张迪晖 黄泽鑫 罗斌

[摘要] 目的 探讨体检女性血清铁蛋白（Fer）与骨密度（BMD）和骨代谢的关系。 方法 选择2017年2～10月于广东省中医院体检中心体检的女性志愿者104名，按照年龄分为高龄组（年龄≥50岁，n = 67）和低龄组（年龄<50岁，n = 37）；按照绝经情况分为绝经组（n = 58）和未绝经组（n = 46）；按照骨量分为骨量正常组（股骨颈和腰椎T值≥ -1 SD，n = 40）和骨量减低组（股骨颈和腰椎T值<-1 SD，n = 64）。比较不同年龄和不同骨量受试者血清Fer、BMD及骨代谢指标水平[碱性磷酸酶（ALP）、Ⅰ型原胶原氨基端延长肽（P1NP）和β-降解产物（β-CTX）]的变化，同时分析月经对于血清Fer、BMD及骨代谢指标水平的影响，另外分析体检女性血清Fer水平与BMD及骨代谢指标水平的相关性。 结果 高龄组女性血清中Fer、ALP、P1NP及β-CTX水平明显高于低龄组，而髋部、腰椎第1～4节（L1～4）和总股骨的BMD水平显著低于低龄组，且差异均有统计学意义（P < 0.05）；与骨量减低组相比，骨量正常组血清Fer、ALP、P1NP及β-CTX水平明显降低，而髋部、L1～4和总股骨的BMD水平显著升高，且差异均有统计学意义（P < 0.05）；绝经组血清中Fer、ALP、P1NP及β-CTX水平明显高于未绝经组，而髋部、L1～4和总股骨的BMD水平显著低于未绝经组；体检女性血清Fer与髋部、L1～4和总股骨的BMD水平呈负相关（r = -0.698、-0.714、-0.682，P < 0.05），而与血清中ALP、P1NP及β-CTX水平呈正相關（r = 0.732、0.725、0.619，P < 0.05）。 结论 女性血清Fer水平受到年龄、月经的影响，同时与BMD及骨代谢指标联系密切，可以作为预测骨量下降的重要指标。

[关键词] 女性；铁蛋白；骨密度；骨代谢

[中图分类号] R580 [文献标识码] A [文章编号] 1673-7210（2018）09（a）-0075-04

[Abstract] Objective To explore the relationship between serum ferritin （Fer） and bone density （BMD）， bone metabolism in physical examination. Methods A total of 104 cases of female volunteers from February 2017 to October 2017 in Physical Examination Center of Guangdong Province Traditional Chinese Medical Hospital were selected. According to the age， they were divided into elder group （age≥50， n = 67） and young group （age<50， n = 37）. According to the menopausal status， they were divided into the postmenopausal group （n = 58） and the non-menopausal group （n = 46）. According to the bone mass， they were divided into the normal bone mass group （femoral neck and lumbar T value≥-1 SD， n = 40） and the bone mass reduction group （femoral neck and lumbar T value<-1 SD， n = 64）. The levels of serum Fer， BMD and bone metabolism index [alkaline phosphatase （ALP）， type Ⅰ collagen amino terminal extension of the peptide （P1NP） and β-degradation products （β-CTX）] of the volunteers with different age and different bone mass were compared， meanwhile the effect of menstruation on serum Fer， BMD and bone metabolism indices was analyzed. In addition， the correlation between serum Fer and the levels of BMD and bone metabolism index was analyzed. Results The levels of Fer， ALP， P1NP and β-CTX of the elder group were obviously higher than the young group， while the BMD of hip and L1-4 and total femoral were significantly lower than the young group， and the differences were statistically significant （P < 0.05）. Compared with bone mass reduction group， the levels of Fer， ALP， P1NP and β-CTX of normal bone mass group significantly decreased， but the BMD of hip and L1-4 and total femoral significantly increased， and the differences were statistically significant （P < 0.05）. The levels of Fer， ALP， P1NP and β-CTX of menopausal group were significantly higher than those of the non-menopausal group， while the BMD levels of the hip， L1-4 and the total femur were significantly lower than those in the non-menopausal group. There was a negative correlation between serum Fer and BMD levels of hip， L1-4 and the total femur （r = -0.698， -0.714， -0.682， P < 0.05）， but a positive correlation with ALP， P1NP and β-CTX in serum （r = 0.732， 0.725， 0.619， P < 0.05）. Conclusion The female serum Fer level is affected by age and menstruation， which is closely related to BMD and bone metabolism index， and it can act as an important indicator for predicting the decline of bone mass.

[Key words] Women； Ferritin； Bone mineral density； Bone metabolism

骨质疏松是一种全身性代谢性骨骼疾病，指的是骨组织微结构被破坏，骨量下降，增加骨脆性，容易导致骨折[1]。随着人口老龄化速度的加快，骨质疏松的发病率逐年升高，多见于老年人和绝经后妇女，严重影响患者的生活质量，增加社会的经济负担[2]。骨量下降是正常人向骨质疏松过渡的阶段，患者表现为骨量丢失和骨密度（Bone mineral density，BMD）下降，如果不对此进行有效治疗，任由骨量丢失，则会改变骨结构[3]。早期骨量丢失阶段未伴随骨结构破坏，主要表现在腰椎和髋部，进行积极治疗，能够逆转骨骼病变，因此进行早期治疗具有重要的意义[4]。近年来，铁与骨量的联系受到临床医师的关注，铁作为一种过渡金属，通过催化活性氧而影响细胞功能，当体内铁含量过载，各脏器均会受到损伤，导致心肌病、老年痴呆及肝硬化等[5]。铁过载与骨质疏松的发生及发展具有密切联系，大量的铁抑制骨细胞增殖，不仅降低骨形成指标水平，而且增加骨吸收量[6]。血清铁蛋白（ferritin，Fer）是血清中储存铁的载体，血清中Fer结合一定量的铁，从而反映体内铁储存的情况，血清Fer能够与组织中的铁发生转化，影响骨形成和骨吸收[7]。……