低血清硫酸脱氢表雄酮水平对老年男性髋部骨质疏松性骨折风险的影响
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摘要
目的探讨低血清硫酸脱氢表雄酮(DHEAS)水平对老年男性髋部骨质疏松性骨折风险的影响。方法将120例老年男性髋部骨质疏松性骨折患者根据未来10年髋部骨质疏松性骨折概率判定标准分为高危组(n=72)和低危组(n=48)。检测患者临床及实验室指标,比较血清DHEAS水平与各指标的相关性,并应用多因素非条件logistic回归分析判断影响老年男性髋部骨质疏松性骨折的危险性因素。结果高危组在年龄、吸烟史人数、嗜酒史人数方面显著高于低危组(P<0.05),在BMI、DHEAS水平、雌二醇水平、性激素结合球蛋白水平、血清IGF-1水平、骨钙素水平、骨密度水平显著低于低危组(P<0.05)。DHEAS与年龄呈负相关(P<0.05);与BMI、雌二醇水平、性激素结合球蛋白水平、血清IGF-1水平、皮质醇水平、骨钙素水平、骨密度水平呈正相关(P<0.05)。年龄越大、DHEAS及雌二醇水平偏低、骨密度值偏低的老年男性会增加髋部骨质疏松性骨折风险(P<0.05)。结论低血清DHEAS水平能增加老年男性髋部骨质疏松性骨折风险,老年男性患者应提前进行DHEAS治疗,预防髋部骨质疏松性骨折发生。
Objective To investigate the effect of low serum dehydroepiandrosterone sulfate( DHEAS) on the risk of osteoporotic hip fracture in elderly men. Methods According to the probability of hip fracture in the next 10 years,120 elderly patients with osteoporotic hip fracture were divided into high risk group( n = 72) and low risk group( n =48). The clinical and laboratory indexes were detected,and the correlation between serum DHEAS level and each index was compared. Multivariate non conditional logistic regression analysis was used to determine the risk factors of osteoporotic hip fracture in elderly men. Results The high-risk group of age,smoking history cases number,drinking history cases number were significantly higher than those in the low risk group( P < 0. 05),BMI,DHEAS,estradiol,sex hormone binding globulin levels,the level of serum IGF-1,osteocalcin,bone density levels were significantly lower than those of low risk group( P < 0. 05). DHEAS was negatively correlated with age( P < 0. 05); and BMI,the level of estradiol,sex hormone binding globulin level,the level of serum IGF-1,cortisol,osteocalcin,bone density levels were correlated positively( P < 0. 05). Older age,lower levels of DHEAS and estradiol,lower bone mineral density could increase the risk of hip fracture in the elderly men( P < 0. 05). Conclusions Low serum DHEAS levels can increase the risk of osteoporotic fractures in elderly men,and older men should be treated with DHEAS in advance to prevent hip fractures.
Objective To investigate the effect of low serum dehydroepiandrosterone sulfate( DHEAS) on the risk of osteoporotic hip fracture in elderly men. Methods According to the probability of hip fracture in the next 10 years,120 elderly patients with osteoporotic hip fracture were divided into high risk group( n = 72) and low risk group( n =48). The clinical and laboratory indexes were detected,and the correlation between serum DHEAS level and each index was compared. Multivariate non conditional logistic regression analysis was used to determine the risk factors of osteoporotic hip fracture in elderly men. Results The high-risk group of age,smoking history cases number,drinking history cases number were significantly higher than those in the low risk group( P < 0. 05),BMI,DHEAS,estradiol,sex hormone binding globulin levels,the level of serum IGF-1,osteocalcin,bone density levels were significantly lower than those of low risk group( P < 0. 05). DHEAS was negatively correlated with age( P < 0. 05); and BMI,the level of estradiol,sex hormone binding globulin level,the level of serum IGF-1,cortisol,osteocalcin,bone density levels were correlated positively( P < 0. 05). Older age,lower levels of DHEAS and estradiol,lower bone mineral density could increase the risk of hip fracture in the elderly men( P < 0. 05). Conclusions Low serum DHEAS levels can increase the risk of osteoporotic fractures in elderly men,and older men should be treated with DHEAS in advance to prevent hip fractures.
引文
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[11]陆玉莲,钱铁镛,陈一丁,等.男性T2DM患者性激素水平与其骨代谢指标和骨密度的相关性研究[J].海南医学院学报,2016,22(20):2393-2396.
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[13]Herman W A,Seńko A,Korczowska I,et al.Could serum DHEA and DHEAS levels be good risk predictors of metabolic syndrome and osteoporosis in the population of ageing men?[J].Pol Merkur Lekarski,2009,27(159):197-201.
[14]王颖,庞小芬,巩云霞,等.血清雌二醇和游离睾酮与老年男性骨密度的相关性[J].中国骨质疏松杂志,2010,16(6):420-423.
[15]李毅中,庄华烽,郭良瑞,等.骨密度和25羟维生素D在骨质疏松性髋部骨折的作用[J].中国骨质疏松杂志,2015,21(12):1457-1459.
[2]Murray C R,Simmons J G,Allen N B,et al.Associations between dehydroepiandrosterone(DHEA)levels,pituitary volume,and social anxiety in children[J].Psychoneuroendocrinoiogy,2016,64(1):31-39.
[3]Maninger N,Wolkowitz O M,Reus V I,et al.Neurobiological and neuropsychiatric effects of dehydroepiandrosterone(DHEA)and DHEA sulfate(DHEAS)[J].Front Neuroendocrinol,2009,30(1):65-91.
[4]刘息平,吴晓兰,赵艳,等.硫酸脱氢表雄酮与骨质疏松的关系及在临床中的应用[J].检验医学与临床,2010,7(23):2581-2582.
[3]Chernykh E R,Leplina O Y,Tikhonova M A,et al.Elevated levels of dehydroepiandrosterone as a potential mechanism of dendritic cell impairment during pregnancy[J].BMC Immunol,2015,16(1):2-11.
[5]Kanis J A,Compston J,Cooper C,et al.Sign Guidelines for Scotland:BMD versus FRAX Versus QFracture[J].Calcified Tissue Int,2016,98(5):417-425.
[6]张智海,刘忠厚,李娜,等.中国人骨质疏松症诊断标准专家共识(第三稿·2014版)[J].中国骨质疏松杂志,2014,20(9):1007-1010.
[7]Harvey N C,Johansson H,Odén A,et al.FRAX predicts incident falls in elderly men:findings from Mr Os Sweden[J].Osteoporosis Int,2016,27(1):267-274.
[8]王田琪,刘幼硕,黄武,等.老年男性骨代谢相关性激素与年龄和骨密度的相关性[J].中华老年医学杂志,2007,26(5):341-344.
[9]Ohlsson C,Nethander M,Kindmark A,et al.Low serum DHEAS predicts increased fracture risk in older men:the Mros Sweden study[J].J Bone Miner Res,2017,1(1):356-365.
[10]郑洁,瞿茹怡,李圣贤,等.老年女性硫酸脱氢表雄酮水平及骨代谢指标与骨量的关系[J].中华内分泌代谢杂志,2014,30(8):650-653.
[11]陆玉莲,钱铁镛,陈一丁,等.男性T2DM患者性激素水平与其骨代谢指标和骨密度的相关性研究[J].海南医学院学报,2016,22(20):2393-2396.
[12]Seven A,Yuksel B,Kabil K S,et al.The evaluation of hormonal and psychological parameters that affect bone mineral density in postmenopausal women[J].Eur Rev Med Pharmacol Sci,2016,20(1):20-25.
[13]Herman W A,Seńko A,Korczowska I,et al.Could serum DHEA and DHEAS levels be good risk predictors of metabolic syndrome and osteoporosis in the population of ageing men?[J].Pol Merkur Lekarski,2009,27(159):197-201.
[14]王颖,庞小芬,巩云霞,等.血清雌二醇和游离睾酮与老年男性骨密度的相关性[J].中国骨质疏松杂志,2010,16(6):420-423.
[15]李毅中,庄华烽,郭良瑞,等.骨密度和25羟维生素D在骨质疏松性髋部骨折的作用[J].中国骨质疏松杂志,2015,21(12):1457-1459.