骨代谢生化指标对肝炎后肝硬化并发骨质疏松的预测价值  

Predictive value of biochemical indexes of bone metabolism in patients with posthepatitic cirrhosis complicated with osteoporosis

作　　者：江雅平[1] 周佳[1] 焦莉莉[1] 侯艳峰 王玎玲[1] JIANG Ya-ping;ZHOU Jia;JIAO Li-li;HOU Yan-feng;WANG Ding-ling(Clinical Laboratory,Peking University First Hospital,Beijng 100034,China)

机构地区：[1]北京大学第一医院检验科,北京100034

出　　处：《中华骨质疏松和骨矿盐疾病杂志》2020年第4期326-333,共8页Chinese Journal Of Osteoporosis And Bone Mineral Research

摘　　要：目的探讨多种骨代谢生化指标预测肝炎后肝硬化并发骨质疏松(osteoporosis,OP)风险的临床意义。方法纳入肝炎后肝硬化患者72例,包括并发OP(OP组)34例,未并发OP(NOP组)38例,同期年龄、性别、体质量指数(body mass index,BMI)、女性绝经状态等匹配的健康体检者35例作为对照组。测定骨代谢生化指标:血钙(calcium,Ca)、血磷(phosphorus,P)、甲状旁腺素(parathyroid hormone,PTH)、25-羟维生素D(25-hydroxyvitamin D,25OHD)、骨形成标志物[骨钙素(osteocalcin,OC)、碱性磷酸酶(alkaline phosphatase,ALP)和Ⅰ型原胶原N端前肽(N-terminal propeptide of typeⅠprecollagen,PINP)]和骨吸收标志物Ⅰ型胶原羧基端肽区交联(type I collagen cross-linked C-telopeptide,CTX)。血Ca水平根据同步血清白蛋白(albumin,ALB)水平进行校正后再进行统计和比较。结果(1)与NOP组比较,OP组校正血Ca、25OHD和OC水平偏低(P<0.05),且伴有PTH、ALP、PINP及CTX水平升高(P<0.05),血P差异无统计学意义(P>0.05)。(2)二元Logistic回归显示,25OHD和OC与肝炎后肝硬化并发OP呈负相关。CTX、PINP、ALP和PTH升高是肝炎后肝硬化并发OP的危险因素,比值比(Odds ratio,OR)分别为8.237(2.748~69.810)、7.176(2.218~34.012)、2.014(1.982~2.819)和1.064(1.033~1.082)。(3)受试者工作特征(receiver operator characteristic,ROC)曲线结果显示,CTX的曲线下面积(area under the curve,AUC)为0.799(95%CI为0.718~0.863,P<0.001),PINP的AUC为0.727(95%CI为0.612~0.789,P=0.001),对于肝炎后肝硬化并发OP的预测价值最高。CTX、PINP、ALP、OC、PTH和25OHD 6个指标联合预测肝炎后肝硬化并发OP的敏感度达98.6%。结论CTX与PINP预测肝炎后肝硬化并发OP更为敏感。多种骨代谢生化指标联合检测可以明显提高预测敏感度,从而有利于对肝炎后肝硬化并发OP高风险患者进行早期干预,减少OP甚至OP性骨折的发生。Objective To explore the clinical significance of various biochemical indexes of bone metabolism in predicting the risk of osteoporosis(OP)in posthepatitic cirrhosis.Methods 72 patients with posthepatitic cirrhosis were included,including 34 patients with OP(OP group),38 patients without OP(NOP group),and 35 healthy persons matched in age,sex,body mass index(BMI),and menopausal state of women were included as control group.Blood calcium,phosphorus,parathyroid hormone(PTH),25-hydroxyvitamin D(25 OHD),osteocalcin(OC),alkaline phosphatase(ALP),N-terminal propeptide of typeⅠprecollagen(PINP),and typeⅠcollagen cross-linked C-telopeptide(CTX)were measured.The serum calcium level was adjusted according to the level of albumin(ALB),and then the statistics and comparison were made.Results(1)Compared with NOP group,the levels of adjusted serum calcium,25 OHD,and OC in OP group were significantly lower(P<0.05),and the levels of PTH,ALP,PINP,and CTX were higher(P<0.05),and there was no significant difference in blood phosphorus(P>0.05).(2)Binary Logistic regression showed that 25 OHD and OC were negatively correlated with OP in posthepatitic cirrhosis.CTX,PINP,ALP,and PTH were the risk factors of OP in posthepatitic cirrhosis,and the odds ratio values were 8.237(2.748-69.810),7.176(2.218-34.012),2.014(1.982-2.819),and 1.064(1.033-1.082),respectively.(3)Receiver operator characteristic curve showed that CTX(area under curve 0.799,95%CI:0.718-0.863,P<0.001)and PINP(area under curve 0.727,95%CI:0.612-0.789,P=0.001)had the highest predictive value for OP in posthepatitic cirrhosis.The sensitivity of CTX,PINP,ALP,OC,PTH,and 25 OHD combined to predict OP in posthepatitic cirrhosis was 98.6%.Conclusions CTX and PINP are more sensitive to predict OP in patients with posthepatitic cirrhosis.The combined detection of multiple biochemical indexes of bone metabolism can significantly improve the prediction sensitivity,so as to intervene early in patients with high risk of OP in posthepatitic cirrhosis and reduce the occurrence of OP

关 键 词：肝炎后肝硬化 骨质疏松 骨代谢 生化指标 

分 类 号：R683[医药卫生—骨科学]