中国骨质疏松杂志

成人无功能性垂体腺瘤患者术后垂体功能减退对骨密度和身体成分的影响

The effect of postoperative hypopituitarism on bone mineral density and body composition in adult patients with nonfunctional pituitary adenoma

DOI：10.3969/j.issn.1006-7108.2022.01.005

中文关键词: 无功能性垂体腺瘤垂体功能减退骨密度脂肪含量骨骼肌质量

英文关键词:non-functional pituitary adenoma hypopituitarism bone mineral density fat content skeletal muscle mass

基金项目:国家自然科学基金（81770877）

作者	单位
黄蓓1 刘隆福1 冯松山2 赵子进2 陈慧玲1 李臻琰2 蒋铁建1*	1.中南大学湘雅医院内分泌科，湖南长沙 410008 2.中南大学湘雅医院神经外科，湖南长沙 410008

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中文摘要:

目的横断面调查成人无功能性垂体腺瘤（non-functional pituitary adenoma，NFPA）术后垂体功能减退患者骨密度（bone mineral density，BMD）及身体成分的改变，进一步分析BMD与身体成分的关系。方法收集2018年11月至2020年1月就诊于中南大学湘雅医院的成人NFPA术后垂体功能减退患者43例，并收集年龄、性别比、体质量指数（body mass index，BMI）匹配的健康对照组56例，测量所有研究对象BMI、腰围、腰臀比，采用双能X线骨密度仪（DEXA）评估腰椎及髋关节的BMD并分析骨骼肌质量及体脂含量。结果（1）垂体功能减退组腰椎L1～4、股骨颈的BMD及Z值，全身总和骨矿含量在垂体功能减退组均显著低于对照组（P＜0.05）。（2）在男性，垂体功能减退患者的腰臀比、腰围身高比、躯干及全身脂肪百分比、脂肪指数显著高于对照组；在女性，垂体功能减退患者的腰围、腰臀比、躯干及全身脂肪百分比、A/G比率、躯干脂肪比/腿部脂肪比均显著高于对照组（P＜0.05）。（3）Pearson相关性分析显示，四肢骨骼肌质量（ASM）、骨骼肌质量指数（SMI）与男性患者各部位的BMD呈显著正相关，躯干及全身脂肪百分比与女性患者髋部BMD呈显著负相关（P＜0.05）。多元线性回归分析示，SMI是男性患者腰椎L1～4 BMD、股骨颈BMD、全髋关节BMD、全身骨矿含量的独立保护因素（P＜0.05）。结论（1）成人无功能性垂体腺瘤术后发生垂体功能减退的患者出现骨密度减低及腹部脂肪沉积的风险增加。（2）骨骼肌质量及体脂对骨密度有重要影响，SMI是男性垂体功能减退患者腰椎与髋部骨密度、全身骨矿含量的独立保护因素。

英文摘要:

Objective A cross-sectional survey was performed to assess the changes in bone mineral density (BMD) and body composition in non-functional pituitary adenoma (NFPA) patients with postoperative hypopituitarism, and to further analyze the interrelationship between BMD and body composition. Methods A total of 43 patients with postoperative hypopituitarism of NFPA who were treated in Xiangya Hospital from November 2018 to January 2020 and 56 age-gender-BMI-matched patients in control group were enrolled in this study. BMI, waist circumference, and waist-to-hip ratio were measured in all subjects. BMD of the lumbar vertebra and hip, skeletal muscle mass, and body fat mass were measured using dual-energy X-ray absorptiometry (DEXA). Results (1) The BMD and Z values at the lumbar vertebra L1-4, femoral neck, and the total bone mineral content in the hypopituitarism group were significantly lower than those in the control group (P<0.05). (2) In males, the waist-to-hip ratio, waist-to-height ratio, trunk fat percentage, total fat percentage, and fat index in the hypopituitarism group was significantly higher than those in the control group. In females, the waist circumference, waist-to-hip ratio, trunk fat percentage, total fat percentage, A/G ratio, and % trunk fat / % leg fat in the hypopituitarism group were significantly higher than those in the control group (P<0.05). (3) Pearson correlation analysis showed that appendicular skeletal muscle mass (ASM) and skeletal muscle index (SMI) were significantly positively correlated with BMD at each site of male patients. The percentage of the trunk fat and the total fat were significantly negatively correlated with the BMD at the hip in female patients (P<0.05). Multiple linear regression analysis showed that SMI was an independent protective factor for the BMD at lumbar vertebra L1-4, femoral neck, total hip, and total bone mineral content in male patients with postoperative hypopituitarism of NFPA (P<0.05). Conclusion The risks of BMD loss and abdominal fat deposition are higher in NFPA patients with postoperative hypopituitarism. Muscle mass and body fat have important effects on BMD. SMI is an independent protective factor for BMD at the lumbar vertebra, hip, and total bone mineral content in male NFPA patients with postoperative hypopituitarism.

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