摘要
目的 探讨绝经后骨质疏松症(PMOP)患者血清β胶原降解产物(β-CTx)、Ⅰ型原胶原N端前肽(PINP)及骨钙素(OC)水平的变化及其临床意义。方法 选择2019年3月至2021年4月于联勤保障部队第九〇九医院厦门大学附属东南医院就诊的PMOP患者185例作为研究对象(PMOP组),另选择绝经后骨量正常的体检者138例为对照组,对比两组的临床资料,采用套索算法(LASSO)及Logistic回归分析女性PMOP的独立危险因素,并采用R语言构建列线图模型。结果 PMOP组的L1~L4段腰椎骨密度(BMD)(t=5.132)、全髋BMD(t=4.813)、股骨颈BMD(t=4.981)、β-CTx(t=9.726)、PINP(t=25.457)、OC(t=13.258)水平,以及糖尿病(χ^(2)=15.248)、骨折病史(χ^(2)=15.089)、PMOP家族史(χ^(2)=14.859)、维生素D缺乏(χ^(2)=8.670)、缺乏运动(χ^(2)=21.615)、雌激素替代治疗(χ^(2)=27.255)、补充钙剂(χ^(2)=57.288)的分布情况与对照组比较差异均有统计学意义(P<0.05)。在调整混杂因素后,当β-CTx≥0.52μg/L时,β-CTx每增加0.20μg/L,受试者发生PMOP的风险增加17.00%;当PINP≥50.15μg/L时,PINP每增加2.00μg/L,受试者发生PMOP的风险增加14.00%;当OC≥21.52μg/L时,OC每增加1.00μg/L,受试者发生PMOP的风险增加11.00%。β-CTx、PINP、OC水平及维生素D缺乏均为女性绝经后骨质疏松的危险因素,而雌激素替代治疗及补充钙剂为保护因素。构建的列线图模型在预测女性绝经后骨质疏松方面具有较高的区分度、准确性和临床适用性。结论 血清β-CTx、PINP、OC水平异常变化与PMOP的发生密切相关,三者联合25羟基维生素D[25(OH)D]、雌激素替代治疗及补充钙剂等因素构建的列线图模型对PMOP具有较高的预测价值,可作为临床筛选高危人群的敏感指标。
Objective To investigate the changes and clinical significance of serum beta collagen degradation products(β-CTx),procollagen type Ⅰ N-terminal propeptide(PINP) and osteocalcin(OC) levels in postmenopausal osteoporosis(PMOP) patients.Methods A total of 185 PMOP patients who visited in the No.909 Hospital of Joint Logistics Support Force, Southeast Hospital Affiliated to Xiamen University from March 2019 to April 2021 were selected as the study objects(the PMOP group),and 138 physical examiners with normal bone mass after menopause were selected as the control group.The clinical data of the two groups were compared.The independent risk factors of female PMOP were analyzed by least absolute shrinkage and selection operator(LASSO) and Logistic regression, and the nomogram prediction model was constructed by R language.Results There were significant differences between the control group and the PMOP group in the distributions of L_1-L_4 lumbar vertebrae bone mineral density(BMD)(t=5.132),total hip BMD(t=4.813),femoral neck BMD(t=4.981),β-CTx(t=9.726),PINP(t=25.457),OC(t=13.258),diabetes mellitus(χ^(2)=15.248),history of fracture(χ^(2)=15.089),PMOP family history(χ^(2)=14.859),vitamin D deficiency(χ^(2)=8.670),lack of exercise(χ^(2)=21.615),estrogen replacement therapy(χ^(2)=27.255) and calcium supplementation(χ^(2)=57.288)(P<0.05).After adjusting for confounders, when β-CTx ≥0.52μg/L,the risk of PMOP increased by 17.00% for per 0.20μg/L increase of β-CTx, when PINP ≥50.15μg/L,the risk of PMOP increased by 14.00% for per 2.00μg/L increase of PINP,and when OC ≥21.52μg/L,per 1.00μg/L increase of OC increased the risk of PMOP by 11.00%.The levels of β-CTx, PINP and OC and vitamin D deficiency were the risk factors for postmenopausal osteoporosis, while estrogen replacement therapy and calcium supplement were the protective factors.The nomogram model had high discrimination, accuracy and clinical applicability in predicting female postmenopausal osteoporosis.Conclusion The abnormal changes of serum β-CTx, PINP and OC levels are closely related to the occurrence of PMOP,the nomogram model constructed by the three factors combined with 25-hydroxy vitamin D[25(OH)D],estrogen replacement therapy and calcium supplement has high predictive value for PMOP,and can be used as a sensitive indicator for clinical screening of high-risk population.
作者
王少容
梁声强
林淳峥
Wang Shaorong;LIANG Shengqiang;Lin Chunzheng(Department of Clinical Laboratory,Southeast Hospital,Xiamen University,Zhangzhou,Fujian 363000,China)
出处
《中国妇幼健康研究》
2023年第5期53-59,共7页
Chinese Journal of Woman and Child Health Research
基金
2020年漳州市科技拥军资助项目(ZZ2020KD04)。
关键词
绝经后骨质疏松症
β胶原降解产物
Ⅰ型原胶原N端前肽
骨钙素
预测
postmenopausal osteoporosis
beta collagen degradation products
procollagen type Ⅰ N-terminal propeptide
osteocalcin
prediction
