【作者】 刘勇；

【导师】 孙志明；

【作者基本信息】 天津医科大学 ， 外科学 骨外（专业学位）， 2018， 硕士

【摘要】 目的:本研究研究目的主要是通过汇总分析明确绝经前后女性血清瘦素水平的差异以及血清瘦素浓度与各部位骨骼骨密度相关性。了解女性绝经对血清瘦素水平的影响,验证血清瘦素浓度能否成为预测绝经前后女性人群骨量指标之一的可能性。方法:本研究分为两部分,通过检索Pub Med(Medline)、EMBASE、Cochrane Library数据库以及对相关文献的二次检索,收集截至到2017年12月30日期间公开发表的文献。第一部分检索词为Leptin、Premenopausal、Premenopause、Postmenopausal、Postmenopause。通过制定的纳入及排除标准筛选相关文献,收集绝经前后女性数量及血清瘦素浓度等数据资料,通过应用统计软件Review Manager 5.3进行统计分析,使用血清瘦素浓度的标准化均数差(SMD)和95%置信区间(95%CI)来评估绝经前女后女性血清瘦素浓度水平之间的差异,验证女性绝经是否会影响血清瘦素分泌水平的变化。第二部分检索词为Leptin、Bone mineral density、Premenopausal、Premenopause、Postmenopausal、Postmenopause。通过制定的纳入及排除标准筛选相关文献,并收集纳入文献的基本信息以及患者数量、骨密度、相关系数等数据指标。通过应用统计软件R version 3.4.3进行统计分析,应用分析软件中的meta程序包以及metacor程序包来合并不同人群中身体不同骨骼部位骨密度与血清瘦素浓度水平之间的相关系数r,通过合并后的相关系数分析绝经前后女性血清瘦素浓度与身体不同部位骨骼骨密度的相关性。结果:第一部分根据检索策略最初检索出文献302篇文献,按照纳入及排除标准进行筛选,最终纳入研究的文献有42篇,包含6136名绝经前女性、5392名绝经后女性。统计结果显示,所纳入的关于绝经前后妇女血清瘦素研究的异质性检验结果,I2=94%,P<0.00001。采用随机效应模型合并各项研究数据后结果显示,绝经前女性较绝经后女性存在更高的血清瘦素浓度(SMD=-0.19,95%CI=[-0.36,-0.02],P=0.02)。第二部分研究根据检索策略最初检索出文献305篇文献,按照纳入及排除标准进行筛选,最终纳入研究的文献有43篇,其中涉及绝经后妇女的文献研究37篇,包含4960名绝经后女性,涉及绝经前妇女的文献研究16篇,包含1654名绝经前女性。对各文献中收集的相关系数r通过使用逆方差法以及Fisher’s z变换进行合并,将合并结果进行汇总分析。Meta分析结果显示,绝经前女性血清素浓度与身体各部位骨骼骨密度合并后的相关系数如下:全身骨密度(r=0.20,P<0.0001);髋关节(r=0.30,P<0.0001);股骨颈(r=0.12,P=0.0001);腰椎(r=0.09,P=0.0006);大转子区(r=0.11,P=0.1521);前臂远端(r=0.07,P=0.3924);桡骨(r=0.23,P<0.01);骨盆(r=0.39,P<0.05),前臂(r=0.084,P=0.336);Ward’s区(r=0.005,P=0.951);股骨(r=0.129,P=0.635)。绝经后女性血清瘦素浓度与身体各部位骨骼骨密度合并后的相关系数如下:全身骨密度(r=0.15,P=0.03);髋关节(r=0.20,P=0.0003);股骨颈(r=0.25,P<0.0001);腰椎(r=0.17,P<0.0001);大转子区(r=0.14,P<0.0001);桡骨(r=0.26,P<0.001);前臂(r=0.13,P=0.0188);前臂远端(r=0.09;P=0.2651);骨盆(r=0.3,P>0.05);Ward’s区(r=0.12,P=0.0051);腕关节(r=-0.145,P=0.391);股骨(r=0.298;P=0.004)。结论:本研究统计分析结果显示,(1)绝经前女性血清瘦素浓度较绝经后女性高,绝经会影响瘦素的分泌。(2)在绝经前和绝经后女性中,血清瘦素水平与身体大多部位骨骼骨密度均呈正相关,即更高血清瘦素浓度对应着更高的骨密度。更多还原

【Abstract】 Objective:The purpose of this study is to analyze the differences in serum leptin levels and the correlation between serum leptin concentrations and bone mineral density in premenopausal and postmenopausal women.To understand the effect of menopausal status on serum leptin levels and to verify whether serum leptin concentration may be one of the predictors of bone mass in premenopausal and postmenopausal women.Methods:We carried out a search in MEDLINE,EMBASE,Cochrane Library database for relevant studies.(1)The first part of the search terms are Leptin,Premenopausal,Premenopause,Postmenopausal,Postmenopause.Data were extracted using a standardized form.Statistical analysis was performed using the statistical software Review Manager 5.3,using the standardized mean difference(SMD)of serum leptin concentrations.A 95%confidence interval(95%CI)was used to assess the difference between serum leptin levels in premenopausal and postmenopausal women and to verify whether menopausal status affects serum leptin secretion levels.(2)The second part of the search terms are Leptin,Bone mineral density,Premenopausal,Premenopause,Postmenopausal,Postmenopause.Data were extracted using a standardized form.Statistical analysis was performed using statistical software R version 3.4.3.The meta and metacoor packages in the analysis software were used to correlate the correlation coefficient r between bone mineral density and serum leptin concentrations in different skeletal regions of different populations.The correlation coefficient between the serum leptin concentrations and the bone mineral density in different parts of the body in premenopausal and postmenopausal women was analyzed by the combined correlation coefficients.Results:(1)In the first part,302 articles were initially searched according to the search strategy,42 articles were included in the final study,including 6136premenopausal women and 5392 postmenopausal women.The statistical results show that the heterogeneity test results of the included studies on serum leptin in premenopausal women were I~2=94%,P<0.00001.Using the random effects model combined with various studies,the results showed that premenopausal women had higher serum leptin concentrations than postmenopausal women(SMD=-0.19,95%CI=[-0.36,-0.02],P=0.02).(2)In the second part of the research,305 articles of literature were initially searched according to the search strategy,43 articles eventually included in the study,including 38 literature studies involving postmenopausal women,including 4960postmenopausal women.There are 16 literature studies involving premenopausal women,including 1654 premenopausal women.The correlation coefficient r collected in each document was merged by using the inverse variance method and the Fisher’s z-transform,and the combined results were analyzed.The meta-analysis showed that the correlation coefficient of premenopausal women’s serotonin concentration with the bone mineral density in various parts of the body was as follows:whole body(r=0.20,P<0.0001);total hip(r=0.30,P<0.0001);femoral neck(r=0.12,P=P=0.0001);lumbar spine(r=0.09,P=0.0006);trochanter(r=0.11,P=0.1521);distal forearm(r=0.07,P=0.3924);tibia(r=0.23,P<0.01);pelvis(r=0.39,P<0.05),total forearm(r=0.084,P=0.336);Ward’s triangle(r=0.005,P=0.951);femur(r=0.129,P=0.635).The correlation coefficients of serum leptin concentrations in postmenopausal women combined with bone mineral density in various parts of the body were as follows:whole body bone density(r=0.15,P=0.03);total hip(r=0.20,P=0.0003);femoral neck(r=0.25,P<0.0001);lumbar spine(r=0.17,P<0.0001);trochanter(r=0.14,P<0.0001);tibia(r=0.26,P<0.001);total forearm(r=0.13,P=0.0188);distal forearm(r=0.09;P=0.2651);pelvis(r=0.3,P>0.05);Ward’s triangle(r=0.12,P=0.0051);wrist(r=-0.145,P=0.391);femur(r=0.298;P=0.004).Conclusion:As shown above,(1)the serum leptin concentration in premenopausal women is higher than that in postmenopausal women,and the menopause will affect the production of leptin.(2)In premenopausal and postmenopausal women,serum leptin levels are positively correlated with bone mineral density in most parts of the body,higher serum leptin concentrations correspond to higher bone density.更多还原