中国实用妇科与产科杂志

中国实用妇科与产科杂志

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雌激素联合阿仑膦酸钠对完全型雄激素不敏感综合征患者骨密度的影响

郝丽娟，田秦杰   

  1. 作者单位：1.重庆市妇幼保健院生殖内分泌科，重庆400013;2.中国医学科学院 北京协和医院妇产科，北京100730
  • 出版日期:2012-12-02 发布日期:2012-11-19
  • 通讯作者: 田秦杰

Study of bone mineral density in complete androgen insensitivity syndrome: estrogen alone or estrogen with bisphosphonates treatment after orchiectomy.

HAO Li-juan*, TIAN Qin-jie.   

  1. Chongqing Health Centre for Women and Children, Chongqing 400013, China
  • Online:2012-12-02 Published:2012-11-19

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摘要：

目的:探讨完全型雄激素不敏感综合征(CAIS)患者的骨密度变化和治疗。方法:回顾性分析北京协和医院1994年4月至2010年7月收治的26例CAIS患者性腺切除术前后的骨密度特征，以及性腺切除术后有随访资料者单纯雌激素补充治疗(A组，10例)和雌激素联合阿仑膦酸钠治疗(B组，3例)后的骨密度特征。采用双能X线骨密度仪测量患者的腰椎和股骨颈骨密度，并与正常男性和女性的骨密度进行比较和分析。结果:(1)26例术前行骨密度检查的患者中，>19～<30岁15例腰椎2～4骨密度为(0.94±0.07)g/cm2，比正常男、女性下降 (P<0.01);股骨颈骨密度为(0.84±0.07)g/cm2，比正常男性下降(〖WTBX〗P〖WTBZ〗<0.05)。(2)A组术后进行15次骨密度检查，>19～<30岁6例患者股骨颈骨密度为(0.92±0.09)g/cm2，与正常男、女性比较差异无统计学意义(P>0.05)。>19～<30岁、30～39岁腰椎2～4骨密度分别为(0.97±0.05)g/cm2、(0.98±0.03)g/cm2，比正常男、女性下降 (P<0.01、P<0.05)。 (3)B组术后进行10次骨密度检查，>19～<30岁、30～39岁的2例患者股骨颈骨密度分别为(1.00±0.03)g/cm2、(0.99±0.03)g/cm2，与正常男、女性比较差异无统计学意义(P>0.05)。>19～<30岁、30～39岁腰椎2～4骨密度分别为(0.98±0.02)g/cm2、(1.00±0.01)g/cm2，比正常男、女性下降 (P<0.05、P<0.01)。结论:CAIS患者的骨密度有不同程度的下降，尤其是腰椎，提示雌激素和雄激素可能在骨量的获得和维持中起重要的作用。雌激素联合阿仑膦酸钠治疗可能提高CAIS股骨颈的骨密度，疗效优于单用雌激素补充治疗。　　

关键词: 完全型雄激素不敏感综合征, 骨密度, 雌激素, 雄激素, 阿仑膦酸钠

Abstract:

Objective:To explore the characteristics and treatment effects of bone mineral density (BMD) in complete androgen insensitivity syndrome (CAIS) of Chinese patients. Methods:Twentysix cases of CAIS (1994-04～2010-07) were studied retrospectively through comparing BMD of pre and postorchiectomy with normal Chinese men and women. The treatment effect of estrogen alone (group A, 10 cases) was compared with estrogen plus alendronate (group B, 3 cases) in the patients of postorchiectomy. BMD at the lumbar spine/the femur neck were measured by dual energy X-ray absorptiometry (DXA). Results:Twentysix cases of CAIS had preorchiectomy DXA，in which 15 cases had significantly reduced lumbar 2～4 BMD [(0.94±0.07)g/cm2] compared with the normal male or female (P<0.001), and 15 cases had significantly reduced femur neck BMD [(0.84±0.07)g/cm2] compared with the normal male (P<0.05). Ten cases in A group had 15 postorchiectomy DXA，in which femur neck BMD in subjects aged >19～<30 years old [(0.92±0.09)g/cm2] was not significantly differ from the normal control(P>0.05)，but lumbar 2～4 BMD in subjects aged >19～<30 years old [(0.97±0.05)g/cm2, P<0.01] and aged 30～39 years old [(0.98±0.03)g/cm2, P<0.05] was lower than that of the normal control. Three cases in B group had 10 postorchiectomy DXA, in which femur neck BMD in subjects aged >19～<30 years old [(1.00±0.03)g/cm2] and aged 30～39 years old [(0.99±0.03)g/cm2] was not significantly differ from the normal control (P>0.05). The lumbar 2～4 BMD in subjects aged >19～<30 years old [(0.98±0.02)g/cm2, P<005] and aged 30～39 years old [(1.00±0.01)g/cm2, P<0.01] were lower than that of the normal control. Conclusions:Patients of CAIS exhibited the decreased BMD values，especially in lumbar vertebra. This suggests that estrogen and androgen play important roles in the acquirement and maintenance of bone mass. The treatment effect of estrogen plus alendronate on increasing femur neck BMD is better than estrogen alone.

Key words: complete androgen insensitivity syndrome, bone mineral density, estrogen, androgen, alendronate

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