血清肌酐和血红蛋白及BMI与西藏地区藏族中老年居民骨质疏松的相关性及其预测价值分析  

Correlation of serum creatinine,hemoglobin and BMI with osteoporosis and its predictive value in middle-aged and elderly Tibetan residents in Xizang

作　　者：丁康致 王鹏 张静 张玉飞 熊海 DING Kangzhi;WANG Peng;ZHANG Jing;ZHANG Yufei;XIONG Hai(Medical College of Tibet University,Lhasa 850000;Department of Laboratory,West China School of Public Health/West China Fourth Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]西藏大学医学院,西藏拉萨850000 [2]四川大学华西公共卫生学院/华西第四医院检验科,四川成都610041

出　　处：《西安交通大学学报（医学版）》2024年第6期1013-1019,共7页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：中央财政支持地方高校改革发展专项资金(No.00060585,No.00060695/051);西藏自治区高层次人才引进资助项目(No.18080273)。

摘　　要：目的分析血清肌酐(Cr)、血红蛋白(HGB)及体质量指数(BMI)与西藏地区藏族中老年居民骨质疏松症的关系以及对骨质疏松症的预测价值。方法于2021年11月至2023年8月间,采取多阶段随机整群抽样的方法,在西藏阿里地区(普兰县、札达县、日土县、改则县)、那曲市(那曲县、尼玛县、安多县、双湖县、班戈县)、山南市(隆子县)、拉萨市(尼木县)采集564名藏族中老年居民的人口学、血液指标及骨密度等信息。按其是否患有骨质疏松分为骨质疏松组(90例)及非骨质疏松组(474例)。采用Pearson相关法分析骨密度(bone mineral density,BMD)与各变量的相关性。采用二元Logistic回归分析藏族中老年居民骨质疏松症的相关影响因素,构建预测骨质疏松的高风险因素回归方程模型,使用Hosmer-Lemeshow检验模型的拟合度。采用受试者工作特征(receive operating characteristic,ROC)曲线评估血清Cr、HGB和BMI联合检测对西藏地区藏族中老年居民骨质疏松的预测效能。结果女性骨质疏松患病率高于男性。骨质疏松组身高、体质量、谷丙转氨酶、谷草转氨酶、尿素氮、尿酸、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、同型半胱氨酸、血清Cr、HGB、BMI水平显著降低(P<0.05)。相关性分析结果显示,年龄与BMD呈负相关,体质量、血清Cr、HGB、BMI与BMD呈正相关(P<0.05)。多因素二元Logistic结果显示,年龄(OR=1.085)、血清Cr(OR=0.891)、BMI(OR=0.475)、HGB(OR=0.966)是发生骨质疏松症的影响因素(P<0.05)。建立预测骨质疏松症患病风险的Logit(P)模型=6.265+0.086×年龄+(-0.109×Cr)+(-0.020×HGB)+(-0.213×BMI)。该模型ROC曲线下面积为0.932,灵敏度为88.9%,特异度为82.5%。Hosmer-Lemeshow检验模型的拟合度良好(P=0.960),根据Logit(P)模型可计算L评分=-29.413+(-0.404×年龄)+0.512×Cr+0.094×HGB+BMI,当L评分>8.9时,可诊断该患者患病。结论西藏地区藏族中老年居民随增龄,Objective To analyze the correlation of serum creatinine(Cr),hemoglobin(HGB)and body mass index(BMI)with osteoporosis in middle-aged and elderly Tibetan residents in Xizang and its predictive value for osteoporosis.Methods Between November 2021 and August 2023,using multistage random cluster sampling method information on demographics,we collected blood indices and bone mineral density from 564 middle-aged and elderly Tibetan residents in Ali(Pulan,Zada,Ritu,and Rezhe counties),Nagchu(Nagchu,Nyima,Amdo,S huanghu,and Bango counties),Shannan(Lunzi county),and Lhasa(Nimu county),Tibetan regions.They were divided into osteoporosis group(90 cases)and non-osteoporosis group(474 cases)according to whether they suffered from osteoporosis or not.Pearson correlation method was used to analyze the correlation between bone mineral density(BMD)and each variable.Binary Logistic regression was used to analyze the related influencing factors of osteoporosis in middle-aged and elderly Tibetan residents,and the regression equation model of predicting the risk factors of osteoporosis was constructed.The fitting degree of the model was tested by Hosmer-Lemeshow test model.Receiver operating characteristic(ROC)curve was used to evaluate the predictive efficacy of serum Cr,HGB and BMI combined tests on osteoporosis in middle-aged and elderly Tibetan residents in Xizang.Results The prevalence of osteoporosis was higher in females than in males.Among the osteoporosis group,height and weight,alanine aminotransferase,glutamine aminotransferase,urea nitrogen,uric acid,total cholesterol,triglyceride,low-density lipoprotein cholesterol,homocysteine,serum Cr,HGB and BMI were significantly lower(P<0.05).Correlation analysis showed that age was negatively correlated with BMD,while body weight,serum Cr,HGB and BMI were positively correlated with BMD(P<0.05).Multivariate binary Logistic results showed that age(OR=1.085),serum Cr(OR=0.891),BMI(OR=0.475),and HGB(OR=0.966)were the influencing factors for the occurrence of osteoporosis(P<0.05).To est

关 键 词：西藏地区 中老年藏族居民 骨质疏松 预测价值 

分 类 号：R681.1[医药卫生—骨科学]