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目的:研究女性从青春前期到初潮腰椎、股骨颈的发育特征及主要影响因素。方法:201名身体健康的女性(10.9±0.7岁)自愿参加本项实验研究并进行体质测量,主要测量脂肪含量(FM)、瘦体重含量(LM)、以及股骨颈(Fn)和腰椎(Ls)骨密度(BMD)、骨量(BMC)和骨面积(BA)。同时检测血清雌二醇(E2)、类胰岛素样生长因子1(IGF-1)、睾酮(T)和维生素D(VD)等。追踪获得受试者初潮的时间,以此作为时间参考来拟合骨骼的最佳生长曲线。采用stepwise forward多元回归方法来确定腰椎、股骨颈的影响因素。结果:①初潮之前快速增长的股骨颈和腰椎各项指标在初潮之后却出现不同的变化趋势:股骨颈BMD、BMC提高了增长速度;而股骨颈和腰椎BA减慢了增长速度;腰椎BMD、BMC继续保持原有的增长速度。②E2是预测股骨颈BMD和腰椎BMD、BMC增长的重要因子,而VD是预测股骨颈和腰椎BMC、BA变化的重要因素。LM则是预测股骨颈和腰椎BMD、BMC和BA发育的重要因素。结论:女性初潮之前是腰椎、股骨颈的骨面积快速生长时期,而初潮之后则是矿物质积累增长的关键时期。血清维生素D、雌二醇水平与瘦体重含量是女性快速生长时期骨骼发育和矿物质沉积的重要调节因素。
Objective: To study the developmental characteristics and main influencing factors of lumbar spine and femoral neck in women from pre-adolescence to menarche. METHODS: Totally 201 healthy women (10.9 ± 0.7 years) volunteered to participate in this experimental study and performed physical measurements. The main measurements were fat (FM), lean body mass (LM), and femoral neck (Fn) and lumbar spine ) Bone mineral density (BMD), bone mass (BMC) and bone area (BA). Serum estradiol (E2), insulin-like growth factor 1 (IGF-1), testosterone (T) and vitamin D (VD) were also detected. The time to obtain the subjects’ menarche was tracked and used as a time reference to fit the best bone growth curve. The stepwise forward multiple regression method was used to determine the influencing factors of lumbar spine and femoral neck. Results: (1) The indexes of femoral neck and lumbar spine which developed rapidly before menarche showed different trend after menarche: the femoral neck BMD and BMC increased the growth rate; while the femoral neck and lumbar spine BA slowed down the growth rate; lumbar BMD, BMC continues to maintain its original growth rate. ② E2 is an important factor for predicting the growth of BMD and lumbar BMD and BMC in the femoral neck. VD is an important factor for predicting the changes of BMC and BA in femoral neck and lumbar spine. LM is an important factor in predicting the development of BMD, BMC and BA in femoral neck and lumbar spine. CONCLUSION: Before menarche, the bone area of the lumbar spine and femoral neck is rapidly growing, while the menarche is the key period for the mineral accumulation and growth. Serum vitamin D, estradiol levels and lean body mass are important regulators of skeletal development and mineral deposition in fast-growing women.