绝经后骨质疏松患者血清Hepcidin、s-PⅠNP、s-HJV水平与骨折的关系

The relationship between serum levels of Hepcidin,s-PⅠNP,s-HJV and fractures in postmenopausal patients with osteoporosis

目的探讨绝经后骨质疏松患者血清铁调素(Hepcidin)、Ⅰ型前胶原氨基端前肽(s-PⅠNP)、可溶型铁调素调节蛋白(s-HJV)水平与骨折发生的关系。方法选取2018年9月—2020年12月海南医学院第二附属医院骨科收治绝经后骨质疏松患者196例,其中发生骨折113例(骨折组),未发生骨折83例(无骨折组),另纳入同期于医院门诊体检的绝经后未发生骨质疏松女性92例为对照组。酶联免疫吸附试验检测血清Hepcidin、s-PⅠNP、s-HJV水平,双能X线骨密度仪测定桡骨远端、腰椎(L1~4前后位腰椎均值)、股骨颈、全髋、胫骨的骨密度。分析血清Hepcidin、s-PⅠNP、s-HJV与骨密度的相关性,Logistic回归分析绝经后骨质疏松性骨折的影响因素,受试者工作特征曲线(ROC)分析血清Hepcidin、s-PⅠNP、s-HJV预测绝经后骨质疏松患者骨折的价值。结果血清Hepcidin水平及桡骨远端、腰椎、股骨颈、全髋、胫骨骨密度比较,骨折组<无骨折组<对照组(F/P=98.210/0.000、26.520/0.000、13.380/0.000、60.210/0.000、63.540/0.000、154.061/0.000);血清s-PⅠNP、s-HJV水平比较,骨折组>无骨折组>对照组(F/P=113.063/0.000、142.968/0.000);血清Hepcidin与桡骨远端、腰椎、股骨颈、全髋、胫骨骨密度呈正相关(P均<0.01),血清s-PⅠNP、s-HJV与桡骨远端、腰椎、股骨颈、全髋、胫骨骨密度呈负相关(P均<0.01)。高腰椎骨密度、高全髋骨密度、高水平Hepcidin是绝经后骨质疏松性骨折的保护因素[OR(95%CI)=0.655(0.535~0.802)、0.720(0.597~0.867)、0.649(0.509~0.828)],高水平S-PⅠNP、S-HJV是其危险因素[OR(95%CI)=1.664(1.122~2.467)、1.956(1.281~2.987)];血清Hepcidin、s-PⅠNP、s-HJV预测绝经后骨质疏松骨折的曲线下面积分别为0.698、0.658、0.704,3项指标联合预测的曲线下面积为0.932,高于单独检测(Z/P=2.412/0.012、2.569/0.010、2.306/0.016)。结论绝经后骨质疏松骨折患者血清Hepcidin水平降低,s-PⅠNP、s-HJV水平升高,Hepcidin缺乏和s-PⅠNP、s-HJV增加与骨密度下降有关,三者可作为绝经后骨质疏松患者骨折的预测指标。

Objective To explore the relationship between the levels of serum hepcidin(Hepcidin),typeⅠprocollagen N-terminal propeptide(sP-ⅠNP),soluble hepcidin(s-HJV)and fracture occurrence in postmenopausal patients with osteoporosis.Methods From September 2018 to December 2020,196 patients with postmenopausal osteoporosis were admitted to the Department of Orthopedics,the Second Affiliated Hospital of Hainan Medical College,of which 113 cases(fracture group)and 83 cases without fracture(no fracture group),during the same period 92 postmenopausal women who did not develop osteoporosis in the outpatient physical examination of the hospital served as the control group.Enzyme-linked immunosorbent assay was used to detect serum levels of Hepcidin,s-PⅠNP,and sHJV,and dual-energy X-ray bone densitometer was used to determine the bone mineral density of the distal radius,lumbar spine(L1-4 anteroposterior lumbar spine average),femoral neck,total hip,and tibia.The influencing factors of serum Hepcidin,sPINP,sHJV and bone mineral density in postmenopausal osteoporotic fractures were analyzed.Receiver operating characteristic curve(ROC)was used to analyze the value of serum Hepcidin,sPINP,sHJV in predicting fractures in postmenopausal osteoporotic patients.Results Serum Hepcidin level,bone mineral density comparison of distal radius,lumbar vertebrae,femoral neck,total hip,tibia,fracture group<no fracture group<control group(F/P=98.210/0.000,26.520/0.000,13.380/0.000,60.210/0.000,63.540/0.000,154.061/0.000),serum s-PⅠNP,s-HJV level fracture group>no fracture group>control group(F/P=113.063/0.000,142.968/0.000).Serum Hepcidin was positively correlated with the bone mineral density of the distal radius,lumbar vertebrae,femoral neck,total hip,and tibia(all P<0.01).Serum s-PⅠNP and s-HJV were negatively correlated with the bone mineral density of the distal radius,lumbar spine,femoral neck,total hip,and tibia(P<0.01).High lumbar bone density,high total hip bone density,and high levels of Hepcidin are protective factors for postmenopausal osteoporotic fractures[OR(95%CI)=0.655(0.535-0.802),0.720(0.597-0.867),0.649(0.509-0.828)],high levels of S-PⅠNP and s-HJV are the risk factors[OR(95%CI)=1.664(1.122-2.467),1.956(1.281-2.987)].The area under the curve of serum Hepcidin,s-PⅠNP,and s-HJV predicting postmenopausal osteoporotic fractures are 0.698,0.658,and 0.704,respectively.The area under the curve predicted by the combined three indicators is 0.932,which is higher than that of a single test(Z/P=2.412/0.012,2.569/0.010,2.306/0.016).Conclusion Serum Hepcidin levels in postmenopausal osteoporotic fracture patients decreased,and s-PⅠNP and s-HJV levels increased.Hepcidin deficiency and increased s-PⅠNP and s-HJV were related to decreased bone mineral density.The three can be used as predictors of fractures in postmenopausal osteoporotic patients.