摘要目的 研究绝经后髋部脆性骨折患者血清铁过载指标与骨代谢指标间的相互关系,对两者的临床表现进行探讨.方法 回顾性研究2011年2月至2012年6月76例绝经后髋部脆性骨折患者资料,年龄55 ～ 93岁,平均(73±10)岁；绝经时间5～50年,平均(22±10)年.患者均检测血清铁蛋白、转铁蛋白、碱性磷酸酶(ALP)、Ⅰ型原胶原氨基端延长肽(P1NP)、Ⅰ型胶原C端肽B降解产物(β-CTX)和双能X线股骨颈腰椎骨密度指标.采用t检验、Pearson线性相关分析、多元逐步回归分析、偏相关分析,观察铁代谢指标与骨代谢相关指标的关系.结果 患者血清铁蛋白值升至(230±146) μg/L,转铁蛋白降至(1.89±0.33)g/L.血清P1 NP升至(61±32) ng/L,ALP、β-CTX均在正常范围内.股骨颈和腰椎骨密度T值分别为-2.0±1.1和-2.1±1.2(正常范围-1.0～1.0).将患者按照其血清铁蛋白情况分为铁蛋白正常组(血清铁蛋白≤150 μg/L,25例)和铁蛋白升高组(血清铁蛋白＞ 150μg/L,51例).铁蛋白升高组较铁蛋白正常组的股骨颈和腰椎骨密度降低(t=3.13、2.89,P＜0.01),P1 NP和β-CTX升高(t=-2.38、-3.59,P＜0.05).校正混杂因素后,铁蛋白值与股骨颈和腰椎骨密度T值呈负相关(r=-0.335、-0.295,P＜0.05),与P1NP和β-CTX值呈正相关(r=0.467、0.414,P＜0.05),与ALP无显著相关性(r=0.188,P＞0.05)；转铁蛋白值与股骨颈和腰椎骨密度T值呈正相关(r =0.444、0.262,P＜0.05),与ALP、P1NP、β-CTX值呈负相关(r=-0.326、-0.285、-0.278,P＜0.05).结论 绝经后髋部脆性骨折患者存在铁过载现象,铁过载与骨转换活跃导致骨量丢失相关,体内铁过载可能是一个独立影响绝经后骨代谢异常的因素.

abstractsObjective To study relationships between serum ferritin and bone metabolism in patients with hip fragility fractures.Methods This cross-sectional study included 76 postmenopausal women with hip fracture from Feburary 2011 to June 2012.The mean age of the women was (73 ± 10) years (range,55-93 years) and the mean duration of menstruation was (22 ± 10)years (range,5-50 years).Serum concentrations of ferritin,transferrin,alkaline phosphatase (ALP),amino-terminal extension peptide of type Ⅰ collagen (P1NP),C-terminal telopeptides of type Ⅰ collagen (β-CTX)and femoral and lumbar bone mineral density by dual-energy X-ray absorptiometry were measured.Bone metabolism was compared between normal and elevated ferritin groups with t-test,Pearson linear,partial correlation and multiple regression analysis examined associations between iron-and bone-related markers.Results Serum ferritin concentration raised to (230 ± 146) μg/L,transferrin concentration reduced to (1.89 ±0.33)g/L,P1NP concentration raised to (61 ± 32) ng/L when the concentration of serum ALP and β-CTX were in the normal range.T-scores for bone mineral density in the femoral neck (-2.0 ± 1.1) and lumbar (-2.1 ± 1.2)were below the normal ranges (-1.0-1.0).The subjects were divided into two groups according to serum ferritin concentration,normal group(serum ferritin concentration≤ 150 μg/L,n =25) and elevated group (serum ferritin concentration ＞ 150 μg/L,n =51).Patients of elevated group had lower bone mineral density in femoral neck and lumbar than normal group (t =3.13,2.89,P ＜ 0.01),and higher P1NP,β-CTX concentration(t =-2.38,-3.59,P ＜ 0.05).In partial correlation analysis adjusted for confounders,serum ferritin concentration was correlated negatively with bone mineral density in both femoral neck and lumbar (r =-0.335,-0.295,P ＜ 0.05),and positively with P1NP and β-CTX (r=0.467,0.414,P ＜ 0.05),but not correlated with ALP (r =0.188,P ＞ 0.05).Transferrin concentration tended to be correlated positively with bone mineral density in both femoral neck and lumbar (r =0.444,0.262,P ＜0.05) and negatively with ALP,P1NP and β-CTX(r =-0.326,-0.285,-0.278,P ＜0.05).Conclusions Iron overload has a high prevalence in postmenopausal women with fragility fracture.Increased iron stores,which might lead to bone loss and lower bone mineral density by enhancing the activity of bone turnover,could be an independent factor to take effects on bone metabolism on postmenopausal women.