中性粒细胞/淋巴细胞比值和单核细胞/高密度脂蛋白胆固醇比值预测绝经后2型糖尿病患者发生骨质疏松症的价值研究

Predictive Value of Neutrophil-to-lymphocyte Ratio and Monocyte-to-high-density Lipoprotein Cholesterol Ratio for Osteoporosis in Postmenopausal Patients with Type 2 Diabetes Mellitus

背景糖尿病患者并发骨质疏松症(OP)的风险较大,尤其是绝经后2型糖尿病(T2DM)患者,慢性炎症在其中起着重要作用。目的探讨中性粒细胞/淋巴细胞比值(NLR)和单核细胞/高密度脂蛋白胆固醇比值(MHR)对绝经后T2DM患者发生OP的预测价值。方法选取2018年1月至2020年1月于郑州大学第一附属医院内分泌及代谢性疾病科住院的216例绝经后T2DM患者,收集患者的临床资料。采集患者空腹静脉血,测定血常规、血脂等生化指标,计算得到NLR和MHR;采用双能X线吸收法(DXA)测定患者腰椎L_(1-4)、左股骨颈及左髋骨密度(BMD)。根据BMD结果,将患者分为骨量正常组51例、骨量减少组78例、OP组87例,另外根据NLR四分位数(A1~A4组)和MHR四分位数(B1~B4组)将患者分为4组,每组54例。采用Spearman秩相关分析探讨NLR和MHR与各部位BMD的相关性,多因素Logistic回归分析探讨绝经后T2DM患者发生OP的影响因素,受试者工作特征(ROC)曲线评价NLR、MHR及两者联合预测绝经后T2DM患者发生OP的价值。结果骨量减少组NLR、MHR均高于骨量正常组(P<0.05),OP组NLR、MHR均高于骨量正常组和骨量减少组(P<0.05)。A3组L_(1-4)、左股骨颈、左髋BMD均低于A1组(P<0.05);A4组左股骨颈BMD低于A1组,L_(1-4)、左髋BMD低于A1组和A2组(P<0.05)。B2、B3组L_(1-4)、左股骨颈、左髋BMD均低于B1组(P<0.05);B4组L_(1-4)BMD低于B1组、B2组和B3组,左股骨颈、左髋BMD均低于B1组和B2组(P<0.05)。Spearman秩相关分析结果显示,NLR、MHR均分别与L_(1-4)、左股骨颈、左髋BMD呈负相关(P<0.001)。多因素Logistic回归分析结果显示,绝经年限长〔OR=1.092,95%CI(1.005,1.186)〕、NLR水平升高〔OR=2.341,95%CI(1.453,3.770)〕和MHR水平升高〔OR=329.250,95%CI(21.421,5060.810)〕是绝经后T2DM患者发生OP的独立危险因素(P<0.05),体质指数(BMI)升高〔OR=0.806,95%CI(0.718,0.903)〕是绝经后T2DM患者发生OP的独立保护因素(P<0.05)。ROC曲线分析结果显示,NLR、MHR及两者联合预测绝经后T2DM患者发生OP的ROC曲线下面积分别为0.722、0.709、0.787,灵敏度分别为65.5%、52.9%、81.6%,特异度分别为72.1%、79.8%、67.4%;两者联合预测绝经后T2DM患者发生OP的ROC曲线下面积分别高于NLR、MHR(Z=2.418,P<0.05;Z=2.893,P<0.05)。结论NLR和MHR均可单独作为绝经后T2DM患者发生OP的预测指标,且两者联合检测时预测效能及灵敏度更高。

Background People with diabetes mellitus are at increased risk of developing osteoporosis(OP),especially those with postmenopausal type 2 diabetes mellitus(T2DM).Chronic inflammation plays an important role in the development of OP.Objective To explore the predictive value of neutrophil-to-lymphocyte ratio(NLR)and monocyte-to-high-density lipoprotein cholesterol ratio(MHR)for OP in postmenopausal patients with T2DM.Methods Two hundred and sixteen postmenopausal T2DM patients who were hospitalized in the Department of Endocrinology and Metabolism,the First Affiliated Hospital of Zhengzhou University from January 2018 to January 2020 were chosen.Clinical data were obtained,including blood routine and biochemical parameters(such as blood lipids and so on)in fasting venous blood,calculated NLR and MHR,and bone mineral density(BMD)of lumbar spine L_(1-4),left femoral neck and left hip measured by dual-energy X-ray absorptiometry(DXA).According to the BMD,the patients were divided into normal bone mass group(n=51),osteopenia group(n=78)and OP group(n=87).In addition,they were divided into 4 groups according to NLR quartiles(A1 to A4 group)and MHR quartiles(B1 to B4 group),with 54 cases in each.Spearman correlation was used to analyze the association of NLR and MHR with BMD at lumbar spine L_(1-4),left femoral neck and left hip.Multivariate Logistic regression analysis was applied to explore the influencing factors of OP.Receiver operating curve(ROC)analysis was performed to evaluate the value of NLR,MHR and their combination in predicting OP.Results NLR and MHR were increased in the osteopenia group than the normal bone mass group(P<0.05).Compared with the normal bone mass group and the osteopenia group,NLR and MHR in the OP group were statistically significant increased(P<0.05).Compared with A1 group,A3 group had decreased BMD at lumbar spine L_(1-4),left femoral neck and left hip,so did A4 group(P<0.05).A4 group had decreased BMD at lumbar spine L_(1-4),and left hip than A2 group(P<0.05).B1 group had higher BMD at lumbar spine L_(1-4),left femoral neck and left hip than did B2,B3,and B4 groups(P<0.05).B4 group had decreased BMD at lumbar spine L_(1-4),left femoral neck and left hip than did B2 group(P<0.05).B4 group also had decreased BMD at lumbar spine L_(1-4)did B3 group(P<0.05).Spearman correlation analysis showed that both NLR and MHR were negatively correlated with BMD at lumbar spine L_(1-4),left femoral neck and left hip(P<0.001).Multivariate Logistic regression analysis showed that long menopausal duration〔OR=1.092,95%CI(1.005,1.186)〕,increased NLR〔OR=2.341,95%CI(1.453,3.770)〕and increased MHR〔OR=329.250,95%CI(21.421,5060.810)〕were independently associated with elevated risk of OP,while high BMI〔OR=0.806,95%CI(0.718,0.903)〕was associated with decreased risk of OP(P<0.05).ROC analysis demonstrated that in predicting OP,the area under the curve(AUC)of NLR was 0.722,with 65.5%sensitivity and 72.1%specificity,and that of MHR was 0.709 with 52.9%sensitivity and 79.8%specificity,and that of NLR with MHR was 0.787,with 81.6%sensitivity and 67.4%specificity.The AUC of NLR with MHR was greater than that of NLR or MHR alone(Z=2.418,P<0.05;Z=2.893,P<0.05).Conclusion Either NLR or MHR could be used as a predictor of OP in postmenopausal T2DM patients,and the predictive efficiency and sensitivity of the combination of them would be higher.