胰岛素抵抗对老年骨质疏松性骨折患者术后新发骨折的预测价值  

Predictive value of insulin resistance for postoperativenew-onset fractures in elderly patients with osteoporotic fractures

作　　者：卢微波[1] 白绍元[1] 赵东航 Lu Weibo;Bai Shaoyuan;Zhao Donghang(Department of Orthopaedics,Sanmenxia Central Hospital,Sanmenxia 472000,Henan,China)

机构地区：[1]河南省三门峡市中心医院骨科,472000

出　　处：《中华生物医学工程杂志》2020年第1期71-74,共4页Chinese Journal of Biomedical Engineering

摘　　要：目的探讨胰岛素抵抗(IR)对老年骨质疏松性骨折患者术后新发骨折的预测价值。方法选择2013年3月至2018年3月三门峡市中心医院骨科收治的老年骨质疏松性骨折患者122例。排除失访、死亡病例,最终入组患者104例,随访期间根据患者症状和影像学检查结果进行分组,新发骨折组41例,未发骨折63例为对照组。收集纳入患者性别、年龄、体质量指数(BMI)、术前视觉模拟评分(VAS)及Oswestry功能障碍指数问卷表(ODI)评分等一般资料,用双能X射线吸收仪测定骨密度T值,检测血糖和胰岛素水平,计算稳态模型-胰岛素抵抗指数(HOMA-IR)。将HOMA-IR≥1.73定义为IR,IR患者又可分为低IR组(<2)、中IR组(2~6)和高IR组(>6)。结果两组患者性别、年龄、BMI指数、术前VAS评分、术前ODI评分比较差异无统计学意义(P>0.05),新发骨折组骨密度T值低于对照组,IR发病率和HOMA-IR均高于对照组(P<0.05);HOMA-IR预测术后新发骨折的曲线下面积(AUC)为0.894,以>1.91的标准预测约登指数最高为0.688,灵敏度为87.80%,特异度为80.95%;各亚组骨密度T值比较:低IR组>中IR组>高IR组(P<0.05),新发骨折发生率、HOMA-IR比较:低IR组<中IR组<高IR组(P<0.05);Pearson相关性分析结果显示,HOMA-IR与骨密度T值呈明显负相关(r=-0.516,P=0.000),与新发骨折发生率呈正相关(r=0.259,P=0.012),骨密度T值与新发骨折发生率呈明显负相关(r=-0.225,P=0.029)。结论IR与骨质疏松程度密切相关,老年骨质疏松性骨折合并IR患者术后新发骨折的风险更高,可作为新发骨折的预测因素在临床应用。Objective To determine the predictive value of insulin resistance(IR)for postoperative new-onset fractures in elderly patients with osteoporotic fractures.Methods A total of 122 elderly patients with osteoporotic fractures admitted to the Department of Orthopaedics,Sanmenxia Central Hospital between March 2013 and March 2018 were enrolled.The patients who were lost to follow-up or died were excluded,and 104 patients finally participated in this study.During the follow-up,the patients were grouped according to the symptoms and imaging findings,including 41 cases assigned to the new-onset fracture group and 63 others to the control group without new-onset fractures.The general data such as sex,age,body mass index(BMI),preoperative visual analogue scale(VAS)score and Oswestry dysfunction index questionnaire(ODI)score were collected,and the bone mineral density T value was measured by dual energy X-ray absorptiometry.Blood glucose and insulin levels were detected and the homeostasis model assessment of insulin resistance(HOMA-IR)was calculated.HOMA-IR≥1.73 was defined as IR,and accordingly,the IR patients were further divided into low IR sub-group(<2),medium IR sub-group(2-6)and high IR sub-group(>6).Results There were no significant differences in sex,age,BMI index,preoperative VAS and ODI scores between the two groups(P>0.05).The bone mineral density T value was lower,while the IR incidence and HOMA-IR were higher,in new-onset fracture group than those in control group(all P<0.05).Using HOMA-IR for prediction of postoperative new-onset fractures,the area under the curve(AUC)was 0.894;by a cut-off value being>1.91,the highest predicted Yoden index was 0.688,and the sensitivity and specificity were 87.80%and 80.95%,respectively.By comparing among the IR sub-groups,the bone mineral density T value was highest in low IR sub-group,followed by medium and high IR sub-groups(P<0.05),and the incidence of new-onset fractures and HOMA-IR were lowest in low IR sub-group,followed by medium and high IR sub-groups(P<0.05).Pears

关 键 词：胰岛素抵抗 骨密度 老年 骨质疏松性骨折 预测价值 

分 类 号：R687[医药卫生—骨科学] R5[医药卫生—外科学]