摘要
目的:探讨血清雌激素(E2)、铁调素(Hepcidin)、总Ⅰ型胶原氨基端延长肽(t-PINP)/Ⅰ型胶原羧基端肽β特殊序列(β-CTX)比值联合预测老年女性骨质疏松(OP)患者骨折风险的价值.方法:选取2021 年1 月至2023 年 6 月老年女性OP 患者 205 例,根据随访 1 年期间是否发生骨折分为骨折组与未骨折组,两组均于患者入院当日清晨采集静脉血标本,采用化学发光法检测血清E2、Hepcidin、血清t-PINP、β-CTX 水平,比较两组基线资料、血清 E2、Hepcidin、t-PINP/β-CTX 比值水平,分析血清E2、Hepcidin、t-PINP/β-CTX对骨折风险的预测价值.结果:随访1 年,失访4 例,共201 例患者完成随访,其中63 例发生骨折,138 例未发生骨折,骨折发生率为31.34%,将发生骨折与未发生骨折的患者分别纳入骨折组与未骨折组.骨折组年龄、绝经年限、脆性骨折史、雌激素使用史高于未骨折组,髋部、腰椎、Wald三角区骨密度低于未骨折组(P<0.05);骨折组血清 E2、Hepcidin、t-PINP/β-CTX 比值分别为(25.65±4.63)pg/mL、(76.16±15.82)ng/mL、(126.50±15.25),低于未骨折组(32.71±5.09)pg/mL、(102.43±18.90)ng/mL、(152.68±20.10),t-PINP、β-CTX 分别为(60.72±6.57)ng/mL、(0.48±0.10)ng/mL高于未骨折组(56.49±5.03)ng/mL、(0.37±0.08)ng/mL(t=9.378、9.600、5.007、8.342、9.196,P 均<0.001);血清E2、Hepcidin、t-PINP/β-CTX比值与髋部、腰椎、Wald三角区骨密度呈正相关(r=0.622、0.641、0.658、0.609、0.617、0.634、0.710、0.729、0.746,P 均<0.001);在控制年龄、绝经年限、脆性骨折史、雌激素使用史等其他因素前后,血清 E2、Hepcidin、t-PINP/β-CTX 比值仍是老年女性 OP 患者骨折的独立影响因素(P<0.05);血清E2、Hepcidin、t-PINP/β-CTX 比值预测老年女性 OP 患者骨折的AUC分别为0.810、0.789、0.760,最佳截断值分别为 27.77pg/mL、88.49ng/mL、142.52,敏感度分别为68.25%、76.19%、73.02%,特异度分别为76.81%、74.64%、74.64%;三者联合预测老年女性OP 患者骨折的AUC为0.918(95%CI:0.871～0.952),敏感度为87.30%,特异度为83.33%,明显优于三者单独预测(P<0.05).结论:血清E2、Hepcidin、t-PINP/β-CTX比值与老年女性OP 患者骨密度显著相关,是发生骨折的独立影响因素,联合预测骨折风险的价值可靠.
Abstract
Objective:To investigate the combined value of serum estrogen(E2),ferriregulation(Hep-cidin)and the ratio of total type I collagen amino terminal prolongating peptide(t-PINP)/Type I collagen carboxy-terminal peptide β special sequence(β-CTX)in predicting fracture risk in elderly women with oste-oporosis(OP).Methods:A total of 205 elderly female OP patients from January 2021 to June 2023 were se-lected and divided into fracture group and non-fracture group according to whether they had fractures during the 1-year follow-up period.Venous blood samples were collected from both groups on the admission morning of the patient.The levels of serum E2,Hepcidin,serum t-PINP,and β-CTX were detected using chemilu-minescence.Baseline data,serum E2,Hepcidin,and t-PINP/β-CTX ratio levels were compared between the two groups.The predictive value of serum E2,Hepcidin,and t-PINP/β-CTX for fracture risk was ana-lyzed.Results:After a year of follow-up,the contact of 4 patients were lost,and a total of 201 patients com-pleted the follow-up.Among them,63 cases had fractures and 138 cases had no fractures,with a fracture in-cidence at 31.34%.Patients with and without fractures were included in the fracture group and non-fracture group,respectively.The age,menopausal years,history of fragility fractures,and history of estrogen use in the fracture group were higher than those in the non-fracture group,while the bone mineral density of the hip,lumbar spine,and Wald triangle area was lower than that in the non-fracture group(P<0.05).The serum E2,Hepcidin,and t-PINP/β-CTX ratios in the fracture group were(25.65±4.63)pg/mL,(76.16±15.82)ng/mL,and(126.50±15.25),respectively,which were lower than those in the non-fracture group(32.71±5.09)pg/mL,(102.43±18.90)ng/mL,and(152.68±20.10).The t-PINP and β-CTX were(60.72±6.57)ng/mL and(0.48±0.10)ng/mL,respectively,which were higher than those in the non-fracture group(56.49±5.03)ng/mL and(0.37±0.08)ng/mL(t=9.378,9.600,5.007,8.342,9.196,all P<0.001).Serum E2,Hepcidin,and t-PINP/β-CTX ratio were positively correlated with bone mineral density in the hip,lumbar spine,and Wald triangle area(r=0.622,0.641,0.658,0.609,0.617,0.634,0.710,0.729,0.746,all P<0.001).Serum E2,Hepcidin and t-PINP/β-CTX ratio were still independent influencing factors for fracture in elderly female OP patients before and after controlling for age,menopause years,fragility fracture history,estrogen use history and other factors(P<0.05).Serum E2,Hepcidin and t-PINP/β-CTX ratios predicted the fracture AUC of elderly female OP patients to be 0.810,0.789 and 0.760,respectively,and the optimal cut-off values were 27.77 pg/mL,88.49 ng/mL and 142.52,respective-ly.Sensitivity was 68.25%,76.19%,73.02%,and specificity was 76.81%,74.64%,74.64%,respec-tively.The AUC of fracture predicted by the combination of the three methods was 0.918(95%CI:0.871-0.952),the sensitivity was 87.30%,and the specificity was 83.33%,which was significantly better than that predicted by the three methods alone(P<0.05).Conclusion:Serum E2,Hepcidin and t-PINP/β-CTX ra-tios are significantly correlated with bone mineral density in elderly female OP patients,and are independent influencing factors for fracture occurrence,and the combined value of predicting fracture risk is reliable.
维普
万方数据