β-CTX、t-P1NP及N-MID-OT在绝经后女性骨质疏松性骨折风险评估中的应用

The application ofβ-CTX,t-P1NP and N-MID-OT in the risk assessment of osteoporosis fractures in postmenopausal women

目的探讨β胶原特殊序列(β-crosslaps,β-CTX)、总1型胶原氨基端延长肽(t-P1NP)及N端中段骨钙素(N-MID-OT)在绝经后女性骨质疏松性骨折风险评估中的应用价值。方法回顾性分析2020年2月至2022年12月解放军总医院第六医学中心收治的102例绝经后骨质疏松(postmenopausal osteoporosis,PMOP)患者的临床资料,将其作为研究组,并根据是否发生骨折将其分为PMOP骨折组(39例)与PMOP未骨折组(63例),另选100名健康体检者作为对照组。记录所有研究对象的β-CTX、t-P1NP及N-MID-OT水平并进行比较,用ROC曲线评价β-CTX、t-P1NP及N-MID-OT在绝经后女性骨质疏松性骨折风险评估中的应用价值。结果研究组的平均体重、体质量指数、股骨颈骨密度(bone mineral density,BMD)、左髋总和BMD及L 1~4总和BMD均明显低于对照组(P<0.05);而两组研究对象的平均年龄、平均身高及绝经年龄等比较差异均无统计学意义(P>0.05)。研究组的β-CTX、t-P1NP及N-MID-OT均明显高于对照组(t值依次为12.688、37.430、26.599,P<0.05)。β-CTX+t-P1NP+N-MID-OT联合检测用于预测PMOP的AUC值为0.978,敏感度为98.04%,特异度为97.00%,表明β-CTX+t-P1NP+N-MID-OT三指标联合检测用于预测PMOP的效能更高。PMOP骨折组的β-CTX、t-P1NP及N-MID-OT均明显高于PMOP未骨折组(t值依次为6.078、16.363、12.227,P<0.05)。β-CTX+t-P1NP+N-MID-OT联合检测用于评估PMOP骨折风险的AUC值为0.939,敏感度为94.87%,特异度为95.24%,表明β-CTX+t-P1NP+N-MID-OT联合检测用于评估PMOP骨折风险的效能更高。结论PMOP患者β-CTX、t-P1NP及N-MID-OT水平均明显升高,而PMOP骨折患者β-CTX、t-P1NP及N-MID-OT水平升高更为明显,且β-CTX+t-P1NP+N-MID-OT联合检测可显著提高对PMOP预测及骨折风险评估效能,值得借鉴。

Objective To discuss the application value ofβ-CTX,t-P1NP and N-MID-OT in the risk assessment of osteoporosis fractures in postmenopausal women.Methods A retrospective analysis was conducted on the clinical data of 102 postmenopausal osteoporosis(PMOP)patients who admitted to our hospital from Feb 2020 to Dec 2022,which were included in the study group;Based on the occurrence of fractures,the PMOP patients were divided into the PMOP fracture group 39 cases and the PMOP non fracture group 63 cases.Additionally,100 healthy individuals admitted to our hospital were selected as the control group.Record theβ-CTX,t-P1NP and N-MID-OT levels of all research subjects were compared and evaluated;Using receiver operating characteristic evaluate the application value ofβ-CTX,t-P1NP and N-MID-OT in the risk assessment of osteoporosis fractures in postmenopausal women.Results The average body weight,body mass index,femoral neck bone density(BMD),left hip total BMD,and L 1-4 total BMD of the study group were significantly lower than those of the control group(P<0.05);However,there was no statistically significant difference in average age,average height,and menopausal age between the two groups of study subjects(P>0.05).Theβ-CTX(2.59±0.78)μg/L,t-P1NP(73.01±7.25)ng/mL and N-MID-OT(18.41±2.13)ng/mL of the study group were significantly higher than the control group(The values of t were 12.688,37.430 and 26.599 respectively,P<0.05).The AUC value ofβ-CTX+t-P1NP+N-MID-OT combined detection for predicting PMOP was 0.978,the sensitivity was 98.04%and the specificity was 97.00%,which indicated that the combined detection ofβ-CTX+t-P1NP+N-MID-OT was more effective in predicting PMOP.Theβ-CTX(3.19±0.89)μg/L,t-P1NP(89.49±8.35)ng/mL and N-MID-OT(22.16±2.58)ng/mL of the PMOP fracture group were significantly higher than the PMOP unfractured group(The values of t were 6.078,16.363 and 12.227 respectively,P<0.05).The AUC value ofβ-CTX+t-P1NP+N-MID-OT combined detection for evaluating the risk of PMOP fracture was 0.939,the sensitivity was 94.87%and the specificity was 95.24%,which indicated that the combined detection ofβ-CTX+t-P1NP+N-MID-OT was more effective in assessing the risk of PMOP fractures.Conclusion Theβ-CTX,t-P1NP and N-MID-OT levels of the PMOP patients were significantly elevated,while theβ-CTX,t-P1NP and N-MID-OT levels of the PMOP fracture patients increased more significantly,and the combined detection ofβ-CTX+t-P1NP+N-MID-OT can significantly improve the effectiveness of PMOP prediction and fracture risk assessment,which is worth of reference.