血凝学指标在脊柱退行性疾病患者骨质疏松症诊断中的价值  

Value of hemagglutination indicators in the diagnosis of osteoporosis in patients with spinal degenerative diseases

作　　者：刘岩[1] 吴俊[1] Liu Yan;Wu Jun(Department of Clinical Laboratory,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院检验科,北京100035

出　　处：《中华检验医学杂志》2022年第10期1049-1055,共7页Chinese Journal of Laboratory Medicine

摘　　要：目的探讨血凝学指标对脊柱退行性疾病患者骨质疏松症的辅助诊断价值。方法回顾性研究。选取2018年11月至2020年4月就诊于北京积水潭医院脊柱外科的脊柱退行性疾病患者313例,依据定量CT(QCT)检测结果将其分为骨质疏松组(119例)、骨量减少组(101例)和骨量正常组(93例),3组患者均空腹采集静脉血测定凝血和骨代谢指标。单因素方差分析或Kruskal-WallisH检验分析3组间的差异;从各血液指标中筛查与脊柱退行性病变患者骨质疏松症(OP)发病相关的独立危险因素;进一步将骨量减少组与骨量正常组合并为非骨质疏松组,与骨质疏松组进行二分类Logistic回归分析,受试者工作曲线(ROC)评价相关指标在脊柱退行性疾病患者骨质疏松诊断中的价值。结果3组在性别(χ^(2)=13.555,P=0.001)、年龄(F=17.53,P<0.001)、体重指数(BMI)(F=4.068,P=0.018)、Ⅰ型胶原羧基端肽β特殊序列(β-CTx)(χ^(2)=8.684,P=0.013)、25-羟基维生素D[25(OH)D](χ^(2)=6.155,P=0.046)、D-二聚体定量(D-dimer)(χ^(2)=8.111,P=0.017)和血小板计数(platelet,PLT)(F=6.809,P=0.001)的差异有统计学意义,两两比较显示骨量正常组的年龄(P=0.006)、D-dimer(P=0.020)和PLT(P=0.002)低于骨质疏松组;骨量减少组的年龄(P<0.001)和PLT(P=0.006)低于骨质疏松组,而β-CTx(P=0.015)、BMI(P=0.014)高于骨质疏松组。非骨质疏松组与骨质疏松组间性别、年龄、BMI、β-CTx、D-dimer和PLT差异有统计学意义(P均<0.05)。二分类Logistic回归显示年龄(OR=1.164,95%CI 1.097~1.236)、性别(OR=0.495,95%CI 0.274~0.896)、BMI(OR=0.890,95%CI 0.816~0.971)、PLT(OR=1.008,95%CI 1.003~1.103)是骨质疏松症发病的危险因素,P均<0.05。ROC分析显示年龄的曲线下面积(AUC)=0.715(95%CI 0.647~0.783),性别AUC=0.612(95%CI 0.539~0.684),BMI AUC=0.694(95%CI 0.622~0.766),PLT AUC=0.610(95%CI 0.539~0.682),四者联合的AUC=0.768(95%CI 0.706~0.829),P均<0.05。结论基于QCT的结果,PLT计数在脊柱退行性疾病�Objective:To explore the value of hemagglutination index in the diagnosis of osteoporosis in patients with spinal degenerative diseases.Methods:In this retrospective study, 313 patients with spinal degenerative diseases who were admitted to the Department of Spine Surgery of Beijing Jishuitan Hospital from November 2018 to April 2020 were selected and divided into osteoporosis group (119 cases), osteopenia group (101 cases) and normal group (93 cases) according to quantitative computed tomography (QCT) detection results. Fasting venous blood samples were taken to test coagulation indicators and bone turnover markers. One-way ANOVA or Kruskal-Wallis H tests were used to analyze the differences among three groups. The independent risk factors associated with Osteoporosis(OP)in patients with spinal degenerative diseases were screened from the blood indices. Furthermore, the osteopenia group and the normal group were combined into the non-osteoporosis group. Binary Logistic regression analysis was performed between the non-osteoporosis group and the osteoporosis group. Receiver operating curve (ROC) was used to evaluate the diagnostic value of relevant indicators in patients with spinal degenerative diseases.Results:Gender (χ^(2)=13.555, P=0.001), age ( F=17.53, P<0.001), Body Mass Index (BMI) ( F=4.068, P=0.018), β-C-terminal telopeptide of type I collagen (β-CTx) (χ^(2)=8.684, P=0.013), 25-hydroxyvitamin D [25(OH)D] (χ^(2)=6.155, P=0.046), D-dimer (χ^(2)=8.111, P=0.017) and platelet (PLT) ( F=6.809, P=0.001) were different significantly among three groups. The age ( P=0.006), D-dimer ( P=0.020) and PLT ( P=0.002) in normal group were remarkably lower than those in osteoporosis group. Age ( P<0.001) and PLT ( P=0.006) in osteopenia group were considerably lower than those in osteoporosis group, while β-CTX ( P=0.015) and BMI ( P=0.014) were significantly higher than those in osteoporosis group. The differences between non-osteoporosis group and osteoporosis group in gender, age, BMI, β-CTx, D-dimer and PLT w

关 键 词：脊柱疾病 骨质疏松 凝血功能 骨代谢指标 

分 类 号：R681.5[医药卫生—骨科学] R580[医药卫生—外科学]