血清t-P1NP、PTH表达与男性阻塞性睡眠呼吸暂停低通气综合征患者骨密度相关性分析

Correlation analysis of serum t-P1NP,PTH expression and bone mineral density in male patients with obstructive sleep apnea hypopnea syndrome

目的探讨血清总Ⅰ型胶原氨基端延长肽(t-P1NP)、甲状旁腺激素(PTH)表达与男性阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者骨密度的相关性。方法选取2018年2月—2020年6月南京医科大学附属江宁医院呼吸科收治男性OSAHS患者118例为观察组,另选择男性健康体检者118例作为健康对照组。采用多导睡眠(PSG)监测并记录受检者最低血氧饱和度(LSaO_(2))、睡眠呼吸暂停低通气指数(AHI),双能X线吸收法(DXA)测定腰椎(L1-4)、髋部骨密度,全自动生化分析仪检测血清钙、磷,全自动电化学发光免疫分析仪检测血清t-P1NP、PTH,并进行组间比较;采用Spearman分析血清t-P1NP、PTH与骨密度、PSG监测结果的相关性;采用Logistic回归模型分析OSAHS患者发生骨质疏松的影响因素。结果与健康对照组比较,观察组LSaO_(2)降低、AHI升高(t/P=25.962/0.000、81.903/0.000),而血清钙、磷水平比较差异无统计学意义(P>0.05);与健康对照组比较,观察组血清t-P1NP、PTH升高(t/P=3.666/0.000、3.523/0.001),腰椎、髋部骨密度均降低(t/P=7.340/0.000、13.134/0.000);观察组血清t-P1NP、PTH与LSaO_(2)、腰椎骨密度、髋部骨密度均呈负相关(t-P1NP:r/P=-0.607/0.000、-0.568/0.000、-0.626/0.000;PTH:r/P=-0.563/0.000、-0.569/0.000、-0.627/0.000),与AHI均呈正相关(r/P=0.580/0.000、0.513/0.000);AHI及血清t-P1NP、PTH升高均是OSAHS患者发生骨质疏松的危险因素,LSaO_(2)升高是保护因素[OR(95%CI)=2.352(1.795~3.083)、3.168(1.561~6.428)、3.014(1.966~4.621)、0.605(0.440~0.831)]。结论男性OSAHS患者存在骨代谢异常,应动态监测血清t-P1NP、PTH以防治OSAHS患者发生骨质疏松。

Objective To explore the relationship between the expression of serum total type I collagen N-terminal extension peptide(t-P1NP)and parathyroid hormone(PTH)and bone mineral density in male patients with obstructive sleep apnea hypopnea syndrome(OSAHS).Methods One hundred and eighteen male patients with OSAHS admitted to the Department of Respiratory Medicine,Jiangning Hospital,Nanjing Medical University from February 2018 to June 2020 were selected as the observation group.In addition,118 male health examiners were selected as the healthy control group.Use polysomnography(PSG)to monitor and record the subject’s lowest blood oxygen saturation(LSaO_(2)),sleep apnea hypopnea index(AHI),dual-energy X-ray absorptiometry(DXA)to measure the lumbar spine(L1-4)and hip Bone density.Use automatic biochemical analyzer to detect serum calcium and phosphorus.Use automatic electrochemiluminescence immunoassay to detect serum t-P1NP and PTH,and compare between groups.Spearman was used to analyze the correlation of serum t-P1NP,PTH with bone density and PSG Sex.Logistic regression model was used to analyze the influencing factors of osteoporosis in OSAHS patients.Results Compared with the healthy control group,the observation group LSaO_(2) decreased and AHI increased(t/P=25.962/0.000,81.903/0.000),while the serum calcium and phosphorus levels were not significantly different(P>0.05).Compared with the healthy control group In comparison,the observation group's serum t-P1NP and PTH increased(t/P=3.666/0.000,3.523/0.001),and the lumbar and hip bone mineral density decreased(t/P=7.340/0.000,13.134/0.000).The observation group's serum t-P1NP and PTH are negatively correlated with LSaO_(2),lumbar bone mineral density,and hip bone mineral density(t-P1NP:r/P=-0.607/0.000,-0.568/0.000,-0.626/0.000;PTH:r/P=-0.563/0.000,-0.569/0.000,-0.627/0.000),all positively correlated with AHI(r/P=0.580/0.000,0.513/0.000).AHI and serum t-P1NP,PTH increase are all osteoporosis in OSAHS patients Among the risk factors for AIDS,elevated LSaO_(2) is a protective factor[OR(95%CI)=2.352(1.795-3.083),3.168(1.561-6.428),3.014(1.966-4.621),0.605(0.440-0.831)].Conclusion Male patients with OSAHS have abnormal bone metabolism.Serum t-P1NP and PTH should be monitored dynamically to prevent osteoporosis in patients with OSAHS.