产后骨密度恢复影响因素分析

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。

Analysis on the Influencing Factors of the Bone Mineral Density Recovery After Delivery

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;Group B took orally calcium carbonate of 600 mg twice a day,milk of 250 ml once a day,with supervision by our subject member;Group C took orally calcium,milk without supervision or exercise guidance.Results ① The 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.