摘要
目的:探讨绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)合并膝骨关节炎(knee osteoarthritis,KOA)患者的骨代谢特征。方法:选择2014年11月至2017年3月在浙江省中医院就诊的PMOP合并KOA患者作为研究对象。拍摄患者站立位膝关节X线片,根据Kellgren和Lawrence影像分级标准将纳入研究的患者分为5组。采用双能X线吸收法测定患者L1~L4的骨密度,采用电化学发光免疫分析法测定患者的血清维生素D、甲状旁腺激素(parathyroid hormone,PTH)、Ⅰ型前胶原氨基端前肽(N-terminal propeptide of typeⅠprecollagen,PⅠNP)、N端中段骨钙素(N-terminal in the middle osteocalcin,N-MID-OT)、Ⅰ型胶原羧基端肽β特殊序列(βcross-linked C-telopeptide of typeⅠcollagen,β-CTX)水平。结果:纳入研究的患者共124例,0级组26例、Ⅰ级组15例、Ⅱ级组39例、Ⅲ级组26例、Ⅳ级组18例。5组患者的骨密度比较,差异有统计学意义[(0.800±0.045)g·cm^(-2),(0.788±0.048)g·cm^(-2),(0.813±0.042)g·cm^(-2),(0.827±0.051)g·cm^(-2),(0.849±0.049)g·cm^(-2),F=4.724,P=0.001];0级组的骨密度与Ⅰ级组、Ⅱ级组比较,组间差异均无统计学意义(P=0.436,P=0.291);0级组的骨密度小于Ⅲ级组、Ⅳ级组(P=0.040,P=0.001);Ⅰ级组与Ⅱ级组的骨密度比较,差异无统计学意义(P=0.088);Ⅰ级组的骨密度小于Ⅲ级组、Ⅳ级组(P=0.012,P=0.000);Ⅱ级组与Ⅲ级组的骨密度比较,差异无统计学意义(P=0.228);Ⅱ级组的骨密度小于Ⅳ级组(P=0.007);Ⅲ级组与Ⅳ级组的骨密度比较,差异无统计学意义(P=0.126)。5组患者的血清维生素D、N-MID-OT含量比较,组间差异均无统计学意义[(16.72±9.66)ng·m L^(-1),(17.46±13.18)ng·m L^(-1),(17.92±13.22)ng·m L^(-1),(15.93±6.51)ng·m L^(-1),(16.23±5.54)ng·m L^(-1),F=0.180,P=0.948;(24.39±4.73)ng·m L^(-1),(25.92±5.45)ng·m L^(-1),(23.55±4.35)ng·m L^(-1),(22.44±4.71)ng·m L^(-1),(21.29±5.48)ng·m L^(-1),F=2.424,P=0.052]。5组患者血清PTH含量比较,差异有统计
Objective： To explore the characteristics of bone metabolism in patients with postmenopausal osteoporosis（ PMOP） and knee osteoarthritis（ KOA）. Methods： The patients with PMOP and KOA who were treated in Zhejiang Provincial Hospital of Traditional Chinese Medicine from November 2014 to March 2017 were selected out as the subjects. The X-ray films of affected knee in standing position were taken,and the patients enrolled in the study were divided into 5 groups according to Kellgren-Lawrence imaging classification criteria. The bone densities of vertebrae fromL2 to L4 were detected by using dual-energy X-ray absorptiometry（ DEXA）,and the serum levels of vitamin D,parathyroid hormone（ PTH）,N-terminal propeptide of typeⅠprecollagen（ PⅠNP）,N-terminal in the middle osteocalcin（ N-MID-OT） and β cross-linked C-telopeptide of typeⅠcollagen（ β-CTX） were measured by using electro-chemiluminescence immunoassay（ ECLIA）. Results： One hundred and twenty-four patients were enrolled in the study and were divided into grade 0 group（ 26）,gradeⅠgroup（ 15）,gradeⅡgroup（ 39）,gradeⅢgroup（ 26） and gradeⅣgroup（ 18）. There was statistical difference in the bone density between the 5 groups（ 0. 800 ＋/-0. 045,0. 788 ＋/-0. 048,0. 813 ＋/-0. 042,0. 827 ＋/-0. 051,0. 849 ＋/-0. 049 g/cm^-2,F = 4. 724,P =0. 001）. There was no statistical difference in the bone density between grade 0 group and gradeⅠgroup and between grade 0 group and gradeⅡgroup（ P = 0. 436,P = 0. 291）. The bone density was lower in grade 0 group compared to gradeⅢgroup and gradeⅣgroup（ P =0. 040,P = 0. 001）. There was no statistical difference in the bone density between gradeⅠgroup and gradeⅡgroup（ P = 0. 088）. The bone density was lower in gradeⅠgroup compared to gradeⅢgroup and gradeⅣgroup（ P = 0. 012,P = 0. 000）. There was no statistical difference in the bone density between gradeⅡgroup and gradeⅢgroup（ P = 0. 228）. The bone density was lower in g
作者
谭浩林
张润
王刚
应航
童培建
TAN Haolin;ZHANG Run;WANG Gang;YING Hang;TONG Peijian(Fuyang TCM Orthopedic - Traumatological Hospital , Hangzhou 311400 , Zhejiang , China;Anhui Chinese Medical University,Hefei 230012,Anhui,China;Zhejiang Chinese Medical University,Hangzhou 310053, Zhejiang, China;Institute of Traumatology and Orthopedics of Zhejiang,Hangzhou 310053 , Zhejiang, China;Zhejiang Provincial Hospital of Traditional Chinese Medicine,Hangzhou 310006 ,Zhejiang,China)
出处
《中医正骨》
2018年第5期14-19,共6页
The Journal of Traditional Chinese Orthopedics and Traumatology
基金
国家自然科学基金项目(81673997)
浙江省科技计划项目(2014C03035)
关键词
骨关节炎
膝
骨质疏松
绝经后
骨密度
骨代谢
osteoarthritis
knee
osteoporosis
postmenopausal
bone density
bone metabolism
