血清25(OH)D和骨转换标志物与老年髋部骨折的相关性分析

Correlation analysis of serum 25-hydroxyvitamin D and bone turnover markers in senile patients with hip fractures

目的初步探讨血清25(OH)D和骨转换标志物在老年骨质疏松性髋部骨折预测中的价值。方法选取2015年5月至2016年4月就诊于我院的330例老年髋部骨折患者和331例非骨折患者分别作为骨折组和对照组纳入本研究,收集患者的一般临床资料如年龄、性别、身高、体重、体质量指数、吸烟史以及饮酒史,测定血清25(OH)D、1型前胶原氨基末端前肽(Nterminal extension propeptide of type-I collagen,P1NP)、骨钙素(osteocalcin,OC)、1型胶原交联羧基末端肽(C-terminal telopeptide of type-I collagen,CTX)和甲状旁腺激素(parathyroid hormone,PTH),并对其进行统计学分析。结果血清25(OH)D在骨折组明显低于对照组,并且骨折组患者年龄、血清P1NP、OC、CTX和PTH明显高于对照组(P<0.05)。运用Pearson相关分析显示血清25(OH)D与PTH、P1NP、OC和CTX呈明显负相关(P<0.05)。对差异显著的参数经多因素Logistic回归分析显示,年龄、性别、血清25(OH)D、CTX与PTH是骨折发生的独立危险因素(P<0.05)。受试者工作特征(receiver operator curve,ROC)曲线分析结果显示,年龄、血清25(OH)D和CTX的曲线下面积值分别为0.819、0.802和0.666,对预测髋部骨折具有一定的意义。结论高龄、维生素D缺乏以及血清CTX水平升高提示发生老年髋部骨折的风险增高,对于此类患者应警惕髋部骨折的发生,提前采取措施进行预防。

Objective To investigate the clinical value of serum 25（OH） D and bone turnover markers in the prediction of osteoporotic hip fractures in the elderly.Methods A total of 330 cases with hip fractures and 331 cases without fractures from May 2015 to April 2016 were retrospectively analyzed and divided into two groups according to the occurrence of hip fractures.The general clinical information was collected,including age,sex,height,weight,body mass index,and the history of smoking and drinking.Serum levels of 25（OH） D,PINP,OC,CTX,and PTH were measured and analyzed.Results Patients with hip fractures had significantly lower level of serum 25（OH） D,higher levels of serum CTX-1,P1 NP,and OC than those without hip fractures（P〈0.05）.The Pearson correlation analysis showed that serum 25（OH） D was negatively correlated with PTH,P1 NP,OC,and CTX（P〈0.05）.The multiple logistic regression analysis showed that age,serum 25（OH） D,and CTX-1 were independent risk factors of hip fractures in senile patients（P〈0.05）.The receiver operating curves showed that age,serum 25（OH）D,and CTX had AUC values of 0.819,0.802,and 0.666,respectively,which were of significance in predicting hip fractures.Conclusion The older age,vitamin D deficiency,and elevated serum CTX levels suggest an increased risk of hip fracture in elderly patients,who should be aware of hip fractures and take preventive measures in advance.