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| 血清高t-PINP /β-CTX比值和正常低TSH水平与老年女性骨质疏松性椎体骨折相关性研究 |
| Research on the correlation between serum high t-PINP /β-CTX ratio, normal low TSH level and osteoporotic vertebral fracture in elderly women |
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| DOI：10.3969/j.issn.1006-7108.2022.02.002 |
| 中文关键词: 促甲状腺素 t-P1NP/β-CTX 老年女性 骨质疏松症 椎体骨折 |
| 英文关键词:thyrotropin t-P1NP/β-CTX elderly women osteoporosis vertebral fracture |
| 基金项目:四川省干部保健科研课题（川干研2019-605） |
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| 中文摘要: |
| 目的 通过测定甲状腺功能正常的老年女性骨质疏松患者促甲状腺素（TSH）及t-PINP/β-CTX比值，研究其与椎体骨折的相关性。方法 选取2018年1月至2019年12月收治入院的年龄≥60岁的老年甲状腺功能正常的骨质疏松症女性患者。依据是否合并椎体骨折将其分为无骨折组（A组）和骨折组（B组）。完成TSH、骨钙素N段中分子片段（N-MID OC）、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）、25-羟基维生素D [25-(OH）VitD]测定。结果 B组与A组比较，TSH含量明显降低，t-PINP、t-PINP/β-CTX及N-MID OC/β-CTX明显增加。老年女性骨质疏松性椎体骨折与TSH呈负相关,与t-PINP、t-PINP/β-CTX呈正相关,与年龄、N-MID OC、β-CTX、25（OH）D及N-MID OC/β-CTX无相关性。TSH与t-PINP呈负相关,与其它骨代谢指标无相关性。二元Logistic回归显示TSH、t-PINP/β-CTX比值为椎体骨折的风险因素，校正OR为0.375(95% CI：0.259~0.544)，1.006(95% CI：1.002~1.010)。三分层显示，TSH含量越低，椎体骨折发生风险越高，最低层是最高层的约14倍，校正OR为13.76（95% CI：5.35~35.38），t-PINP/β-CTX比值越高，椎体骨折风险越高，最高层是最低层的11倍，校正OR为11.11（95% CI：4.11~30.00）。ROC曲线显示TSH 、t-PINP/β-CTX比值的cut-off值为3.27（95% CI：2.42~3.88），91.6（95% CI：64.05~112.54），其AUC为0.72（95% CI：0.657~0.778）、0.696（95% CI：0.632~0.765），有较高的诊断价值。结论 血清高t-P1NP/β-CTX比值和正常低TSH水平与老年女性骨质疏松椎体骨折明显相关，是其独立危险因素，可用于辅助诊断及预测骨质疏松性椎体骨折的发生。 |
| 英文摘要: |
| Objective By measuring the levels of thyroid stimulating hormone (TSH) and t-PINP/β-CTX ratio in elderly women with osteoporosis and normal thyroid function, the objective to study their correlation with spinal fracture. Methods From January 2018 to December 2019, the elderly women with normal thyroid function and osteoporosis and age over 60 years were selected. The patients were divided into no fracture group (group A) and fracture group (group B). TSH, medium molecular fragment of osteocalcin N segment (N-MID OC), total procollagen type Ⅰamino-terminal propeptide (t-PINP), special sequence β Carboxyterminal peptide of collagen I(β-CTX) and 25-hydroxyvitamin D [25-(OH)Vit D] were detected. Results Compared with group A, the content of TSH was significantly reduced in group B,and t-PINP, t-PINP/β-CTX and N-MID OC/β-CTX were significantlyincreased. Osteoporotic vertebral fractures in elderly women were negatively correlated with TSH, positively correlated with t-PINP, t-PINP/β-CTX, and correlated with age, N-MID OC, β-CTX, 25(OH)D and N- MID OC/β-CTX has no correlation. TSH was negatively correlated with t-PINP, and had no correlation with other bone metabolism indexes. Binary logistic regression showed that TSH, t-PINP/β-CTX ratio were the risk factors for vertebral fracture, with adjusted OR of 0.375 (95% CI: 0.259-0.544) and 1.006 (95% CI: 1.002-1.010).Three layers showed that the lower the TSH level, the higher the risk of vertebral fracture, the lowest layer was about 14 times the highest level, the adjusted OR was 13.76（95% CI：5.35-35.38）, and the higher the t-PINP/β-CTX ratio, the higher the risk of vertebral fracture, the highest layer was 11 times the lowest layer, theadjusted OR was 11.11（95% CI：4.11-30.00）. ROC curve analysis showed that cut-off value of TSH and t-PINP/β-CTX were 3.27(95% CI：2.42-3.88), 91.6(95 CI：64.05-112.54), and AUC was 0.72(95% CI:0.657-0.778),0.696(95% CI :0.632-0.765). It had high diagnostic value. Conclusion The serum high t-P1NP/β-CTX ratio and normal low TSH level are obviously related to osteoporosis vertebral fracture in elderly women and are independent risk factors for auxiliary diagnosis and prediction of its occurrence. |
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