老年CKD患者25(OH)D、SOST水平与OSP和跌倒风险的关系

Relationship between 25(OH)D,SOST levels and OSP,falls risk in elderly patients with CKD

目的探讨老年慢性肾脏病(CKD)患者血清25羟维生素D[25(OH)D]、骨硬化蛋白(SOST)水平与骨质疏松症(OSP)和跌倒风险的关系。方法选取在承德市中心医院确诊的120例CKD患者,根据是否发生OSP将患者分为OSP组(n=33)和非OSP组(n=87)。分析老年CKD患者发生OSP的单因素,并采用Logistic回归分析影响患者OSP和跌倒发生的危险因素;ROC曲线分析血清25-(OH)-D、SOST水平诊断老年CKD患者OSP的价值;比较两组Morse跌倒评估量表(MFS)评分;Pearson相关性分析血清25(OH)D、SOST水平与老年CKD患者跌倒风险之间的相关性。结果OSP组患者合并糖尿病发生率和血清SOST水平明显高于对照组,不同部位BMD和血清25-(OH)-D均显著低于对照组,差异均有统计学意义(P<0.05);Logistic分析显示血清25-(OH)-D水平降低、SOST水平升高均为老年CKD患者并发OSP诊断的独立因素(P<0.05);血清25-(OH)-D和SOST水平联合预测老年CKD患者发生OSP的AUC为0.870(P<0.05);OSP组MFS评分为(65.13±3.24)分,明显高于非OSP组的(41.05±2.98)分,差异有统计学意义(P<0.05);老年CKD患者MFS评分与血清25-(OH)-D水平呈显著正相关(r=0.512,P<0.05),与血清SOST水平呈显著负相关(r=-0.327,P<0.05)。结论老年慢性肾脏病患者血清25羟维生素D和骨硬化蛋白水平表达异常,血清25羟维生素D、骨硬化蛋白可作为骨质疏松症的独立危险因素。

Objective To explore the relationship between serum 25-hydroxyvitamin D[25(OH)D],sclerostin(SOST)levels and osteoporosis(OSP),falls risk in elderly patients with chronic kidney disease(CKD).Methods A total of 120 patients confirmed with CKD in Chengde Central Hospital were enrolled.According to presence or absence of OSP,they were divided into OSP group(n=33)and non-OSP group(n=87).Univariate analysis of OSP was conducted.The risk factors of OSP and falls were analyzed by Logistic regression analysis.The diagnostic value of serum 25-(OH)-D and SOST in OSP was analyzed by ROC curves.The score of Morse Fall Assessment Scale(MFS)between the two groups was compared.The correlation between serum 25-(OH)-D,SOST levels and falls risk was analyzed by Pearson correlation analysis.Results The incidence of diabetes and level of serum SOST in OSP group were significantly higher than those in control group,while BMD and serum 25-(OH)-D at different sites were significantly lower than those in control group(P<0.05).Logistic regression analysis showed that decreased 25-(OH)-D and increased SOST were independent factors of OSP(P<0.05).AUC of serum 25-(OH)-D combined with SOST for predicting OSP was 0.870(P<0.05).MFS score in OSP group was significantly higher than that in non-OSP group[(65.13±3.24)points vs(41.05±2.98)points](P<0.05).MFS score was significantly positively correlated with level of serum 25-(OH)-D(r=0.512,P<0.05),while significantly negatively correlated with level of serum SOST(r=-0.327,P<0.05).Conclusion The expressions of serum 25-(OH)-D and SOST are abnormal in elderly patients with CKD.Serum 25-(OH)-D and SOST can be applied as independent risk factors of osteoporosis.