低骨量与老年钙化性心脏瓣膜病的相关研究

摘要

目的：评价老年人心脏瓣膜钙化和骨量情况，探讨低骨量与老年钙化性心脏瓣膜病（ senile calcified valvulardisease， SCVD）的关系。方法连续收集2011年1月至2013年5月期间在新疆医科大学第一附属医院干部病房住院的患者，年龄≥60岁，符合纳入标准，共353例，其中男性215例，平均年龄（72．09±7．73）岁，女性138例，平均年龄（69．54±6．59）岁。应用超声心动图观察其心脏瓣膜情况，根据老年钙化性心脏瓣膜病诊断标准，将其分为SCVD组（男性57例，女性47例），非SCVD组（男性158例；女性91例）；同时所有研究对象均行双能X线骨密度测定，评估腰椎、全髋关节、股骨颈骨量情况。结果（1） SCVD组和非SCVD组低骨量总人数比较，差异有统计学意义（χ2＝4．315，P＜0．05）。但无论在男性还是女性，两组间比较，差异无统计学意义（ P＞0．05）。（2） SCVD组低骨量患者全髋关节骨密度较非SCVD组降低，差异有统计学意义（ t值：2．455，P＜0．05），两组间股骨颈T值比较，差异有统计学意义（t值：2．051， P＜0．05），两组间全髋关节T值比较，差异有统计学意义（t值：3．066，P＜0．05），两组间最低T值比较，差异有统计学意义（t值：3．218，P＜0．05）。（3）未发现男性SCVD组和非SCVD组腰椎、全髋关节、股骨颈骨密度及T值比较，差异有统计学意义（P＞0．05），但两组间最低T值比较，差异有统计学意义（t值：2．354，P＜0．05）。（4）女性SCVD组和非SCVD组全髋关节T值比较，差异有统计学意义（t值：2．452，P＜0．05），两组间最低T值比较，差异有统计学意义（t值：2．352，P＜0．05）。（5）经logistic回归分析后，无论男性还是女性，SCVD组与非SCVD组年龄比较均存在显著差异，有统计学意义（男性OR：1．061，95％CI：1．019～1．105，P＜0．05，女性OR：1．077，95％CI：1．017～1．139，P＜0．05），年龄与老年钙化性心脏瓣膜病发生风险独立相关，未发现性别、体重指数、高血压、高脂血症、糖尿病、冠心病、低骨量与老年钙化性心脏瓣膜病发生风险相关。（6）经logistic回归分析后，女性最低T值在SCVD组与非SCVD组存在差异，有统计学意义（OR：0．645，95％CI：0．441～0．945，P＜0．05）。结论（1）年龄是SCVD发生的独立危险因素之一。（2）女性SCVD患者需行骨密度测定，尤其是全髋关节部位，来评估骨量情况。（3）女性最低T值与SCVD发病相关，推测女性低骨量可能是使老年钙化性心脏瓣膜病发生风险增加的独立因素。女性低骨量患者需进一步评估瓣膜情况及相关心血管疾病。%Objective To evaluate the bone mass and the calcification of the heart valves in the elderly, and to investigate the relationship between low bone mass and senile calcified valvular disease ( SCVD) .Methods A total of 353 patients, who were hospitalized in the cadre ward in our hospital from January 2011 to May 2013, with age over 60 years old, were enrolled in this study.All these patients fit to the inclusion criteria.Among 353 patients, 215 were males, with an average age of 72.09 ±7.73 years old, and 138 were females, with an average age of 69.54 ±6.59 years old.The heart valves were observed and assessed using transthoracic echocardiography.According to senile calcified valvular disease diagnostic criteria, all subjects were divided into SCVD group (57 men and 47women) and non-SCVD group (158 men and 91women).The bone mineral density (BMD) was detected using dual-energy X-ray absorptiometry, in order to evaluate the bone mass of the lumbar vertebrae, the total hip joint, and the femoral neck.Results 1)The difference of constituent ratios of people with low bone mass in SCVD group and non SCVD group was statistically significant (P<0.05).But no difference between men and women was observed (P>0.05).2)BMD of the total hip joint in patients with low bone mass in SCVD group was significantly lower than that in non SCVD group (P<0.05). The T scores of the femoral neck and the total hip joint between the 2 groups showed significant difference ( P<0.05 ) .And the lowest T score between two groups also showed significant difference ( P <0.05 ) .3 ) No significant difference of BMD of the lumbar vertebrae, the total hip joint, and the femoral neck and T score of men between the 2 groups was observed (P>0.05).But the lowest T score of men between the 2 groups showed significant difference (P<0.05).4)The T score of the total hip joint of women was significant different between the 2 groups (P<0.05), while other values showed no statistical difference.5)Logistic regression analysis showed that age was independently associated with the increased risk of SCVD both in men and women ( men:OR:1.061, 95%CI:1.019-1.105, P<0.05;women:OR:1.077, 95%CI:1.017-1.139, P<0.05, respectively).And no other factors correlated with the risk of SCVD were found.6 ) After logistic regression analysis, the lowest T score of women in SCVD group was significantly different with that in non SCVD group ( OR: 0.645, 95%CI: 0.441 -0.945, P <0.05 ) Conclusion Age is one of the independent risk factors for SCVD.Women with SCVD should receive the detection of BMD, especially in the total hip joint, in order to evaluate the bone mass.The lowest T score may be independently related with increased risk of SCVD in women, indicating women with low bone mass may be an independent factor for increased risk of SCVD.Female patients with low bone mass need further evaluation of heart valves and related cardiovascular disease risks.