目的：探讨骨代谢标志物在社区绝经后骨质疏松症患者发生髋部骨质疏松及骨折诊治过程中的临床意义。方法选取2014年度在江桥镇社区卫生服务中心就诊的绝经后骨质疏松症患者118例，采用双能 X 线吸收仪检测骨密度（BMD）；采用放射免疫法检测Ⅰ型胶原氨基末端延长肽（PINP），酶联免疫吸附测定法检测 S 型Ⅰ型胶原交联羧基末端肽（S-CTX），化学发光法检测1，25二羟维生素 D3〔1，25（OH）2 D3〕水平。运用骨质疏松性骨折风险预测简易工具（FRAX）软件评估骨质疏松症骨折风险，系统自动计算患者未来10年内发生髋部骨质疏松及骨折概率。采用多元线性回归分析 BMD 及各项骨代谢指标与骨折概率的相关性。结果患者 BMD 为_5.0˜_2.5，平均（_3.6±0.7）；PINP 水平为18˜141 ng/ L，平均（57±24） ng/ L；S-CTX水平为0.14˜1.18μg/ L，平均（0.48±0.19）μg/ L；1，25（OH）2 D3水平为4˜92μg/ L，平均（32±16）μg/ L。FRAX 软件结果显示，患者未来10年内发生髋部骨质疏松概率为2.5%˜13.9%，平均（5.6±2.0）%；患者未来10年内发生髋部骨折概率为0˜7.9%，平均（2.2±1.4）%。多元线性回归分析结果显示，BMD 与未来10年内髋部骨质疏松及骨折概率均呈负相关（β=_4.681，SE=1.291，t =_3.626，P <0.05；β=_2.923，SE =0.955，t =_3.060，P <0.05）。PINP 与未来10年内髋部骨质疏松及骨折概率均呈正相关（β=0.065，SE =0.006，t =10.759，P <0.05；β=0.044，SE =0.004，t =9.807，P <0.05）。S-CTX与未来10年内髋部骨质疏松及骨折概率均呈正相关（β=1.709，SE =0.628，t =2.723，P <0.05；β=1.241，SE =0.465，t =2.672，P <0.05）。1，25（OH）2 D3与未来10年内髋部骨质疏松及骨折概率无线性相关性（β=_0.010，SE =0.007，t =_1.401，P >0.05；β=_0.010，SE =0.005，t =_1.906，P >0.05）。结论 PINP 及S-CTX与绝经后骨质疏松症患者未来10年内髋部骨质疏松及骨折概率具有正相关性，提示 PINP 及S-CTX在早期预警骨质疏松及骨折风险中均有重要意义。%Objective To investigate the clinical significance of bone metabolic markers in the assessment of hip osteoporosis and fracture of postmenopausal osteoporosis patients. Methods In 2014, we enrolled 118 postmenopausal osteoporosis patients who received treatment in Jiangqiao Town Community Health Service Center. Bone mineral density(BMD) was examined using dual _ energy X _ ray absorptiometry;PINP was examined using radioimmunoassay;S-CTX was detected by enzyme linked immunosorbent assay;the level of 1,25(OH)2 D3 was detected by chemiluminescence method. Fracture risk was evaluated using FRAX,and the 10 _ year probability of hip osteoporosis and the probability of hip fracture were calculated automotically by the system. Correlation analysis was conducted between BMD,each bone metabolism index and the probability of fracture using multivariate linear regression analysis. Results The BMD of the patients was _ 5. 0 _ 2. 5,being( _ 3. 6 ± 0. 7)on average;the PINP level was 18 _ 141 ng/ L,being(57 ± 24)ng/ L on average;the S-CTX level was 0. 14 _ 1. 18μg/ L,being(0. 48 ± 0. 19) μg/ L on average;the 1,25(OH)2 D3 level was 4 _ 92 μg/ L,being(32 ± 16) μg/ L on average. FRAX software showed that the 10 _ year probability of hip osteoporosis was 2. 5% _ 13. 9% ,being(5. 6 ± 2. 0)% on average;the 10 _ year probability of hip fracture was 0 _ 7. 9% ,being(2. 2 ± 1. 4)% on average. Multivariate linear regression analysis showed that BMD was negatively correlated with the 10 _ year probability of hip osteoporosis and the probability of hip fracture(β = _ 4. 681,SE = 1. 291,t = _ 3. 626,P < 0. 05;β = _ 2. 923,SE = 0. 955,t = _ 3. 060,P < 0. 05). PINP was positively correlated with the 10 _ year probability of hip osteoporosis and the probability of hip fracture( β = 0. 065,SE= 0. 006,t = 10. 759,P < 0. 05;β = 0. 044,SE = 0. 004,t = 9. 807,P < 0. 05). S-CTX was positively correlated with the 10 _ year probability of hip osteoporosis and the probability of hip fracture(β = 1. 709,SE = 0. 628,t = 2. 723,P < 0. 05;β= 1. 241,SE = 0. 465,t = 2. 672,P < 0. 05). There was no significant correlation between the level of 1,25(OH)2 D3 and the 10 _ year probability of hip osteoporosis and the probability of hip fracture(β = _ 0. 010,SE = 0. 007,t = _ 1. 401,P >0. 05;β = _ 0. 010,SE = 0. 005,t = _ 1. 906,P > 0. 05). Conclusion PINP and S-CTX are positively correlated with the 10 _ year probability of hip osteoporosis and the probability of hip fracture in postmenopausal osteoporosis patients. PINP and S-CTX have significance in the early detection of osteoporosis and fracture risk.
展开▼
