补体及脂代谢水平与老年人群骨密度的相关性分析

Analysis of the relationship between complement and lipid metabolism and bone mineral density in elderly population

目的探讨血清补体与脂代谢水平检测对老年性骨质疏松症的辅助诊断价值。方法回顾性分析2016年1至6月在北京积水潭医院体检并进行骨密度检测的老年人群215例,根据骨密度T值分级,将研究对象分为骨质疏松组74例与非骨质疏松组141例。分析人组人群血清补体C3、补体C4、低密度脂蛋白胆固醇(LDL)、高密度脂蛋白胆固醇(HDU、三酰甘油(TG)、总胆固醇(CH0)与骨密度的关系,并采用t检验、非参数检验、二元Logistic回归和受试者工作特征(R 0 C)曲线分析数据。结果骨质疏松组的年龄、C H 0、L D L、H D L、补体C3、C4[分别为(80.6±8.2)岁、(4.43±1.25)m m o l/L、(2.27±0.73)m m o l/L、(1.33±0.39)m m o l/L、(1.12±0.22)g/L和(0.29±0.09)g/L]均显著高于非骨质疏松组[分别为(77.5±8.3)岁、(4.04±1.02)m m o l/L、(1.97±0.59)m m o l/L、(1.19士0.32)m m o l/L、(0.86±0.25)g/L和(0.21±0.06)g/L,值分别为2.571、-3.848、-4.483、-3.951、-1.249和-1.185,P<0.05],8\1丨和双能\射线法(D X A)测定骨密度T值和B M丨显著低于非骨质疏松组[两组结果分别为(22.33±3.8)k g/m 2、-2.74±0.78和(25.03±4.2)kg/m2,0.14±0.9,t值分别为4.624和6.151,P<0.05]。骨质疏松组T G水平显著低于非骨质疏松组[中位数(四分位数)分别为丨.21(0.67,丨.44)m m o l/L和丨.37(0.86,1.67)m m o丨/L,Z=-2.51,P<0.05]。性别与血清H D L、L D L、C 3和C 4水平是预测老年性骨质疏松的独立危险因素(0/?=2.476,P=0.004;0/?=1.305,P=0.038;0/?=1.564,P=0.028;0/f=1.018,P=0.025;0/?=1.023,f>=0.015),女性患病风险是相同年龄男性的2.476倍,只01^、1£^、。3、04每增加一个单位,相应的骨质疏松风险提高了1.305、1.564、1.018和1.023倍。H D L、L D L、C 3和C 4单独检测的R O C曲线下面积分别为0.623、0.595、0.673、0.731,四项联合检测的R O C曲线下面积为0.864。结论血脂与补体水平与骨密度显著相关,联合检测血脂代谢与补体可以提高老年性骨质疏松的诊断效能。

Objective T o investigate the diagnostic value of serum complement level and lipid metabolism level detection in senile osteoporosis.Methods A total of 215 elderly people w h o underwent physical examination and bone mineral density test in Beijing Jishuitan Hospital from January 2016 to June 2016 were divided into osteoporotic group(74)and non-osteoporotic group(141)according to bone mineral density classification.T h e relationship between serum complement C3,complement C4,low density lipoprotein cholesterol(LDL),high density lipoprotein cholesterol(HDL),triglyceride(TG),total cholesterol(C H O)and bone mineral density were analyzed.T h e data were analyzed by i-test,non-parametric test,binary Logistic regression and the receiver operating characteristic(R O C)curve.Results T h e age and C H O,L D L,H D L,complement C 3 and C 4 in the osteoporosis group[(80.6±8.2)years,(4.43±1.25)m m o l/L,(2.27±0.73)m m o l/L,(l.33±0.39)m m o l/L,(1.12±0.22)g/L,(0.29±0.09)g/L],were significantly higher than those in the non-osteoporosis group[(77.5±8.3)years,(4.04±1.02)minol/L,(1.97±0.59)mmol/L,(1.19±0.32)mmol/L,(0.86±0.25)g/L,(0.21±0.06)g/L,,t-value were 2.571,-3.848,-4.483,-3.951,-1.249,—1.185,P<0.05],and the the B M I bone mineral density T-Score value of D X A and in the osteoporosis group were significantly lower than those in the non-osteoporosis group[(22.33±3.8)lcg/m2,-2.74±0.78 and(25.03±4.2)kg/m2,0.14±0.9,while the t value w a s 6.151 and 4.624,respectively,P<0.05].T h e level of T G in osteoporotic group was significantly lower than that in non-osteoporotic group[the median(quartile)was 1.21(0.67,1.44)mmol/L and 1.37(0.86,1.67)mmol/L,respectively,Z=-2.51,P<0.01].Gender and serum levels of H D L,L D L,C 3 and C 4 were independent risk factors for senile osteoporosis(0/?=2.476,P=0.004;0/?=1.305,P=0.038;0/?=1.564,P=0.028;0/?=1.018,P=0.025;0/?=l.023,P=0.015,respectively).T h e risk of osteoporosis in w o m e n was 2.476 times higher than that in m e n of the s a m e age.T h e corresponding risk of osteoporosis increased by 1.305,1.564,1.018 and 1.023 times as H D L,L D L,C 3 and C 4 increased by one unit.T h e areas under the R O C curve detected separately by H D L,L D L,C 3 and C 4 were 0.623,0.595,0.673 and 0.731 respectively,and the area under the R O C curve of the four items was 0.864.Conclusions T h e levels of blood lipids and complements play a great role in bone metabolism.T h e combined detection of blood lipid metabolism and complement can improve the diagnostic efficacy of senile osteoporosis.