中国骨质疏松杂志

血清低Alb和低NMID-OC/β-CTX比值与老年女性骨质疏松性骨折的相关性

Relationship between low serum Alb and NMID-OC/β-CTX ratio and the osteoporotic fracture in elderly women

DOI：10.3969/j.issn.1006-7108.2022.06.008

英文关键词:albumin NMID-OC/β-CTX elderly women osteoporosis fracture

基金项目:四川省干部保健科研课题（川干研2019-605）

作者	单位
徐文1 邹明2 岳建彪2∗	1.成都体育学院附属体育医院，四川成都 610041 2.四川省骨科医院，四川成都 610041

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中文摘要:

目的探讨Alb及NMID-OC/β-CTX比值与老年女性骨质疏松骨折风险的相关性。方法选取2019年1月至2020年12月年龄大于60岁的女性住院患者。无骨质疏松骨折组（A组）491例和骨折组（B组）362例。测定骨钙素N段中分子片段（N-MID OC）、总Ⅰ型前胶原氨基端延长肽（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]、白蛋白（Alb）、血红蛋白（Hb）、钙（Ca）、磷（P）及镁（Mg）。结果（1）与A组相比，B组Hb [118(108，128) VS. 124(114，131)]、NMID-OC [14.7(10.7，20.1) VS. 15.9(11.3，22.6)]、25（OH）Vit-D[18.1(14.3,23.1) VS. 19.5(15.7，25.2)]、NMID-OC/β-CTX[27.1(21.9，37.1) VS. 35.7(26.2，49.9)]、ALB[37.1(34.8，39.8) VS. 39.1(36.9，41.8)]、Ca[2.25(2.17，2.33) VS. 2.29(2.21，2.36)]、Mg[0.86(0.8，0.92) VS. 0.88(0.83，0.92)]降低，P均＜0.01；年龄[75.43±7.54 VS. 72.24±7.27，P＜0.01]及β-CTX [0.55(0.31，0.78) VS 0.49(0.25，0.75)，P＜0.05]升高，差异有统计学意义。（2）骨折与Hb、NMID-OC、25（OH）Vit-D、NMID-OC/β-CTX、ALB、Ca、Mg呈负相关（r分别为-0.18、-0.09、-0.10、-0.23、-0.26、-0.16、-0.10，P均＜0.05），与年龄、β-CTX呈正相关（r分别为0.22、0.07，P均＜0.05）。（3）NMID-OC/β-CTX、Alb为老年女性骨折的风险因素，校正OR分别为0.986(95%CI：0.979～0.993)、0.918(95%CI：0.883～0.955)，P均＜0.05。Alb、NMID-OC/β-CTX比值三分层显示含量越低，骨折风险越高，最低层是最高层的约2倍和5倍，校正OR为1.736、4.695。单独与二者联合检测均可用于骨折的诊断，但联合检测可提高诊断性能，其AUC为0.68，差异有统计学意义，其敏感性、特异性、阳性预示值、阴性预示值分别为70.17%、58.66%、55.6%、72.7%。结论血清低Alb和低NMID-OC/β-CTX比值与老年女性骨质疏松性骨折明显相关，是其危险因素，可用于辅助诊断及预测其发生。

英文摘要:

Objective To study the correlation between Alb and NMID-OC/β-CTX ratio and the risk of osteoporosis fracture in elderly women. Methods Female inpatients over 60 years old were selected from January 2019 to December 2020. There were 491 cases without osteoporotic fractures in group A and 362 cases with osteoporotic fractures in group B. Medium molecular fragment of osteocalcin N segment (N-MID OC), total procollagen typeⅠamino-terminal propeptide (t-PINP), special sequence β carboxyterminal peptide of collagen I (β-CTX), 25-hydroxyvitamin D (25-(OH)Vit D), albumin (ALB), hemoglobin (Hb), calcium (Ca), phosphorus (P), and magnesium (Mg) were measured. Results (1) Compared with those in group A, Hb [118 (108, 128) vs. 124 (114, 131)], NMID-OC [14.7 (10.7, 20.1) vs. 15.9 (11.3, 22.6)], 25(OH)Vit-D [18.1 (14.3, 23.1) vs. 19.5 (15.7, 25.2)], NMID-OC/β-CTX [27.1 (21.9, 37.1) vs. 35.7 (26.2, 49.9)], ALB [37.1 (34.8, 39.8) vs. 39.1 (36.9, 41.8)], Ca [2.25 (2.17, 2.33) vs. 2.29 (2.21, 2.36)], Mg [0.86 (0.8, 0.92) vs. 0.88 (0.83, 0.92)] decreased in group B (all P<0.01). Age [75.43±7.54 vs. 72.24±7.27, P<0.01] and β-CTX [0.55 (0.31, 0.78) vs. 0.49 (0.25, 0.75), P<0.05] increased, and the difference was statistically significant. (2) Correlation analysis showed that the fracture was negatively correlated with Hb, NMID-OC, 25(OH)Vit-D, NMID-OC/β-CTX, Alb, Ca, and Mg (r=-0.18, -0.09, -0.10, -0.23, -0.26, -0.16, and -0.10, respectively, all P<0.05), and positively correlated with age and β-CTX (r=-0.22, 0.07, respectively, both P<0.05). (3) NMID-OC/β-CTX and Alb were risk factors of the fracture in elderly women, and the adjusted OR were 0.986 (95% CI: 0.979-0.993) and 0.918 (95% CI: 0.883-0.955), respectively, both P<0.05. The lower the content of Alb and NMID-OC/β-CTX, the higher the risk of fracture. The lowest layer was about 2 times and 5 times of the highest layer, and the adjusted OR was 1.736 and 4.695. Both of them could be used in the diagnosis of the fracture, but the combined use could improve the diagnostic performance. The AUC was 0.68, and the difference was statistically significant. The sensitivity, specificity, positive predictive value, and negative predictive value were 70.17%, 58.66%, 55.6%, and 72.7%, respectively. Conclusion Low serum Alb and NMID OC/β-CTX ratio are significantly associated with osteoporotic fractures in elderly women, which are risk factors for osteoporotic fractures and can be used for auxiliary diagnosis and prediction of its occurrence.

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