绝经后女性H型高血压合并骨质疏松症患者骨代谢标志物及炎性因子的变化研究

目的　探讨绝经后女性H型高血压合并骨质疏松症患者骨代谢标志物及炎性因子的变化。方法　选取2015年1月—2016年6月苏州大学附属第三医院老年科收治的绝经后女性且既往明确诊断为骨质疏松症的患者164例为研究对象。根据患病情况将患者分为3组，单纯骨质疏松症患者为A组57例、普通高血压合并骨质疏松症患者为B组54例、H型高血压合并骨质疏松症患者为C组53例。测量各组患者腰椎（L1~4）、左侧股骨颈、股骨大粗隆骨密度，检测患者Ⅰ型原胶原N端前肽（PINP）、Ⅰ型胶原C端交联肽（CTX）及炎性因子白介素6（IL-6）水平。结果　B组和C组患者L1~4、股骨颈、股骨大粗隆骨密度较A组降低，CTX、IL-6水平较A组升高（P<0.05）；C组患者L1、L2、L4、股骨颈、股骨大粗隆骨密度较B组降低，CTX、IL-6水平较B组升高（P<0.05）。结论　高血压可以增强绝经后女性破骨细胞的活性及炎性因子IL-6的表达，亦可部分增强成骨细胞的活性，但骨吸收显著大于骨形成，从而引起骨质疏松的加剧。H型高血压可以进一步增加绝经后女性破骨细胞的活性及炎性因子的表达，进而加重骨质疏松症，因此加强对H型高血压患者的血压控制显得尤为重要。

Effects of H-type Hypertension on Bone Metabolism Markers and Inflammatory Factors in Postmenopausal Women with Osteoporosis

Objective　To investigate the changes in bone metabolic markers and inflammatory factors in postmenopausal women with H-type hypertension complicated with osteoporosis.Methods　A total of 164 postmenopausal women diagnosed with osteoporosis and admitted to the Department of Geriatrics of the Third Affiliated Hospital of Soochow University between January 2015 and June 2016 were selected for this study.The patients were divided into three groups：the A group included 57 patients with only osteoporosis；the B group included 54 patients with osteoporosis complicated with ordinary hypertension；and the C group included 53 patients with osteoporosis complicated with H-type hypertension.The bone densities of the lumbar vertebrae （L1-4），left femoral neck，and femoral trochanter in the two groups were measured.The biomarkers N-terminal propeptide of type Ⅰ collagen （PINP），carboxy-terminal cross-linking telopeptide of type Ⅰ collagen （CTX），and inflammatory cytokine interleukin 6 （IL-6） were tested.Results　The bone densities of L1-4，neck，and femoral trochanter in the B and C groups were lower than those in the A group，and the levels of CTX and IL-6 were higher than those in the A group （P<0.05）.The bone densities of L1，L2，L4，neck，and femoral trochanter in the C group were lower，and the levels of CTX and IL-6 were higher，than those in the B group （P<0.05）.Conclusion　Hypertension increases the activity of osteoclasts and the expression of the inflammatory cytokine IL-6 in postmenopausal women.It also moderately increases the activity of osteoblasts；however，the bone resorption effect is significantly greater than the bone formation effect，thus increasing osteoporosis.H-type hypertension further increases the above effect in postmenopausal women，which in turn aggravates osteoporosis.Therefore，strengthening the control of blood pressure is particularly important in patients with H-type hypertension.