Study On The Analysis Of Bone Mineral Density And Bone Metabolism And Changes After Intervention In Patients With Premature Ovarian Insufficiency

Objective:1.To analyze the clinical characteristics of patients with premature ovarian insufficiency,and to understand the changes of bone metabolism and bone density.2.The patients were divided into hormone group,Chinese medicine group and combined group.The effects of patients in three treatments on sex hormone and bone metabolism were observed.3.The patients were divided into two subgroups according to the bone density.The normal bone mass group was treated with hormone or Chinese medicine,and the low bone mass group was treated with hormone or combination therapy.The changes of sex hormone and bone metabolism were observed.Methods:1. Select 85 patients who were diagnosed with POI in the Second Hospital of Hebei Medical University from January 2018 to January 2020 as the research objects.The clinical characteristics and the correlation between serum P1NP,β-CTX,bone mineral density and basic indicators were analyzed.2.The patients were divided into three groups,namely the femoston group,the Kuntai group,the combined group.Patients were followed up and completed relevant laboratory examinations before treatment,3 and 6 months after treatment.Laboratory examinations including:P1NP,β-CTX,Ca,P,ALP,FSH,LH,E₂,AMH,and Kupperman index,comparing the changes in the three treatment groups within and between groups.3.Patients with normal bone mass were divided into two intervention subgroups,namely the femoston group and Kuntai group;patients with abnormal bone mass were divided into two intervention subgroups,namely the femoston group and the combined group.Changes of the above indicators were observed in these groups.4.Record various index values in an Excel sheet and use SPSS 21.0software for statistical analysis.Results:1.Basic information of POI patients（1）Of the 85 patients with POI,23 had primary amenorrhea（27.1%）,62had secondary amenorrhea（72.9%）,and 29 had a history of gestation,accounting for 46.8%of secondary amenorrhea.Among the etiology,12 cases were karyotype abnormalities（14.1%）,9 cases were iatrogenic（10.6%）,7 cases were combined with other immune and endocrine diseases（8.2%）,and 57cases were unknown（67.1%）.（2）Hormones related to ovarian function:the mean value of FSH was90.9±35.99m IU/m L,LH was 42.9±21.97m IU/m L,E₂ was 20.62±15.53pg/m L,and AMH was 0.06±0.08ng/m L.（3）Menopausal symptom score:The median Kupperman index was 7.00（2.50,12.00）.（4）Bone health indicators:The median Ca was 2.46（2.39,2.55）mmol/L,P was 1.30（1.21,1.45）mmol/L.The median value of ALP was80.00（60.00,105.00）U/L,and P1NP was 75.05（46.62,127.85）ng/m L,of which60 cases（70.6%）were higher than the upper limit of the normal reference value.And the median value ofβ-CTX was 0.38（0.25,0.54）ng/m L.The mean value of BMD of the lumbar spine was 0.89±0.13g/cm²,and the left hip was 0.87±0.10g/cm².According to the BMD measurement,39 patients had normal bone mass（45.9%）,and 46 patients had low bone mass（54.1%）.（5）Correlation analysis:P1NP was negatively correlated with BMD in the lumbar spine and left hip,and positively correlated with serum Ca,P,and ALP（P<0.05）;β-CTX was positively correlated with serum Ca,P,and ALP（P<0.05）;ALP was negatively correlated with BMD in lumbar spine and left hip（P<0.05）.2. Comparison of three treatment methods in femoston group,Kuntai group and combined group（1）Sexual hormone and K-index:at 3 and 6 months,FSH,LH,K-index level in the femoston group and the combined group were lower,and E₂ level was higher than that before treatment（P<0.05）.In the Kuntai group,K-index decreased and E₂ level increased（P<0.05）.At 3 months,LH decreased and E₂increased in the combined group were better than those in the femoston group（P<0.05）.At 6 months,FSH and LH in the combined group were lower than those in the Kuntai group（P<0.05）.（2）Bone metabolism:At 3 months,both P1NP and ALP decreased in the femoston group.β-CTX decreased in the combined group.In the Kuntai group,β-CTX increased（P<0.05）.At 6 months,β-CTX decreased in the femoston group.But there was no significant difference in all bone metabolism indexes among the three groups（P>0.05）.3. Subgroup analysis of POI patients by normal bone mass and abnormal bone mass（1）Normal bone mass group:FSH,LH,and K-index decreased and E₂levels increased in the femoston group.Only E₂ level increased in the Kuntai group（P<0.05）.Moreover,the LH level in the femoston group was more significant than that in the Kuntai group（P<0.05）.There was no significant difference in the other indicators between the two groups（P>0.05）.There were no significant changes in the bone metabolism indicators of the femoston group（P>0.05）.β-CTX in Kuntai group increased than that before（P<0.05）,and the difference was statistically significant compared with femoston group（P<0.05）.There was no statistically significant difference between the two groups of the bone metabolism indicators（P>0.05）.（2）Abnormal bone mass group:The FSH level of femoston group decreased compared and the E₂ level increased comparing with before treatment（P<0.05）.The levels of FSH and LH in the combined group were lower than before,and the level of E₂ increased（P<0.05）.And the changes of E₂increasing and LH decreasing in the combined group were more significant than those in the femoston group（P<0.05）.There were no significant changes in the bone metabolism indicators of the femoston group（P>0.05）.P1NP andβ-CTX in the combined group were lower than before（P<0.05）.However,there was no statistically significant difference in the indicators between two groups（P>0.05）.Conclusions:1.In this study,over half of patients with POI were reported with bone metabolism abnormalities,but the Kupperman index of them were low.Therefore,attention must be paid to bone health of patients with POI in clinical diagnosis and treatment.2.Patients with POI should be treated timely after diagnosis.The use of femoston or combination of femoston and Kuntai can effectively improve the hormone level of patients.For patients who have mild symptom and do not want to receive hormonal treatment,they can be given Kuntai treatment,but needed to close follow-up of bone mass changes.3. For POI patients with normal bone mass,Kuntai can improve their symptoms and increase E₂ level.4. For POI patients with abnormal bone mass,the combination of femoston and Kuntai may be more beneficial to improve their bone metabolism.