残余胆固醇与老年女性骨质疏松骨折及骨代谢相关性研究  

Correlation between residual cholesterol and osteoporosis fractures and bone metabolism in elderly women

作　　者：徐文[1] 邹明[2] 池继敏 XU Wen;ZOU Ming;CHI Jimin(The Affiliated Sport Hospital of Chengdu Sport University,Chengdu 610041,China;Sichuan Provincial Orthopedic Hospital,Chengdu 610041,China)

机构地区：[1]成都体育学院附属体育医院,四川成都610041 [2]四川省骨科医院,四川成都610041

出　　处：《中国骨质疏松杂志》2024年第11期1574-1580,共7页Chinese Journal of Osteoporosis

基　　金：成都市医学科研课题(2022447)。

摘　　要：目的探讨残余胆固醇与老年女性骨质疏松性骨折(osteoporosis fracture,OPF)风险及骨代谢平衡相关性。方法选取2021年1月至2023年12月于成都体育学院附属体育医院就诊的60岁以上女性住院患者共2447例,分为无骨折组(A组,1170例)和骨折组(B组,1277例)。检测总胆固醇(Tch)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDLc)、低密度脂蛋白胆固醇(LDLc)、总Ⅰ型胶原氨基端延长肽(tPINP)、Ⅰ型胶原羧基端肽β特殊序列(β-CTX)、25-羟基维生素D[25-(OH)VitD]、总蛋白(TP)、白蛋白(Alb)、钙(Ca)、磷(P)、镁(Mg)、尿素(Urea)、肌酐(Cr)、胱抑素C(Cys-C)、尿酸(UA)、肾小球滤过率(eGFR)、骨形成T值(FT)、骨吸收T值(RT)、骨转换率(TR)及骨重建平衡(BL)。结果(1)骨折组ALB、Ca、P、HDLc、25-OH-VitD、UA、eGFR、BL含量较无骨折组降低,年龄、Glu、TG、Tch、β-CTX、RT、RC较无骨折组增加,差异有统计学意义(P<0.05)。TP、LDLc、Mg、tPINP、Urea、Cre、Cys-C、FT、TR无统计学意义(P>0.05);(2)年龄、RC、BL、UA、ALB为老年女性骨质疏松性骨折的风险因素,OR分别为1.07(95%CI:1.05~1.08)、3.21(95%CI:2.43~4.25)、0.84(95%CI:0.80~0.89)、0.996(95%CI:0.995~0.997)、0.96(95%CI:0.94~0.98),P<0.05;(3)RC含量越高,OPF风险越高,最高层RC每增加一单位,OPF风险增加3.14倍,校正OR为3.14(95%CI:2.38~4.14)。BL与OPF风险呈U型关系,P<0.01,BL截点为-0.43与2.33;(4)RC与BL呈倒U型关系,P<0.01,RC的截点为1.07 mmol/L。结论RC、BL是老年女性OPF的危险因素。BL与OPF风险呈U型相关,与RC呈倒U型相关。Objective To explore the correlation between remnant cholesterol(RC)and the risk of osteoporosis fracture(OPF)and bone metabolism balance in elderly women.Methods A total of 2447 female inpatients aged 60 and above were selected from January 2021 to December 2023.There were 1170 cases in the non-fracture group(Group A)and 1277 cases in the fracture group(Group B).Total cholesterol(Tch),triglycerides(TG),high-density lipoprotein cholesterol(HDLc),low-density lipoprotein cholesterol(LDLc),total procollagen typeⅠamino-terminal propeptide(tPINP),carboxy terminal peptide of type I collagenβSpecial sequence(β-CTX),25 hydroxyvitamin D(25-OH VitD),total protein(TP),albumin(Alb),calcium(Ca),phosphorus(P),magnesium(Mg),Urea(Urea),creatinine(Cr),cystatin C(Cys-C),uric acid(UA),glomerular filtration rate(eGFR),bone formation T score(FT),bone resorption T score(RT),bone turnover rate(TR),and bone remodeling balance(BL)were detected.Results(1)ALB,Ca,P,HDLc,25-OH VitD,UA,eGFR and BL in fracture group decreased compared to the non-fracture group.Age,Glu,TG,Tch,β-CTX,RT and RC increased compared to the non-fracture group,with a statistically significant difference(P<0.05).TP,LDLc,Mg,tPINP,Urea,Cre,Cys-C,FT and TR showed no statistical significance(P>0.05);⑵Age,RC,BL,UA,and ALB are risk factors for osteoporotic fractures in elderly women,with OR values of 1.07(95%CI:1.05-1.08),3.21(95%CI:2.43-4.25),0.84(95%CI:0.80-0.89),0.996(95%CI:0.995-0.997),0.96(95%CI:0.94-0.98),P<0.05;(3)The higher the RC content,the higher the risk of OPF in elderly women.For every unit increase in the highest RC,the risk of OPF increased by 3.14 times,with a adjusted OR of 3.14(95%CI:2.38-4.14).There is a U-shaped relationship between BL and OPF risk(P<0.019),with BL cutoff points of-0.43 and 2.33;(4)RC and BL had an inverted U-shaped relationship(P<0.01),and the cutoff point of RC was 1.07 mmol/L.Conclusion RC and BL are risk factors for OPF in elderly women.BL is associated with an U-shaped risk of OPF and an inverted U-shaped risk of RC.

关 键 词：骨重建平衡 残余胆固醇 老年女性 骨质疏松症 骨折 

分 类 号：R683.2[医药卫生—骨科学]