of cardiology and endocrine and outpatient section of the first affiliated hospital of Jinan university were selected and recorded the basic file, then accepted blood test. They were divided into 55 cases of normal control group,28 cases of pure IGT group,24 cases of IGT combined EH group according to the IGT and hypertension diagnostic criteria. BMD of total body、partial lumbar spine (lumbar vertebrae L1-L4) and proximal femur (including the femoral neck, trochanter and Ward’s triangle) were determined by DXA. All data had been analyzed by SPSS 13.0. Prevalence of osteoporosis were compared between the IGT two groups using Chi-square test, and BMD was compared using covariance analysis. Among the three groups, BMD and laboratory indicators were compared by independent samples T test respectively. The correlation between BMD and risk factors was analyzed using multiple regression method and linear correlation analysis.[Results]In the IGT two groups, The prevalence of lumber osteoporosis in hypertension group were higher than that of the non-hypertension group (P<0.05) while there was no significant difference between the two groups in the whole body OP, bilateral proximal femoral component ratio of OP (P>0.05). All BMDs in the hypertension group were higher than that in the non-hypertension group, and there were significant differences in lumbar L1、L2、L3、L4 BMDs between the two groups (P values were 0.021、0.033、0.036 and 0.029 respectively); however, the difference disappeared after adjustment for the BMI and postprandial 2h C-peptide, the P value also increased remarkably. The level of systolic blood pressure (SBP)、diastolic blood pressure (DBP)、the postprandial 2h plasma glucose, HbAlc and C-peptide in IGT group were significant higher than that in normal control group while there was no significant difference between the two groups in the level of TC, TG, HDL-C, LDL-C and other indicators. BMDs in lumbar L2、L3、L4 and Ward’s triangle in IGT group were significantly lower than that in the normal control group (P values were 0.031、0.026、0.034 and 0.039 respectively), while there was no significant difference between the two groups in BMDs in total body、lumbar spine L1、femoral neck and greater trochanter (P values were 0.329、0.374、0.085 and 0.432 respectively) Multiple regression method and linear correlation analysis showed that BMDs were associated with menopause age、OGTT postprandial 2h plasma glucose、body mass index (BMI) and hypertension combined with IGT.[Conclusion]BMDs in some lumbar spine and Ward’s triangle were significantly reduced in postmenopausal female patients. BMDs in lumbar spine were notably lower in postmenopausal female patients with IGT than those without IGT; while there is no significant differences in Ward’s triangle BMDs. BMDs were negatively correlated with postmenopausal age、postprandial plasma glucose and mean arterial pressure but positively with BMI.更多还原