妊娠哺乳相关骨质疏松症发病率及相关影响因素的调查研究

Investigation on the Incidence of Osteoporosis Associated with Pregnancy and Lactation and Its Related Influencing Factors

摘要: 目的：横断面调查妊娠哺乳相关骨质疏松症(pregnancy and lactation-associated osteoporosis, PLO)发病率及相关影响因素，为产妇骨骼健康提供指导。方法：对656例新疆克拉玛依市中心医院自愿参加X线吸收检测法(dual energy X-ray absorptiometry, DXA)骨密度测量的产妇于产后6个月进行腰椎、髋部的骨密度测量，采用自行设计的调查问卷进行PLO生活方式的调查，同时对骨量异常患者进行骨转换指标、生化指标检测。结果：产后6月骨质疏松症(T值 ≤ −2.5)患病率：8/656 = 1.21%、骨量减少(−2.5 < T值 < −1.0)患病率：72/656 = 10.97%，PLO (Z值 < −2.0) 11/656 = 1.67%。按T值标准，PLO组：1) 基础病因素：骨量减少患者：24例，骨质疏松8例；2) 二胎：骨质疏松6例，骨量减少8例；3) 所有骨量异常患者均钙、维生素D摄入不足且均运动小于30分钟/天；4) 日照时间小于30分钟/天者：骨质疏松4例，骨量减少30例；5) 长期喝茶9例均为骨量减少患者；6) 产后6个月月经未复潮者：骨质疏松8例，骨量减少30例；7) 骨转换指标：血清PINP、β-CTX、甲状旁腺激素、碱性磷酸酶除甲状腺功能亢进患者外均在正常范围；25-羟VitD平均13.2 ng/ml；8) 疼痛评分(VAS) 1.24 ± 0.95分，疼痛、抽搐(月) 3.2月；9) 母乳喂养率100%且≥6个月。正常骨量组：1) 基础病因素：2例(慢性胃炎2例)；2) 二胎2人；3) 钙、维生素D摄入不足56例，运动小于30分钟/天64例；4) 日照时间小于30分钟/天者14例；5) 不良健康习惯者0例；6) 6个月月经未复潮者0例；7) 骨转换指标：未测；25-羟VitD未测；8) 疼痛评分(VAS) 0.24 ± 0.36分，无抽搐；9) 母乳喂养率30.1%，平均时间3.12月。结论：PLO发病率较低且伴随骨痛；PLO危险因素为基础疾病、不良饮食习惯、哺乳时间6个月、钙和维生素D摄入不足、日照时间不足及运动不足，混合危险因素可能存在叠加促进作用；以上结论需要大样本继续验证。

Abstract: Objective: To investigate the incidence of pregnancy and lactation-associated osteoporosis (PLO) and its related factors in a cross-sectional manner, and to provide guidance for bone health of parturients. Methods: The BMD of lumbar spine and hip of 656 parturients who volunteered to take part in Dual Energy X-Ray Absorptiometry (DXA) measurement in Karamay Central Hospital of Xinjiang at 6 months postpartum were measured. A self-designed questionnaire was used to investigate PLO lifestyle. Meanwhile, bone conversion indexes and biochemical indexes were detected in patients with abnormal bone mass. Results: The prevalence of osteoporosis (T value ≤ −2.5) at 6 months postpartum was 8/656 = 1.21%, the prevalence of osteopenia (−2.5 < T-value < −1.0) was 72/656 = 10.97% (T value), PLO (Z value) 11/656 = 1.67%. According to the T-value standard, PLO group: 1) Basic disease factors: osteopenia: 24 cases, 8 cases of osteoporosis; 2) Second birth: osteoporosis in 6 cases, bone loss in 8 cases; 3) All patients with abnormal bone mass had insufficient calcium and vitamin D intake and exercised less than 30 minutes per day; 4) Patients with sunshine time less than 30 minutes per day had osteoporosis in 4 cases and bone loss in 30 cases; 5) Drinking tea for a long time in 9 patients with osteopenia; 6) 6 months of menstruation did not return to the tide: osteoporosis in 8 cases, bone loss in 30 cases; 7) Bone turnover indexes: serum PINP, β-CTX, parathyroid hormone and alkaline phosphatase were all in the normal range except for patients with hyperthyroidism; the average 25-hydroxy VitD was 13.2 ng/mL; 8) Pain score (VAS) 1.24 ± 0.95, pain and convulsions (months) 3.2 months; 9) Breastfeeding rate 100%, ≥6 months. Normal bone mass group: 1) basic disease factors: 2 cases (chronic gastritis 2 cases); 2) there were 2 children in the second child; 3) there were 56 patients with insufficient calcium and vitamin D intake and 64 patients with exercise less than 30 minutes per day; 4) the sunshine time was less than 30 minutes per day in 14 cases; 5) 0 cases with bad health habits; 6) 6 months without menstrual regurgitation in 0 cases; 7) bone turnover index: unmeasured; 25-hydroxy VitD was not measured; 8) pain score (VAS) 0.24 ± 0.36, no convulsions; 9) the rate of breastfeeding was 30.1%, with an average duration of 3.12 months. Conclusion: The incidence of PLO is low and accompanied by bone pain. PLO risk factors are based on diseases, poor dietary habits, breastfeeding time of 6 months, insufficient calcium and vitamin D intake, insufficient sunshine time and insufficient exercise, and mixed risk factors may have a superimposed promoting effect. The above conclusions need to be further verified with large samples.