老年髋部骨折患者血清戊糖素、RAGE、sRAGE水平与骨密度的关系

Correlation between the serum levels of pentosidine,RAGE,sRAGE and bone mineral density in elderly patients with hip fracture

目的了解老年髋部骨折患者血清戊糖素、晚期糖基化终末产物受体(RAGE)和sRAGE水平的状况,探讨这些指标与骨密度(BMD)正常、骨量减少和骨质疏松之间的关系。方法回顾性分析2018年01月至2019年06月,常州市中医医院治疗的老年髋部骨折66例患者,其中女性49例,男性17例,平均年龄(68±9)岁。患者常规检测L2~4节段BMD的T值,依据BMD的T值不同将病例分为三组:骨密度正常组、骨量减少组和骨质疏松组。酶联免疫吸附测定血清戊糖素、RAGE、sRAGE水平,并检测生化指标血碱性磷酸酶(ALP)等的水平。分析血清戊糖素、RAGE、sRAGE水平与腰椎BMD的相关性。结果骨量减少组和骨质疏松组血清戊糖素、RAGE水平显著高于骨密度正常组相比(血清戊糖素三组间方差分析:F=10.779,P=0.000,骨量减少组与骨质疏松组血清戊糖素LSD两两比较P=0.116,骨量减少组与骨密度正常组血清戊糖素LSD两两比较P=0.006,骨质疏松组与骨密度正常组血清戊糖素LSD两两比较P=0.000;RAGE三组间方差分析F=11.331,P=0.000,骨量减少组与骨质疏松组RAGE LSD两两比较P=0.057,骨量减少组与骨密度正常组RAGE LSD两两比较P=0.010,骨质疏松组与骨密度正常组RAGE LSD两两比较P=0.000),骨量减少组和骨质疏松组sRAGE水平显著低于骨密度正常组(sRAGE三组间方差分析F=14.211,P=0.000,骨量减少组与骨质疏松组sRAGE LSD两两比较P=0.046,骨量减少组与骨密度正常组sRAGE LSD两两比较P=0.003,骨质疏松组与骨密度正常组sRAGE LSD两两比较P=0.000);血清戊糖素、RAGE水平与腰椎BMD呈负相关性(r=-0.575,P=0.000;r=-0.446,P=0.000),血清sRAGE水平与腰椎BMD呈正相关性(r=0.618,P=0.000)。结论血清戊糖素、RAGE及sRAGE水平与腰椎BMD之间有显著的相关性,可作为临床骨质疏松症诊断的参考参数,值得临床开展应用。

Objective This study aims to explore the correlation of serum levels of pentosidine,receptor for advanced glycation end-product(RAGE)and soluble receptor for advanced glycation end-product(sRAGE)in elderly patients with hip fractures with their bone mass density(BMD).Methods A retrospective analysis was conducted for 66 elderly patients with hip fractures hospitalized in our Department of Orthopedics between January 2018 and June 2019.Dual-energy X-ray absorptiometry was used to measure the BMDs of the 2nd-4th lumbar;enzyme-linked immunosorbent assay was adopted to determine the levels of serum pentosidine,RAGE and sRAGE,and automatic biochemical analyzer was utilized to analyze the serum levels of alkaline phosphatase(ALP),tartrate-resistant acid phosphatase 5b(TRACP5b),osteocalcin(OC),calcium(Ca),and substance P(P).Based on their BMDs,all patients were divided into a normal bone mass group,an osteopenia group,and an osteoporosis group.Results Compared with the normal bone mass group,the levels of serum pentosidine and RAGE in osteopenia group and osteoporosis group were significantly higher(Analysis of variance among the three groups of serum pentosidine F=10.779,P=0.000.There were significant differences between the two groups(P=0.116,P=0.006,P=0.000).Analysis of variance among the three groups of serum pentosidine(F=11.331,P=0.000).There were significant differences between the two groups(P=0.057,P=0.010,P=0.000).The levels of sRAGE in osteopenia group and osteoporosis group were significantly lower(Analysis of variance among the three groups of serum sRAGE(F=14.211,P=0.000).There were significant differences between the two groups(P=0.046,P=0.003,P=0.000).There was a significant negative correlation between serum pentosidine level and lumbar BMD(r=-0.575,P=0.000),a significant negative correlation between serum RAGE level and lumbar BMD(r=-0.446,P=0.000),and a significant positive correlation between serum sRAGE level and lumbar BMD(r=0.618,P=0.000).Conclusion There is a significant correlation between serum pentosidine,RAGE,sRAGE levels and lumbar BMD,which can be used as a reference parameter for the diagnosis of osteoporosis and is worthy of clinical application.