40岁以上人群血清可溶性信号素4D与骨质疏松症的相关性研究

Relationship between serum semaphorin 4D and osteoporosis in people over 40 years old

目的研究顺德地区40岁以上人群血清可溶性信号素4D(Sema4D)水平与骨质疏松症的关系,为早发现、早诊断、早治疗骨质疏松症提供一定的参考依据。方法收集2021年1月至6月佛山市顺德区伦教医院符合要求的患者共174例,记录患者的临床一般资料,血清骨代谢指标:1,25二羟基维生素D[1,25(OH)2VD]、总Ⅰ型胶原氨基端前肽(PINP)、β-胶原降解产物(β-CTX)、骨钙素、骨密度、血清Sema4D水平。将纳入的患者分为骨质疏松组(103例)和非骨质疏松组(71例),分析两组间以上指标的差异。并进一步细化分层,分别分析绝经后骨质疏松症(70例)、男性骨质疏松症(45例)、老年性骨质疏松症(83例)患者骨质疏松组和非骨质疏松组的差异。两组间的比较采用t检验、χ^(2)检验。结果骨质疏松组患者的年龄[(74.058±10.179)岁]、β-CTX[(0.459±0.420)μg/L]、骨钙素[(9.756±0.904)μg/L]显著高于非骨质疏松组[(58.296±12.052)岁、(0.339±0.026)μg/L、(9.290±1.425)μg/L],而1,25(OH)2VD、骨密度则低于非骨质疏松组[(64.348±13.310)nmol/L比(71.014±23.960)nmol/L、(-3.748±1.208)比(-1.596±0.725)],差异均有统计学意义(均P<0.05)。绝经后女性骨质疏松症组患者的年龄、PINP、β-CTX、骨钙素显著高于非骨质疏松组,而骨密度则低于非骨质疏松组(均P<0.05);男性骨质疏松组患者的年龄、β-CTX显著高于非骨质疏松组,而骨密度、1,25(OH)_(2) VD、PINP则低于非骨质疏松组(均P<0.05);老年骨质疏松组患者的PINP、β-CTX、骨钙素显著高于非骨质疏松组,而骨密度低于非骨质疏松组(均P<0.05)。所有类型的原发性骨质疏松症患者骨质疏松组与非骨质疏松组间的血清Sema4D水平差异均无统计意义(均P>0.05)。结论顺德地区40岁以上人群血清Sema4D水平与原发性骨质疏松症无明显相关性,对原发性骨质疏松症进行进一步的分层分析也未发现血清Sema4D水平与骨质疏松症的相关性。今后可考虑扩大样本量,同时在纳入病例时对相关因素进行控制,以期更为客观地反映Sema4D水平与原发性骨质疏松症的关系。

Objective To study the relationship between serum soluble semaphore 4D(Sema4D)and osteoporosis in people over 40 years old at Shunde District,and to provide references for the early detection,diagnosis,and treatment of osteoporosis.Methods A total of 174 patients with primary osteoporosis treated at Lunjiao Hospital at Shunde District from January to June 2021 were selected.The general clinical data,serum bone metabolism indicators[1,25 dihydroxy vitamin D(1,25(OH)2VD),total type Ⅰ collagen N-terminal propeptide(PINP),β-collagen degradation products(β-CTX),and osteocalcin(N-MID)],bone mineral density(BMD),and serum Sema4D were recorded.The patients were divided into an osteoporosis group(103 cases)and a non-osteoporosis group(71 cases),and the differences in the above indicators between these two groups were analyzed.And the patients were further stratified,and the differences between the patients with postmenopausal osteoporosis(70 cases),male osteoporosis(45 cases),and senile osteoporosis(83 cases)in the osteoporosis group and the non-osteoporosis group were analyzed.t andχ^(2) test was applied.Results The age and levels of β-CTXandN-MIDwere(74.058±10.179),(0.459±0.420)μg/L and(9.756±0.904)μg/L in the osteoporosis group,and were(58.296±12.052),(0.339±0.026)μg/L,and(9.290±1.425)μg/L in the non-osteoporotic group,with statistical differences(all P<0.05).The 1,25(OH)2VD level and BMD were(64.348±13.310)nmol/L and(71.014±23.960)nmol/L in the osteoporosis group,and were(-3.748±1.208)and(-1.596±0.725)in the non-osteoporosis group,with statistical differences(both P<0.05).The age,PINP,β-CTX,and N-MID of the postmenopausal women in the osteoporosis group were significantly higher than those in the non-osteoporosis group,while the BMD was lower(all P<0.05).The age and β-CTX of the male osteoporosis group were significantly higher than those of the non-osteoporosis group,while the BMD,1,25(OH)_(2)VD,and PINP were lower(all P<0.05).The PINP,β-CTX,and N-MID of the elderly osteoporosis group were higher than those of the non-osteoporosis group.The BMD of the elderly osteoporosis group was lower than that of the non-osteoporosis group(P<0.05).There were no statistical differences in the serum Sema4D levels between all types of primary osteoporosis patients in the osteoporosis group and the non-osteoporosis group(all P>0.05).Conclusion There is no obvious correlation between serum Sema4D and osteoporosis in people over 40 years old at Shunde District.Further stratified analysis of primary osteoporosis did not find a correlation between serum Sema4D and osteoporosis.In the future,we should consider expanding the sample size and controlling related factors when including cases,in order to more objectively reflect the relationship between Sema4D and primary osteoporosis.