骨代谢相关指标及不同部位骨密度的检测在绝经后女性骨质疏松筛查中的应用  

Application of bone metabolism indexes and detection of bone mineral density in screening osteoporosis in post⁃menopausal women

作　　者：吴莉青 杨熠菲 严平 WU Liqing;YANG Yifei;YAN Ping(Department of Clinical Laboratory,Fuyang Chinese Orthope-dics&Traumatology Hospital,Hangzhou 311400,China)

机构地区：[1]杭州市富阳中医骨伤医院检验科,浙江杭州311400

出　　处：《全科医学临床与教育》2024年第11期966-969,共4页Clinical Education of General Practice

基　　金：国家重点研发计划项目子课题(2021YFC2501700)。

摘　　要：目的探讨骨代谢相关指标甲状旁腺激素(PTH)、血清25-羟基维生素D[25(OH)D]、β-胶原特殊序列(β-CTx)、总Ⅰ型胶原氨基端延长肽(t-P1NP)、N端骨钙素(N-MID)及腰椎、股骨骨密度的检测在绝经后女性骨质疏松临床诊断中的应用价值。方法收集骨科及疼痛科门诊就诊且完成骨质疏松筛查的绝经后女性患者共150例,根据骨密度结果分为骨质疏松组和非骨质疏松组。分析不同部位的骨密度T值对骨质疏松筛查诊断结果的影响;比较不同组别患者的年龄、体重指数(BMI)及骨代谢相关指标,同时应用受试者工作特征(ROC)曲线分析年龄、BMI、单一骨代谢检测指标及联合指标对骨质疏松的诊断价值。结果参照不同部位骨密度T值进行骨质疏松的筛查诊断,筛查结论的一致性较差(Kappa=0.28);骨质疏松组的年龄高于非骨质疏松组,BMI低于非骨质疏松组,差异均有统计学意义(Z=-2.97,t=2.46,P均<0.05)。两组的PTH、25(OH)D、β-CTx、t-P1NP和N-MID水平比较,差异均无统计学意义(Z分别=-0.83、-0.72、-0.99、-0.43、-0.85,P均>0.05)。骨代谢相关指标与骨密度结果的相关性分析显示,25(OH)D、β-CTx与左股骨股骨颈骨密度、T值呈负相关(r分别=-0.20、-0.18、-0.18、-0.20,P均<0.05)。骨代谢单一指标检测对骨质疏松筛查的诊断效能不高(AUC在0.52~0.54),联合指标分析对骨质疏松筛查诊断的效能(AUC=0.72)明显优于单一指标(Z分别=3.24、3.14、2.80、2.94、3.10,P均<0.05)。结论不同部位骨密度的检测对骨质疏松的筛查诊断结论有影响;单一骨代谢指标与骨质疏松之间未发现有明显的关联,但指标的联合检测对骨质疏松的筛查及辅助诊断有一定的价值。Objective To explore the value of bone metabolism indexes such as parathyroid hormone(PTH),serum 25-hydroxy vitamin D[25(OH)D],β-collagen special sequence(β-CTx),total typeⅠcollagen amino-terminal prolon⁃gation peptide(t-P1NP),N-terminal osteocalcin(N-MID),and lumbar vertebrae and femur bone mineral density(BMD)in the clinical diagnosis of osteoporosis in postmenopausal women.Methods A total of 150 postmenopausal fe⁃male patients who completed osteoporosis screening were collected from orthopedics and pain clinics,and divided into os⁃teoporosis group and non-osteoporosis group according to BMD results.The impact of BMD T value in different parts on the diagnosis result of osteoporosis screening was analyzed.Age,body mass index(BMI)and bone metabolism related in⁃dexes of patients in different groups were compared.Meanwhile,ROC curve was used to analyze the diagnostic value of age,BMI,bone metabolism single index and combined index in osteoporosis.Results The screening diagnosis of osteo⁃porosis with reference to the T value of BMD at differ⁃ent sites showed poor consistency of the screening con⁃clusions(Kappa=0.28).The age of the osteoporosis group was higher than that of the non-osteoporosis group,and the BMI was lower than that of the non-os⁃teoporosis group,with statistical significance(Z=-2.97,t=2.46,P<0.05).There were no significant differences in PTH,25(OH)D,β-CTx,t-P1NP and N-MID levels between the two groups(Z=-0.83,-0.72,-0.99,-0.43,-0.85,P>0.05).Correlation analysis of bone metabolism related indexes and bone mineral density results showed that 25(OH)D andβ-CTx were negatively correlated with bone mineral density and T value of femoral neck of left fe⁃mur(r=-0.20,-0.18,-0.18,-0.20,P<0.05).The diagnostic efficacy of single index of bone metabolism for osteoporosis screening was not high(AUC 0.52-0.54),and the diagnostic efficacy of combined index analysis for osteoporosis screen⁃ing(AUC=0.72)was significantly better than that of single index(Z=3.24,3.14,2.80,2.94,3.10,P<0.05).Con

关 键 词：骨质疏松 骨代谢 骨密度 

分 类 号：R580[医药卫生—内分泌]