中老年人群臂踝脉搏波传导速度>1 400 cm/s预测脆性骨折的价值分析

Predictive value of brachial-ankle pulse wave velocity>1 400 cm/s in fragility fracture in middle-aged and elderly population

目的探讨中老年人群臂踝脉搏波传导速度(baPWV)升高(>1400 cm/s)对脆性骨折的预测价值。方法2011年5月至10月采用整群抽样的方法对贵阳市云岩区50岁以上男性及绝经后女性共3265人进行问卷调查、体格检查、血脂等代谢相关指标,QUS跟骨骨密度及臂踝脉搏波传导速度的测定,根据baPWV值分为baPWV正常组和baPWV升高组,并随访38个月,记录随访人群骨折发生情况,最终2637名基线及随访资料完整的研究对象被纳入分析。结果3年脆性骨折总发生率为5.08%,其中男性人群baPWV正常组脆性骨折事件率为1.6%,baPWV升高组骨折事件率为2.0%,两组无统计学差异(P>0.05)。绝经后女性人群baPWV正常组脆性骨折事件率为4.4%,baPWV升高组骨折事件率为7.1%,两组具有统计学差异(P<0.05)。进一步行多因素COX比例风险回归分析显示,绝经后女性骨密度T值(HR 0.839,95%CI 0.741~0.952,P=0.006)及baPWV(HR 1.700,95%CI 1.046~2.763,P=0.042)与脆性骨折累计发生的危险相关。结论baPWV值>1400 cm/s与绝经后女性脆性骨折风险独立相关,前者可能是预测脆性骨折的独立危险因素。但在中老年男性患者中此类差异不明显。

Objective To explore the predictive value of brachial-ankle pulse wave velocity(baPWV)>1400 cm/s in fragility fracture in middle-aged and elderly population.Methods From May to October 2011,questionnaire survey was conducted on a total of 3265 males over 50 years old and postmenopausal females in Yunyan District,Guiyang City,and physical examination was carried out to measure their metabolic related indicators such as blood lipids,QUS calcaneus bone densities,and brachial-ankle pulse wave velocities.According to their baPWV,the enrolled subjects were divided into a normal baPWV group and an elevated baPWV group.Follow-up was performed for 38 months,and the incidence of fractures was tracked.Finally,2637 subjects with complete baseline and follow-up data were enrolled in this research for analysis.Results The 3-year total incidence of fragility fracture was 5.08%.In particular,the rate of fragility fractures among males in the normal baPWV group was 1.6%,and that in the elevated baPWV group was 2.0%.There was no statistically significant difference between the two groups(P>0.05).The rate of fragility fracture events among postmenopausal females in the normal baPWV group was 4.4%,and that in the elevated baPWV group was 7.1%.There was statistically significant difference between the two groups(P<0.05).Further multivariate COX regression(or proportional hazards regression)analysis showed that the bone density T value(HR 0.839,95%CI 0.741-0.952,P=0.006)and baPWV(HR 1.700,95%CI 1.046-2.763,P=0.042)were related with risk of fragility fractures in postmenopausal women.Conclusion A baPWV greater than 1400 cm/s could be independently associated with the risk of fragility fractures in postmenopausal females and might be an independent risk factor for predicting fragility fractures.However,such differences were not as evident in middle-aged and elderly male patients.