神经性厌食症女性的肽YY（PYY）水平与骨密度（BMD）
Peptide YY (PYY) levels and bone mineral density (BMD) in women with anorexia nervosa.
作者信息
Utz Andrea L, Lawson Elizabeth A, Misra Madhusmita, Mickley Diane, Gleysteen Suzanne, Herzog David B, Klibanski Anne, Miller Karen K
机构信息
Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA; MassGeneral Hospital for Children and Harvard Medical School, Boston, MA 02114, USA.
出版信息
Bone. 2008 Jul;43(1):135-139. doi: 10.1016/j.bone.2008.03.007. Epub 2008 Mar 25.
INTRODUCTION
Anorexia nervosa (AN) is a psychiatric illness that results in significant bone loss. Studies examining the neuroendocrine dysregulation that occurs in AN may increase understanding of endocrine systems that regulate bone mass. Peptide YY (PYY) is an anorexigenic peptide derived primarily from the intestine, with actions mediated via activation of Y receptors. We have previously shown that PYY levels are elevated in adolescents with AN. Y2 receptor knockout mice have increased bone mineral density (BMD) and thus PYY may play a role in regulating bone mass. We hypothesized that PYY levels would be inversely associated with BMD in women with AN.
METHODS
This was a cross-sectional study performed in a General Clinical Research Center of 12 adult women with AN, (mean+/-SEM) mean age 30.9+/-1.8 years, BMI 17.1+/-0.4 kg/m2, and % ideal body weight 77.5+/-1.7%. PYY concentrations were measured hourly from 20:00 h to 08:00 h. BMD was measured using dual X-ray absorptiometry (DXA).
RESULTS
In women with AN, mean overnight PYY levels strongly inversely correlated with BMD at the PA spine (r=-0.77, p=0.003), lateral spine (r=-0.82, p=0.002), total hip (r=-0.75, p=0.005), femoral neck (r=-0.72, p=0.009), total radius (r=-0.72, p=0.009) and 1/3 distal radius (r=-0.81, p=0.002). Body mass index was inversely correlated with PYY level (r=-0.64, p=0.03). Multivariate stepwise regression analysis was performed to determine the contribution of age, duration of AN, BMI, fat-free mass, and PYY to BMD. For PA and lateral spine, PYY was the primary determinant of BMD, accounting for 59% and 67% of the variability, respectively. Fat-free mass and duration of anorexia nervosa were the primary determinants of BMD at other skeletal sites.
CONCLUSIONS
In women with anorexia nervosa, an elevated PYY level is strongly associated with diminished BMD, particularly at the spine. Therefore further investigation of the hypothesis that PYY may contribute to the prevalent bone pathology in this disorder is merited.
引言
神经性厌食症（AN）是一种导致显著骨质流失的精神疾病。研究AN中发生的神经内分泌失调可能会增进对调节骨量的内分泌系统的理解。肽YY（PYY）是一种主要来源于肠道的厌食性肽，其作用通过Y受体的激活介导。我们之前已经表明，AN青少年的PYY水平升高。Y2受体基因敲除小鼠的骨矿物质密度（BMD）增加，因此PYY可能在调节骨量中起作用。我们假设AN女性的PYY水平与BMD呈负相关。
方法
这是一项在综合临床研究中心对12名成年AN女性进行的横断面研究，（平均±标准误）平均年龄30.9±1.8岁，体重指数17.1±0.4kg/m²，理想体重百分比77.5±1.7%。从20:00至08:00每小时测量一次PYY浓度。使用双能X线吸收法（DXA）测量BMD。
结果
在AN女性中，夜间平均PYY水平与腰椎正位（r=-0.77，p=0.003）、腰椎侧位（r=-0.82，p=0.002）、全髋部（r=-0.75，p=0.005）、股骨颈（r=-0.72，p=0.009）、桡骨全长（r=-0.72，p=0.009）和桡骨远端1/3（r=-0.81，p=0.002）的BMD呈强烈负相关。体重指数与PYY水平呈负相关（r=-0.64，p=0.03）。进行多因素逐步回归分析以确定年龄、AN病程、体重指数、去脂体重和PYY对BMD的影响。对于腰椎正位和侧位，PYY是BMD的主要决定因素，分别占变异性的59%和67%。去脂体重和神经性厌食症病程是其他骨骼部位BMD的主要决定因素。
结论
在神经性厌食症女性中，PYY水平升高与BMD降低密切相关，尤其是在脊柱。因此，值得进一步研究PYY可能导致该疾病中普遍存在的骨骼病理的假说。
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