妊娠期妇女骨密度及骨代谢特征研究
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摘要
目的探讨妊娠期妇女骨密度(BMD)变化趋势及骨代谢特征。方法选取2016年1月至2018年1月在宁波市北仑区人民医院分娩的妊娠妇女200例作为妊娠组,同时选取健康妇女150例作为对照组,分别检测对照组和妊娠组早孕期、中孕期和晚孕期BMD、血清钙、碱性磷酸酶(ALP)、骨钙素(BGP)、尿钙/尿肌酐(Cr)、尿脱氧吡啶啉(DPD)/Cr水平。结果妊娠组晚孕期BMD为(0.45±0.07)g/cm~2,低于中孕期、早孕期水平及对照组(t值分别为11.16、12.40、11.69,均P<0.05);对照组和妊娠组各孕期血清钙水平比较差异无统计学意义(均P>0.05);妊娠组晚孕期血清ALP、尿钙/Cr及尿DPD/Cr明显高于中孕期、早孕期水平及对照组(ALP:t值分别为16.12、24.15、25.12;尿钙/Cr:t值分别为9.20、28.04、33.71;尿DPD/Cr:t值分别为19.26、27.64、34.32,均P<0.05),而血清BGP明显低于中孕期、早孕期水平及对照组(t值分别为9.03、15.86、17.19,均P<0.05)。孕妇晚孕期BMD与血清ALP、尿钙/Cr及尿DPD/Cr呈负相关(r分别为-0.46、-0.42、-0.43,均P<0.05),与BGP呈正相关(r=0.38,P<0.05)。结论妊娠期妇女BMD有所降低,尤其晚孕期下降明显,与骨代谢指标有一定相关性。
Objective To investigate the change trend of bone mineral density(BMD) and bone metabolism in pregnant women. Methods Two hundred pregnant women(pregnancy group) who delivered in Beilun District People's Hospital of Ningbo City from January 2016 to January 2018 were selected, and 150 healthy women were selected as control group. The levels of BMD, serum calcium, alkaline phosphatase(ALP), bone gla protein(BGP), urinary calcium/urinary creatinine(Cr) and urine deoxypyridine(DPD)/Cr were detected in the control group and the pregnancy group during early pregnancy, middle pregnancy and late pregnancy. Results In late pregnancy, BMD was 0.45±0.07 g/cm~2 in pregnancy group, which was lower than the level in middle pregnancy and early pregnancy and that in the control group(t value was 11.16, 12.40 and 11.69, respectively, all P<0.05). There was no significant difference in serum calcium levels between the control group and pregnancy group(all P>0.05). The serum ALP, urinary calcium/Cr and urine DPD/Cr in late pregnancy in pregnancy group were significantly higher than those in middle pregnancy and early pregnancy and those in the control group(ALP:t value was 16.12, 24.15 and 25.12; urinary calcium/Cr :t value was 9.20, 28.04 and 33.71; urine DPD/Cr:t value was 19.26, 27.64 and 34.32, respectively, all P<0.05), but the serum BGP was obviously lower than in middle pregnancy and early pregnancy and that in the control group(t value was 9.03, 15.86 and 17.19, respectively, all P<0.05). BMD in late pregnancy was negatively correlated with serum ALP, urinary calcium/Cr and urine DPD/Cr(r value was-0.462,-0.419 and-0.43, respectively, all P<0.05), but was positively correlated with BGP(r=0.38,P<0.05). Conclusion BMD in pregnant women is decreased, especially in late pregnancy, which is correlated with bone metabolism index.
Objective To investigate the change trend of bone mineral density(BMD) and bone metabolism in pregnant women. Methods Two hundred pregnant women(pregnancy group) who delivered in Beilun District People's Hospital of Ningbo City from January 2016 to January 2018 were selected, and 150 healthy women were selected as control group. The levels of BMD, serum calcium, alkaline phosphatase(ALP), bone gla protein(BGP), urinary calcium/urinary creatinine(Cr) and urine deoxypyridine(DPD)/Cr were detected in the control group and the pregnancy group during early pregnancy, middle pregnancy and late pregnancy. Results In late pregnancy, BMD was 0.45±0.07 g/cm~2 in pregnancy group, which was lower than the level in middle pregnancy and early pregnancy and that in the control group(t value was 11.16, 12.40 and 11.69, respectively, all P<0.05). There was no significant difference in serum calcium levels between the control group and pregnancy group(all P>0.05). The serum ALP, urinary calcium/Cr and urine DPD/Cr in late pregnancy in pregnancy group were significantly higher than those in middle pregnancy and early pregnancy and those in the control group(ALP:t value was 16.12, 24.15 and 25.12; urinary calcium/Cr :t value was 9.20, 28.04 and 33.71; urine DPD/Cr:t value was 19.26, 27.64 and 34.32, respectively, all P<0.05), but the serum BGP was obviously lower than in middle pregnancy and early pregnancy and that in the control group(t value was 9.03, 15.86 and 17.19, respectively, all P<0.05). BMD in late pregnancy was negatively correlated with serum ALP, urinary calcium/Cr and urine DPD/Cr(r value was-0.462,-0.419 and-0.43, respectively, all P<0.05), but was positively correlated with BGP(r=0.38,P<0.05). Conclusion BMD in pregnant women is decreased, especially in late pregnancy, which is correlated with bone metabolism index.
引文
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[3]杨明芳,陈磊.早孕妇女骨密度情况及相关因素分析[J].山西医药杂志,2016,45(19):2283-2285.
[4]Ozdemir D,Tam A A,Dirikoc A,et al.Postpartum osteoporosis and vertebral fractures in two patients treated with enoxaparin during pregnancy[J].Osteoporos Int,2015,26(1):415-418.
[5]李士红,刘阳.骨关节病变及骨折患者围术期骨代谢标志物检测及骨密度变化[J].中国组织工程研究,2016,20(35):5290-5295.
[6]Ota S,Inoue R,Shiozaki T,et al.Atypical femoral fracture after receiving antiresorptive drugs in breast cancer patients with bone metastasis[J].Breast Cancer,2017,24(4):601-607.
[7]Osorio L E,Boechat M I,Mirochnick M,et al.Bone age and mineral density assessments using plain roentgenograms in Tenofovir-exposed infants in Malawi and Brazil enrolled in HIV prevention trials network 057[J].Pediatr Infect Dis J,2017,36(2):184-188.
[8]王士艳,蒋洁,蒋霞.1 056例产妇骨密度检测结果分析[J].实用临床医药杂志,2017,21(21):228-229.
[9]Ozturk G,Akpinar P,Karamanlioglu A D,et al.Pregnancy-related osteoporotic vertebral compression fractures in two patients treated with low-molecular-weight heparin during pregnancy: case reports[J].Gynecol Endocrinol,2018,34(5):378-380.
[10]Teichtahl A J,Wang Y,Wluka A E,et al.Associations between systemic bone mineral density and early knee cartilage changes in people without clinical knee disease[J].Arthritis Res Ther,2017,19(1):98.
[11]Wei W,Shary J R,Garrett-Mayer E,et al.Bone mineral density during pregnancy in women participating in a randomized controlled trial of vitamin D supplementation[J].Am J Clin Nutr,2017,106(6):1422-1430.
[12]姚宇红.产后早期妇女超声骨密度及影响因素研究[J].中国药物与临床,2017,17(2):199-201.
[13]Bommersbach T J,Fischer P R,Pettifor J M,et al.The relationship between maternal and child bone density in Nigerian children with and without nutritional rickets[J].Osteoporos Int,2018,29(6):1313-1320.
[14]Beckman J P,Camp J J,Lahr B D,et al.Pregnancy history, coronary artery calcification and bone mineral density in menopausal women[J].Climacteric,2018,21(1):53-59.
[15]李冰,孔燕.钙营养综合干预对孕妇骨密度影响的研究[J].中国计划生育学杂志,2016,24(5):319-321.