骨质疏松患者抗苗勒管激素与骨标志物和雌激素的相关性研究

摘要

目的 研究未绝经女性骨质疏松患者血清抗苗勒管激素(anti-Mullerian hormone,AMH)与骨代谢指标:Ⅰ型原胶原氨基端延长肽(TPINP),β胶原特殊序列(β-CTX),25-羟基维生素D[25(OH)D],甲状旁腺激素(PTH),血清骨钙素(OC)及雌激素(E2)的相关性,为防治骨质疏松提供依据.方法 选取2014年12月～2016年3月在西安市红会医院骨质疏松门诊首次就诊的未绝经女性患者159例,根据骨密度(BMD)值将患者分为骨质疏松组(43例),骨量减少组(56例),骨量正常组(60例).用罗氏电化学发光免疫分析仪测定血清中AMH,E2,TPINP,OC,β-CTX,25(OH)D和PTH水平.组间两两比较采用独立样本t检验,各指标与AMH相关性采用Pearson相关分析,通过ROC曲线分析AMH对骨量减少的诊断价值.结果 骨质疏松组、骨量减少组AMH,E2平均水平明显低于骨量正常组(t=-6.183～-0.956,P=0.000～0.040),差异有统计学意义,且三组AMH呈先增高后降低趋势;骨质疏松组TPINP,OC,β-CTX,PTH明显高于骨量正常组(t=3.159～5.973,P=0.000～0.010),差异有统计学意义.骨质疏松组25(OH)D与骨量减少组、骨量正常组比较(t=-0.938～-0.469,P=0.351～0.640),差异无统计学意义.相关分析显示:AMH和BMD(r=0.422,P=0.000)呈正相关,和TPINP(r=-0.184,P=0.020),β-CTX(r=-0.173,P=0.030),OC(r=-0.238,P=0.003)呈负相关,但与E2(r=0.150,P=0.059),25(OH)D(r=0.036,P=0.652),PTH(r=-0.140,P=0.078)无相关性;ROC分析显示:骨质疏松组、骨量减少组和骨量正常组比较,AMH的ROC曲线下面积(AUC)为0.728(95％CI:0.652～0.795),AMH敏感度为78.79％,特异度为63.33％.结论 AMH是预测骨量减少的良好指标.%Objective To assess the serum level of anti-Mullerian hormone (AMH) in premenopausal women with osteoporosis and its correlation with bone biochemical markers and estrogen (E2).Methods From December 2014 to March 2016,159 subjects of premenopausal women in the osteoporosis outpatient clinic of Xi'an Honghui Hospital were selected.According to the bone mineral density (BMD),the patients were divided into osteoporosis group (43 cases),osteopenia group (56 cases),bone mass normal group (60 cases).AMH,E2,TPINP,OC,β-CTX,25(OH)D and PTH were measured by automatic electrochemiluminescence immunoassay system (ECLIA).T-test and Pearson correlation analysis were used to describe the statistics.The date with statistical significance were analyzed by receiver operating characteristic(ROC) curve.Results The serum AMH level in osteoporosis and osteopenia groups were respectively lower than the normal group (t=-6.183～-0.956,P=0.000～0.040).The TPINP,OC,β-CTX and PTH in osteoporosis were much higher than the normal group (t=3.159 ～ 5.973,P=0.000 ～ 0.010),all of them was a statistical significance.The 25 (OH)D had no statistical significance between the three groups (t=-0.938～-0.469,P=0.351～0.640).The serum AMH level of three groups firstly increased (20～25) and then decreased (＞25) with age increasing.AMH was positively correlated with BMD (r=0.422,P=0.000),but negatively correlated with TPINP (r=-0.184,P =0.020),β-CTX (r=-0.173,P=0.030),OC (r=-0.238,P=0.003).There were no correlation with E2 (r=0.150,P=0.059),25(OH)D (r=0.036,P=0.652),PTH (r=-0.140,P=0.078).The area under the ROC curve was 0.728.Conclusion The serum AMH level was a better parameter for predicting low bone mass.