血清TSH和t-PINP/β-CTX比值对老年椎体骨折患者的诊断价值

The diagnostic value of serum TSH and t-PINP/β-CTX ratio in elderly patients with vertebral fractures

目的通过测定老年骨质疏松患者的促甲状腺素(thyroid stimulating hormone,TSH)水平及相关骨代谢生化标志物,研究其与椎体骨折的相关性。方法选取2018年1月至2019年12月收治入院的年龄>60岁的符合骨质疏松与亚临床甲状腺功能紊乱诊断标准的老年骨科患者。依据是否合并椎体骨折将其分为无骨折组(A组)和骨折组(B组)。使用电化学发光法在仪器上完成TSH、骨钙素(BGP)、总Ⅰ型胶原氨基端延长肽(t-PINP)、Ⅰ型胶原羧基端肽β特殊序列(β-CTX),25-羟基维生素D[25(OH)D]测定。结果B组TSH、BGP含量较A组降低,t-PINP/β-CTX比值B组较A组增加,差异有统计学意义(P<0.05)。双变量相关性分析显示老年骨质疏松椎体骨折与TSH、BGP呈显著负相关(r=-0.195、-0.133,P均<0.05),与t-PINP/β-CTX比值呈显著正相关(r=0.371,P<0.05),与β-CTX、t-PINP、25(OH)D及BGP/β-CTX比值无相关性(r=0.173、0.126、0.739、0.799,P均>0.05)。TSH、t-PINP/β-CTX比值与TSH联合t-PINP/β-CTX比值检测相比,TSH+t-PINP/β-CTX比值的AUC最大,其AUC为0.825,差异有统计学意义(P<0.01),联合检测时敏感性、特异性、阳性预示值、阴性预示值分别为81.99%、70.05%、79.3%、73.6%。结论血清TSH水平与t-P1NP/β-CTX比值与老年骨质疏松椎体骨折明显相关,可预示老年椎体骨折的发生。

Objective By measuring the levels of thyroid stimulating hormone(TSH)and related biochemical markers of bone metabolism in elderly patients with osteoporosis,this paper proposes to study their correlation with spinal fractures.Methods From January 2018 to December 2019,the elderly patients over 60 years old who met the diagnostic criteria of osteoporosis and subclinical thyroid dysfunction in our orthopedic department were selected.They were divided non-fracture group(group A)and fracture group(group B).Serum levels of TSH,BGP,t-PINP,β-CTX,and 25(OH)D were determined with electrochemical luminescence method.Results TSH and BGP contents in group B were lower than those in group A,and t-PINP/β-CTX in group B was higher than that in group A.The differences were statistically significant(P<0.05).Bivariate correlation analysis showed that the elderly osteoporotic spinal fracture was negatively correlated with TSH and BGP(r=-0.195,-0.133,PALL<0.05),positively correlated with t-PINP/β-CTX(r=0.371,P<0.05),and uncorrelated withβ-CTX,t-PINP,25(OH)D,and BGP/β-CTX(r=-0.195,-0.133,PALL<0.05).The AUC of TSH combined with t-PINP/β-CTX ratio was 0.825,which was the highest compared to that of TSH and t-PINP/β-CTX,and the difference was statistically significant(P<0.05).The sensitivity,specificity,positive predictive value,and negative predictive value were 81.99%,70.05%,79.3%,and 73.6%,respectively.Conclusion Serum TSH level and t-P1NP/β-CTX ratio are significantly related to the elderly osteoporotic spinal fractures,which can predict the occurrence of spinal fractures in the elderly.