血清雌激素铁调素 t-PINP/β-CTX比值联合预测老年女性骨质疏松患者骨折风险的价值

doi:10.3969/j.issn.1006-6233.2024.12.026

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摘要 目的: 探讨血清雌激素(E₂)、铁调素(Hepcidin)、总Ⅰ型胶原氨基端延长肽(t-PINP)/Ⅰ型胶原羧基端肽β特殊序列(β-CTX)比值联合预测老年女性骨质疏松(OP)患者骨折风险的价值。方法: 选取2021年1月至2023年6月老年女性OP患者205例,根据随访1年期间是否发生骨折分为骨折组与未骨折组,两组均于患者入院当日清晨采集静脉血标本,采用化学发光法检测血清E₂、Hepcidin、血清t-PINP、β-CTX水平,比较两组基线资料、血清E₂、Hepcidin、t-PINP/β-CTX比值水平,分析血清E₂、Hepcidin、t-PINP/β-CTX对骨折风险的预测价值。结果: 随访1年,失访4例,共201例患者完成随访,其中63例发生骨折,138例未发生骨折,骨折发生率为31.34%,将发生骨折与未发生骨折的患者分别纳入骨折组与未骨折组。骨折组年龄、绝经年限、脆性骨折史、雌激素使用史高于未骨折组,髋部、腰椎、Wald三角区骨密度低于未骨折组(P<0.05);骨折组血清E₂、Hepcidin、t-PINP/β-CTX比值分别为(25.65±4.63)pg/mL、(76.16±15.82)ng/mL、(126.50±15.25),低于未骨折组(32.71±5.09)pg/mL、(102.43±18.90)ng/mL、(152.68±20.10),t-PINP、β-CTX分别为(60.72±6.57)ng/mL、(0.48±0.10)ng/mL高于未骨折组(56.49±5.03)ng/mL、(0.37±0.08)ng/mL(t=9.378、9.600、5.007、8.342、9.196,P均<0.001);血清E₂、Hepcidin、t-PINP/β-CTX比值与髋部、腰椎、Wald三角区骨密度呈正相关(r=0.622、0.641、0.658、0.609、0.617、0.634、0.710、0.729、0.746,P均<0.001);在控制年龄、绝经年限、脆性骨折史、雌激素使用史等其他因素前后,血清E₂、Hepcidin、t-PINP/β-CTX比值仍是老年女性OP患者骨折的独立影响因素(P<0.05);血清E₂、Hepcidin、t-PINP/β-CTX比值预测老年女性OP患者骨折的AUC分别为0.810、0.789、0.760,最佳截断值分别为27.77pg/mL、88.49ng/mL、142.52,敏感度分别为68.25%、76.19%、73.02%,特异度分别为76.81%、74.64%、74.64%;三者联合预测老年女性OP患者骨折的AUC为0.918(95%CI:0.871~0.952),敏感度为87.30%,特异度为83.33%,明显优于三者单独预测(P<0.05)。结论: 血清E₂、Hepcidin、t-PINP/β-CTX比值与老年女性OP患者骨密度显著相关,是发生骨折的独立影响因素,联合预测骨折风险的价值可靠。

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关键词 ：老年女性, 骨质疏松, 雌激素, 铁调素, 总Ⅰ型胶原氨基端延长肽, Ⅰ型胶原羧基端肽β特殊序列, 骨折风险

Abstract：Objective: To investigate the combined value of serum estrogen (E₂), ferriregulation (Hepcidin) and the ratio of total type I collagen amino terminal prolongating peptide (t-PINP)/Type I collagen carboxy-terminal peptide β special sequence (β-CTX) in predicting fracture risk in elderly women with osteoporosis (OP).Methods: A total of 205 elderly female OP patients from January 2021 to June 2023 were selected and divided into fracture group and non-fracture group according to whether they had fractures during the 1-year follow-up period. Venous blood samples were collected from both groups on the admission morning of the patient. The levels of serum E₂, Hepcidin, serum t-PINP, and β-CTX were detected using chemiluminescence. Baseline data, serum E₂, Hepcidin, and t-PINP/β-CTX ratio levels were compared between the two groups. The predictive value of serum E₂, Hepcidin, and t-PINP/β-CTX for fracture risk was analyzed.Results: After a year of follow-up, the contact of 4 patients were lost, and a total of 201 patients completed the follow-up. Among them, 63 cases had fractures and 138 cases had no fractures, with a fracture incidence at 31.34%. Patients with and without fractures were included in the fracture group and non-fracture group, respectively. The age, menopausal years, history of fragility fractures, and history of estrogen use in the fracture group were higher than those in the non-fracture group, while the bone mineral density of the hip, lumbar spine, and Wald triangle area was lower than that in the non-fracture group (P<0.05). The serum E₂, Hepcidin, and t-PINP/β-CTX ratios in the fracture group were (25.65±4.63) pg/mL, (76.16±15.82) ng/mL, and (126.50±15.25), respectively, which were lower than those in the non-fracture group (32.71±5.09) pg/mL, (102.43±18.90) ng/mL, and (152.68±20.10). The t-PINP and β-CTX were (60.72±6.57) ng/mL and (0.48±0.10) ng/mL, respectively, which were higher than those in the non-fracture group (56.49±5.03) ng/mL and (0.37±0.08) ng/mL (t=9.378, 9.600, 5.007, 8.342, 9.196, all P<0.001). Serum E₂, Hepcidin, and t-PINP/β-CTX ratio were positively correlated with bone mineral density in the hip, lumbar spine, and Wald triangle area (r=0.622, 0.641, 0.658, 0.609, 0.617, 0.634, 0.710, 0.729, 0.746, all P<0.001). Serum E₂, Hepcidin and t-PINP/β-CTX ratio were still independent influencing factors for fracture in elderly female OP patients before and after controlling for age, menopause years, fragility fracture history, estrogen use history and other factors (P<0.05). Serum E₂, Hepcidin and t-PINP/β-CTX ratios predicted the fracture AUC of elderly female OP patients to be 0.810, 0.789 and 0.760, respectively, and the optimal cut-off values were 27.77 pg/mL, 88.49 ng/mL and 142.52, respectively. Sensitivity was 68.25%, 76.19%, 73.02%, and specificity was 76.81%, 74.64%, 74.64%, respectively. The AUC of fracture predicted by the combination of the three methods was 0.918 (95%CI: 0.871-0.952), the sensitivity was 87.30%, and the specificity was 83.33%, which was significantly better than that predicted by the three methods alone (P<0.05).Conclusion: Serum E₂, Hepcidin and t-PINP/β-CTX ratios are significantly correlated with bone mineral density in elderly female OP patients, and are independent influencing factors for fracture occurrence, and the combined value of predicting fracture risk is reliable.

Key words： Elderly women Osteoporosis Estrogen Ferrimodulin Total type I collagen amino terminal extension peptide Special sequence of carboxy-terminal peptide β of type I collagen Fracture risk

基金资助:湖北省自然科学基金资助项目,(编号:2020CDB1249)

通讯作者: 胡珊

引用本文:

吴旭磊, 刘坤, 王承良, 刘丹, 张白雪, 胡珊. 血清雌激素铁调素 t-PINP/β-CTX比值联合预测老年女性骨质疏松患者骨折风险的价值[J]. 河北医学, 2024, 30(12): 2078-2084.
WU Xulei, LIU Kun, WANG Chengliang, et al. Value of Combined Serum Estrogen, Sideromodulin, and t-PINP/β-CTX Ratio for Prediction of Fracture Risk in Elderly Women with Osteoporosis. HeBei Med, 2024, 30(12): 2078-2084.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2024.12.026 或 http://www.hbyxzzs.cn/CN/Y2024/V30/I12/2078

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