摘要
目的分析绝经后女性患者血清Smad同源物4(Smad4)和成骨细胞特异性转录因子(Osterix)水平与骨密度(BMD)及骨折发生率的相关性。方法选取2020年5月至2022年5月西安交通大学第二附属医院收治的157例45~70岁绝经女性作为研究对象,按BMD将患者分为BMD正常组(n=51)、BMD减少组(n=59)、骨质疏松症(OP)组(n=47);根据是否骨折分为骨折组(n=48)和非骨折组(n=109)。检测研究对象血清Smad4、Osterix、β胶原降解产物(β-CTX)、Ⅰ型胶原氨基端延长肽(P1NP)、骨桥蛋白(OPN)及N端骨钙素(N-MID)水平;分析血清Smad4与Osterix的相关性,及血清Smad4、Osterix与骨代谢指标间的相关性,以及影响患者发生OP的因素。绘制受试者工作特征(ROC)曲线分析血清Smad4、Osterix水平对发生骨折风险的预测价值。结果与BMD正常组比较,BMD减少组和OP组的β-CTX、P1NP、OPN、N-MID依次升高,股骨BMD、腰椎L1-4BMD依次降低(P<0.05);BMD减少组和OP组的血清Smad4和Osterix水平依次降低(P<0.05);OP组骨折发生率显著高于BMD正常组和BMD减少组(P<0.001),BMD减少组骨折发生率显著高于BMD正常组(P=0.027)。骨折组的血清Smad4、Osterix水平显著低于非骨折组(P<0.05)。Pearson分析结果表明,Smad4和Osterix的表达水平呈正相关(P<0.05);Spearman分析结果表明,Smad4表达水平与β-CTX、P1NP、OPN和N-MID呈负相关(P<0.05),与股骨BMD和腰椎L1-4BMD呈正相关(P<0.05);Osterix的表达水平与β-CTX、P1NP、OPN和N-MID呈负相关(P<0.05),与股骨BMD和腰椎L1-4BMD呈正相关(P<0.05)。多因素Logistic回归分析表明,低水平Smad4、Osterix、股骨BMD、腰椎L1-4BMD是影响OP发生的危险因素(P<0.05)。绘制ROC曲线结果显示,血清Smad4预测骨折风险的曲线下面积(AUC)为0.937,血清Osterix预测骨折风险的AUC为0.911,二者联合预测骨折风险的AUC为0.974,二者联合优于血清Smad4和Osterix各自单独诊断(Z联合vs.Smad4=3.843、Z联合vs.Osterix=2.386,P<0.05)。结论绝经后OP患者血清Smad4和Osterix呈低表达,与患者的骨代谢生化指标和BMD密切相关,且是影响OP发生的独立危险因素,二者联合可以更好地预测患者发生骨折的风险。
Objective To analyze the correlation between serum Smad homolog 4(Smad4)and osteoblast-specific transcription factor(Osterix)levels and bone mineral density(BMD)and fracture incidence in postmenopausal women.Methods A total of 157 menopausal women aged 45-70 years old who were admitted to the Second Affiliated Hospital of Xi'an Jiaotong University from May 2020 to May 2022 were selected as the study subjects.According to BMD,the patients were divided into normal BMD group(n=51),BMDreduced group(n=59),and osteoporosis(OP)group(n=47).They were divided into fracture group(n=48)and non-fracture group(n=109)based on fracture condition.The serum levels of Smad4,Osterix,βcollagen degradation products(β-CTX),typeⅠcollagen aminoterminal elongation peptide(P1NP),osteopontin(OPN)and N-terminal osteocalcin(N-MID)were detected.The correlation between serum Smad4 and Osterix,the correlation between serum Smad4,Osterix and bone metabolism indexes and the factors affecting the occurrence of OP in patients were analyzed.The receiver operating characteristic(ROC)curve was plotted to analyze the predictive value of serum Smad4 and Osterix levels on the risk of fracture.Results Compared with the normal BMD group,β-CTX,P1NP,OPN,N-MID levels in the BMD-reduced group and the OP group were successively increased,and femoral BMD and L1-4 BMD of the lumbar spine were successively decreased(P<0.05),the serum levels of Smad4 and Osterix in the BMD reduced group and the OP group were successively decreased(P<0.05),the incidence of fracture in the OP group was significantly higher than that in the normal BMD group and the BMD-reduced group(P<0.001),and the incidence of fracture in the BMD-reduced group was significantly higher than that in the normal BMD group(P=0.027).The serum levels of Smad4 and Osterix in the fracture group were significantly lower than those in the non-fracture group(P<0.05).Pearson analysis showed that the expression levels of Smad4 and Osterix were positively correlated(P<0.05),and Spearman analysis showed that the expression levels of Smad4 were negatively correlated withβCTX,P1NP,OPN and N-MID(P<0.05),and positively correlated with femoral BMD and lumbar L1-4 BMD(P<0.05).Multivariate Logistic regression analysis showed that low level Smad4,Osterix,femoral BMD,and lumbar L1-4 BMD were risk factors for the occurrence of OP(P<0.05).The results of ROC curve plotting showed that the area under the curve(AUC)of serum Smad4 predicted fracture risk was 0.937,the AUC of serum Osterix predicted fracture risk was 0.911,and the combination of the two was superior to the diagnosis of serum Smad4 and Osterix separately(Z combination vs.Smad4=3.843 and Zcombination vs.Osterix=2.386,P<0.05).Conclusions Serum Smad4 and Osterix were low in postmenopausal patients with OP,which is closely related to the biochemical indexes of bone metabolism and BMD of patients,and is an independent risk factor affecting the occurrence of OP,and the combination of the two can better predict the risk of fracture in patients.
作者
王秀萍
郑天博
段锦花
吕娟
陈雨
王小英
WANG Xiuping;ZHENG Tianbo;DUAN Jinhua;LYU Juan;CHEN Yu;WANG Xiaoying(Department of Health Management,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710005,Shaanxi,China;Department of Gynecology,521 Hospital of Norinco Group,Xi'an 710068,Shaanxi,China)
出处
《中国性科学》
2024年第1期37-41,共5页
Chinese Journal of Human Sexuality
基金
陕西省重点研发计划项目(2019SF-116)。
