本文選題：文山州壯族　切入點(diǎn)：骨質(zhì)疏松癥　出處：《昆明醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的：1.采用雙能X線吸收測定法對(duì)云南省文山地區(qū)壯族中老年人群進(jìn)行骨密度測定,結(jié)合其生活方式,探討文山地區(qū)壯族中老年人群骨質(zhì)疏松癥的發(fā)病率。2.結(jié)合云南省文山地區(qū)壯族中老年人群個(gè)人基本體征、生活環(huán)境和日常生活習(xí)慣,探討文山地區(qū)壯族中老年人群骨質(zhì)疏松癥發(fā)病的相關(guān)危險(xiǎn)因素,為云南省文山地區(qū)壯族中老年人群骨質(zhì)疏松癥的預(yù)防和診斷提供參考依據(jù)。3.測定云南省文山地區(qū)壯族中老年人群骨質(zhì)疏松癥血清骨代謝標(biāo)志物,了解其變化規(guī)律,預(yù)測骨質(zhì)疏松性骨折的發(fā)生情況。方法：采用現(xiàn)代流行病學(xué)分層隨機(jī)抽樣法,抽取文山州廣南縣壩美鎮(zhèn)經(jīng)濟(jì)條件好、中、差的村委會(huì)各一個(gè),隨機(jī)抽取年齡≥40歲的壯族人群124例,以10歲為一個(gè)年齡組進(jìn)行分組,對(duì)受試者進(jìn)行骨密度測定、基本體征測量、骨質(zhì)疏松相關(guān)影響因素問卷調(diào)查,并選取其中一部分受試者72例進(jìn)行血清VDR、BGP、NTX、CTX的測定。所得數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果：1.文山州壯族中老年人骨質(zhì)疏松總患病率為8.1%,其中男性患病率為6.0%,女性患病率為9.5%,女性高于男性,但差異無統(tǒng)計(jì)學(xué)意義。男、女性骨質(zhì)疏松患病率總體隨著年齡的增長呈上升趨勢(shì),男性、女性不同年齡組患病率比較無統(tǒng)計(jì)學(xué)意義,各年齡組男性與女性骨質(zhì)疏松患病率比較均無統(tǒng)計(jì)學(xué)意義。2.文山州壯族男、女性骨密度T值總體隨著年齡的增長呈下降趨勢(shì),男性60-69和70-79歲年齡組和其他年齡組比較差異均有統(tǒng)計(jì)學(xué)差異(P0.05),女性40-49歲年齡組和其他年齡組比較差異有統(tǒng)計(jì)學(xué)差異(P0.05)。各年齡組女性骨密度T值均比男性低,60-69和70-79歲年齡組女性骨密度T值和男性比較差異具有統(tǒng)計(jì)學(xué)意義。3.文山州壯族中老年人群年齡和男、女性骨密度T值有負(fù)相關(guān)關(guān)系(r=-0.551,P0.01;r=-0.607,P0.01),高血壓和男、女性骨密度T值有負(fù)相關(guān)關(guān)系(r:-O.387,P0.01:r:-0.234,P0.05),文化程度和男、女性骨密度T值有正相關(guān)關(guān)系(r:0.411,P0.01:r=0.327,P0.01),腰圍和男、女性骨密度T值有正相關(guān)關(guān)系(r=0.294,P0.05:r=0.253,P0.05),臀圍和男、女性骨密度T值有正相關(guān)關(guān)系(r=0.383,P0.01),飲食豆制品、飲酒和男性骨密度T值有正相關(guān)關(guān)系(r:0.438,P0.01；r:0.324,P0.05),喝茶和男性骨密度T值有負(fù)相關(guān)關(guān)系(r=0.363,P0.01),體重、體重指數(shù)、0STA指數(shù)和女性骨密度T值有正相關(guān)關(guān)系(r:0.656,P0.01:r=0.609,P0.01；r--0.611,P0.01),素食、服用激素、孕次、產(chǎn)次和女性骨密度T值有負(fù)相關(guān)關(guān)系(r=-0.270,P0.05；r=-0.378,P0.01；r=-0.365,P0.01；r=-0.393,P 0.01).男女性骨質(zhì)疏松患者平均0STA指數(shù)為-2.279±3.9704。4.文山州壯族中老年人VDR水平總體隨年齡的增長呈上升趨勢(shì),總體波動(dòng)在35.05±20.74-48.74±22.69pg/ml之間。男性BGP水平最高出現(xiàn)在50～59歲年齡段,為1.86±1.52ng/ml,女性BGP水平最高在40～49歲年齡段,為1.34±1.08ng/ml,其后緩慢下降。NTX.CTX水平均隨年齡增長呈緩慢上升趨勢(shì),NTX總體波動(dòng)在0.43±O.26～0.67±0.23nmBCE／L,CTX總體波動(dòng)在0.24±0.89～ 0.35±0.13ug/L.VDR、BGP、NTX、CTX與年齡、骨質(zhì)疏松相關(guān)性均無統(tǒng)計(jì)學(xué)意義。結(jié)論：1.文山州壯族中老年人骨質(zhì)疏松患病率總體低于同類報(bào)道水平,女性患病率高于男性。2.文山州壯族中老年人骨密度T值總體隨年齡的增長呈下降趨勢(shì),骨質(zhì)疏松患病率總體隨年齡的增長呈上升趨勢(shì)。男性60歲以后骨密度T值明顯下降,而女性則為50歲以后,原因主要與女性絕經(jīng)后雌激素下降密切相關(guān)。3.高年齡、高血壓、骨質(zhì)疏松知識(shí)匱乏是文山州壯族中老年人骨質(zhì)疏松的共同危險(xiǎn)因素,男性骨質(zhì)疏松的危險(xiǎn)因素還有喝茶,女性骨質(zhì)疏松的危險(xiǎn)因素還有素食、服用激素、多孕次、多產(chǎn)次；適當(dāng)?shù)难鼑⑼螄俏纳街輭炎逯欣夏耆斯琴|(zhì)疏松的共同保護(hù)因素,男性骨質(zhì)疏松的保護(hù)因素還有食用豆制品、適當(dāng)飲酒,女性骨質(zhì)疏松的保護(hù)因素還有適當(dāng)?shù)捏w重、體重指數(shù)。4.文山州壯族中老年人OSTA指數(shù)低于-2.3時(shí),應(yīng)高度警惕骨質(zhì)疏松。5.文山州壯族中老年人VDR水平總體隨年齡的增長呈上升趨勢(shì),男性60歲以前骨形成持續(xù)加強(qiáng),其后緩慢下降,女性50歲以前骨形成持續(xù)加強(qiáng),其后緩慢下降,40歲以后,男女性骨吸收持續(xù)加強(qiáng),但總體處于低骨轉(zhuǎn)換狀態(tài)。其骨代謝標(biāo)志物水平可反映骨密度T值的基本情況。6.搞好文山州壯族群眾骨質(zhì)疏松防治工作,應(yīng)加強(qiáng)相關(guān)知識(shí)的基層宣傳工作,根據(jù)相關(guān)的骨質(zhì)疏松危險(xiǎn)和保護(hù)因素采取綜合干預(yù)措施,控制可控危險(xiǎn)因素,加強(qiáng)保護(hù)因素,動(dòng)態(tài)監(jiān)測骨轉(zhuǎn)換標(biāo)志,給予相應(yīng)抗骨質(zhì)疏松治療,降低和延緩當(dāng)?shù)刂欣夏陦炎迦罕姽琴|(zhì)疏松和骨質(zhì)疏松性骨折的發(fā)生。
[Abstract]:Objective: 1. using dual energy X-ray absorptiometry bone mineral density in the elderly population of Zhuang Nationality in Wenshan city in Yunnan Province, with its way of life, to explore the osteoporosis of aged people in Wenshan Zhuang in the incidence rate of.2. combined with the Zhuang Nationality in Wenshan area of Yunnan province in the elderly people the basic signs, living environment and daily life habits. To explore the risk area of Wenshan Zhuang in the elderly osteoporosis factors, to provide reference for the determination of.3. in Yunnan Province, the mountain area Zhuang osteoporosis in middle-aged and elderly people in serum bone metabolic markers for the diagnosis and prevention of elderly population of Zhuang Nationality in Wenshan area of Yunnan Province in osteoporosis, understand the change rule, to predict the occurrence of osteoporosis fracture. Methods: using modern epidemiology stratified random sampling method from Wenshan Guangnan County town of the United States and good economic conditions, poor. The village of each one, randomly selected from 40 years of age or older in Zhuang population in 124 cases, with 10 years as one age group were divided into two groups of subjects to determine the bone density, physical measurement, survey influence osteoporosis factor questionnaire, and selected a part of 72 subjects in serum VDR BGP, NTX, CTX were measured. The data were statistically analyzed. Results: 1. Wenshan Zhuang in the elderly osteoporosis total prevalence rate was 8.1%, the prevalence rate of male was 6%, female prevalence rate was 9.5%, female is higher than male, but the difference was not statistically significant. The male female, the prevalence rate of osteoporosis with overall age increased, men and women of different age groups prevalence rate had no significant difference between male and female in each age group, the prevalence rate of osteoporosis was no significant difference of.2. in Wenshan Zhuang nationality male, female bone mineral density T value with the whole year Age decreased, there were statistically significant differences between men 60-69 and 70-79 age group and other age groups (P0.05), there were significant differences between the female 40-49 year old age group and other age groups (P0.05). Each age group of women bone density T values were lower than men, 60-69 and 70-79 year old age group the BMD of female T and male were statistically significant in elderly age and male.3. of Wenshan Zhuang, BMD T value had negative correlation (r=-0.551, P0.01; r=-0.607, P0.01), hypertension and male, female bone mineral density T value had negative correlation (r:-O.387, P0.01:r:-0.234, P0.05), culture the degree of male and female bone density, T value had positive correlation (r:0.411, P0.01:r=0.327, P0.01), waist circumference and male, female bone mineral density T value had positive correlation (r=0.294, P0.05:r=0.253, P0.05), hip circumference and male, female bone mineral density T value had positive correlation (r= 0.383, P0.01), soy products, alcohol and bone mineral density in male T value had positive correlation (r:0.438, P0.01; r:0.324, P0.05), tea and bone mineral density in male T value has negative correlation (r=0.363, P0.01), body weight, body mass index, 0STA index and BMD T value had positive correlation (r:0.656, P0.01:r=0.609, P0.01; r--0.611, P0.01), vegetarian, steroid, gravidity, parity and BMD T value had negative correlation (r=-0.270, P0.05; r=-0.378, P0.01; r=-0.365, P0.01; r=-0.393, P 0.01). Male and female osteoporosis patients with the average 0STA index for the overall level of VDR in elderly patients -2.279 + 3.9704.4. in Wenshan Zhuang increased with age, the overall volatility between 35.05 + 20.74-48.74 + 22.69pg/ml. The highest BGP level in men 50~59 years of age, 1.86 + 1.52ng/ml, BGP level was highest in women 40~49 years of age, 1.34 + 1.08ng/m L, then a slow decline in the level of.NTX.CTX were increased with age increased slowly, the overall volatility in NTX 0.43 + O.26 ~ 0.67 + 0.23nmBCE / L, CTX overall fluctuations in 0.24 + 0.89 ~ 0.35 + 0.13ug/L.VDR, BGP, NTX, CTX and age, patients with osteoporosis were not statistically significant. Conclusion: 1. Wenshan Zhuang the elderly osteoporosis prevalence is lower than the overall level of similar reports, the prevalence of female is higher than that of T bone density in the elderly male.2. Wenshan Zhuang value decreased with the increase of age, the prevalence rate of osteoporosis increased with age increased. 60 men after the age of bone mineral density T value decreased, and the female is 50 years old, and the main cause of postmenopausal women estrogen is closely related to the decrease of.3. high age, hypertension, osteoporosis, lack of knowledge is a common risk state of Wenshan Zhuang osteoporosis of the elderly male factors, bone The risk factors of osteoporosis and osteoporotic women drink tea, the risk factors are vegetarian, taking hormones, number of pregnancies, productive times; appropriate waist circumference, hip circumference is to protect the state of Wenshan Zhuang osteoporosis of the elderly, the protective factors for male osteoporosis and eating soy products, moderate alcohol consumption, women with protective factors loose and proper weight, body mass index.4. of Wenshan Zhuang in the elderly OSTA index is less than -2.3, the overall level of VDR should be highly vigilant elderly osteoporosis.5. Wenshan Zhuang with age increased, male 60 years old bone formation continued to strengthen, then declined slowly, female 50 years old bone the formation of continuous strengthening, then declined slowly, after the age of 40, and continue to strengthen the absorption of bone, but overall in low bone turnover. The bone metabolism markers can reflect the bone mineral density T value of medium The.6. in Wenshan Zhuang people osteoporosis prevention and control work, should strengthen the grassroots advocacy work related knowledge, according to the osteoporosis risk and protective factors related to take comprehensive measures, the controllable risk factors, strengthen the protection factors, dynamic monitoring of bone turnover markers, give the corresponding anti osteoporosis treatment, reduce and delay the local elderly the Zhuang people of osteoporosis and osteoporotic fractures.

【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R580

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