产后骨密度恢复影响因素分析

摘要

Objective To investigate the influencing factors of the bone mineral density( BMD ) recovery after delivery. Methods One hundred and forty-four health parturient women who had full-term delivery of single fetus were enrolled in the study. The markers of bone metabolism( alkaline phosphatase( ALP ), urine calcium/creatinine ( Ca/Cr ) and one femoral neck bone mineral density were measured respectively 3 days and 12 months after delivery, and the time of lactation was recorded. All mothers were randomly divided into three groups( group A, B, C ), each group of 48 cases. Group A took orally calcium carbonate of 600 mg twice a day, milk of 250 ml once a day, and received exercise guidance; Croup B took orally calcium carbonate of 600 mg twice a day, milk of 250 ml once a day, with supervision by our subject member;Croup C took orally calcium,milk without supervision or exercise guidance. Results ①The rate of osteopenia at 3 days after delivery was 76.9%( 100/130 ),which showed no significant difference among 3 groups( P >0.05 ). ② There was significant difference in the BMD of the left side femoral neck 12 months after delivery among 3 groups( P < 0.05 ), group A got the most; ALP and urine Ca/Cr showed significant difference among 3 groups( P <0.05 ),but group A was the least. ③ Taking calcium and exercise,breast-feeding time and the early-stage BMD after delivery had notable correlation with the recovery of the BMD 12 months after delivery( P < 0. 05 ). Conclusion Pregnancy could cause the bone mass loss, the recovery after delivery is closely related with the state of the BMD during pregnancy and the breast-feeding time. However,the appropriate exercise combined with high-calcium diet during the lactation period can promote the recovery of bone mass.%目的 探讨产后骨密度恢复的影响因素.方法 单胎足月分娩的健康产妇144例,分别于产后3 d内、产后12个月测量骨代谢指标[血碱性磷酸酶(ALP)、尿钙/尿肌酐(Ca/Cr)]和一侧股骨颈骨密度,记录产妇的哺乳时间.将产妇随机分为3组,每组48例.A组产妇口服碳酸钙600 mg,牛奶250 ml,2次/d,指导运动;B组产妇口服碳酸钙600 mg,牛奶250 ml,2次/d,专人负责督导;C组无专人督导其服钙片、牛奶且无运动指导.结果 (1)产后3 d内骨量减少发生率为76.9%(100/130),3组间比较差异无统计学意义(P＞0.05);(2)产后12个月3组左侧股骨颈骨密度差异有统计学意义(P＜0.05),A组最高;3组的血ALP、尿Ca/Cr比较差异有统计学意义(P＜0.05),A组最低;(3)产后是否补钙及运动、哺乳时间长短及产后早期骨密度值与产后12个月骨密度恢复有显著相关(P＜0.05).结论 孕期容易发生骨量减少,产后骨密度恢复与孕期骨密度状况及哺乳时间长短密切相关.哺乳期适当的运动辅以高钙饮食可促进骨量恢复.