摘要
目的了解老年髋部骨质疏松性骨折患者早期骨代谢的特点,并对骨折早期骨代谢生化指标的变化情况进行分析,指导早期的抗骨质疏松治疗。方法本研究共纳入180例,分为老年髋部骨折组120例(股骨颈骨折60例和股骨粗隆间骨折60例)及非骨折组(60例)。老年髋部骨折组平均年龄为(80.1±7.1)岁,其中男34例,女86例。非骨折组平均年龄(78.5±4.6)岁,其中男25例,女35例。老年髋部骨折患者分别于入院后、术后第1天测量血清骨代谢相关生化指标[P1NP、β-CTX、OC、25(OH)D、ALP、钙、磷],术后测定骨密度。非骨折组入院后即测定血清骨代谢相关生化指标[P1NP、β-CTX、OC、25(OH)D、ALP、钙、磷]和骨密度。通过组间和组内独立样本t检验、χ~2检验和组内配对样本t检验,比较两组骨密度及骨代谢生化指标,并分别比较老年髋部骨折组内不同骨折类型患者及不同性别患者早期骨代谢生化指标的差异,分析老年髋部骨折患者早期骨代谢生化指标的变化情况。结果老年髋部骨折组与非骨折组相比,髋部骨密度较低,差异有统计学意义(P<0.01),血清中25(OH)D水平较低,差异有统计学意义(P<0.05),钙、磷水平较低,差异有统计学意义(P<0.01,P<0.05),而P1NP、β-CTX、OC和ALP差异均无统计学意义(P>0.05);老年髋部骨折组中,股骨粗隆间骨折患者与股骨颈骨折患者相比,血清钙水平较低,差异有统计学意义(P<0.05),血清P1NP、β-CTX、OC、25(OH)D、ALP和磷差异均无统计学意义(P>0.05);老年髋部骨折组中,女性患者与男性患者比较:血清OC、ALP和磷水平较高,差异有统计学意义(P<0.01,P<0.01,P<0.05),血清P1NP、β-CTX、25(OH)D和钙水平差异均无统计学意义(P>0.05);骨折早期骨代谢生化指标的变化情况:P1NP、OC、25(OH)D、钙水平明显下降,差异均有统计学意义(P<0.05,P<0.01,P<0.01,P<0.01,P<0.05),β-CTX、磷水平明显升高,差异有统计学意义(P<0.01,P<0.01)。结论与非骨折组相比,老年髋部骨折组髋部骨密度明显较低,25(OH)D、钙、磷水平明显较低,应重视25(OH)D和钙剂的补充;髋部骨折早期骨代谢水平即发生明显变化,骨形成减弱而骨破坏增强,应在早期进行抗骨质疏松治疗。
Objective To clarify the characteristics of bone metabolism in elderly patients with osteoporotic hip fracture, and to analyze the fluctuant features of bone metabolism biochemical markers in the early stage to guide the early anti-osteoporosis treatment. Methods A total of 180 cases were enrolled in this study. The patients were divided into the elderly hip fracture group（ 60 cases of femoral neck fractures and 60 cases of femoral intertrochanteric fractures） and non-fracture group（ 60 cases）. The average age of the hip fracture group was（ 80.1 ± 7.1） years, including 34 males and 86 females. The average age of the non-fracture group was（ 78.5 ± 4.6） years, including 25 males and 35 females. For the elderly hip fracture group, bone metabolism biochemical markers（ P1 NP, β-CTX, OC, 25（ OH） D, ALP, calcium, phosphorus） were measured respectively on the day after the admission and the day after the operation. Bone mineral density was measured after the operation. For the non-fracture group, bone metabolism biochemical markers（ P1 NP, β-CTX, OC, 25（ OH） D, ALP, calcium, phosphorus） and bone mineral density were measured on the day after the admission. T test and chi-square test were used to compare the differences of bone metabolism biochemical markers between groups（ the elderly hip fracture group versus non-fracture group, femoral neck fractures versus intertrochanteric fractures, woman versus man）. Matched t-test was used to analyze the fluctuant features of bone metabolism biochemical markers in the early stage of the fracture. Results The elderly hip fracture group（ compared with the non-fractured group）： the hip bone mineral density was lower with statistically significant differences（ P〈0.01）; 25（ OH） D level was lower with statistically significant differences（ P〈0.05）; calcium and phosphorus levels were lower with statistically significant differences（ P〈0.01, P〈0.05）; no significant differences in P1 NP, β-CTX, OC and ALP,（ P〈0.05）. Femoral intertrochanteric fracture（ Compared with femoral neck fractures）： lower level of serum calcium with statistically significant differences（ P〈0.05）; no significant differences in P1 NP, β-CTX, OC, 25（ OH） D, ALP and phosphorus between the two groups（ P〈0.05）. The elderly female patients with hip fracture had higher level of serum OC, ALP and phosphorus when compared with the elderly male patients, with statistically significant differences（ P〈0.01, P〈0.01, P〈0.05）; no significant differences in serum levels of P1 NP, β-CTX, 25（ OH） D and calcium（ P〈0.05）. The level of P1 NP, OC, 25（ OH） D and calcium decreased with statistically significant differences（ P〈0.05, P〈0.01, P〈0.01, P〈0.01, P〈0.05）, while the level of β-CTX and phosphorus increased in the early stage of the fracture with statistically significant differences（ P〈0.01, P〈0.01）. Conclusions 25（ OH） D, calcium and phosphorus levels are significantly lower in the elderly hip fracture group so that 25（ OH） D and calcium supplementation should be paid more attention in the treatment of the hip fracture. The level of bone metabolism biochemical markers changes significantly on the early stage of the fracture. Bone formation markers decease and bone resorption markers increase, so that anti-osteoporosis treatment should be taken immediately.
作者
刘军川
薛庆云
文良元
纪泉
石磊
王飞
孙凤坡
赵懋宇
LIU Jun-chuan, XUE Qing-yun, WEN Liang-yuan, JI Quan, SHI Lei, WANG Fei, SUN Feng-po, ZHAO Mao-yu.(Peking University fifih School of Clinical Medicine, Beijing, 100730, Chin)
出处
《中国骨与关节杂志》
CAS
2018年第3期163-167,共5页
Chinese Journal of Bone and Joint
