雌二醇、SM4D、骨钙素、铁调素对PMO的预测价值

Predictive value of estradiol,SM4D,osteocalcin and hepcidin in PMO

目的探究血清雌二醇、4D同型二聚体(SM4D)、骨钙素、铁调素对绝经后骨质疏松(PMO)的预测价值。方法选取2019年2月至2021年2月重庆市第五人民医院门诊或住院治疗的109例PMO女性患者作为观察组,收集临床相关资料,并选取同期67例绝经后非骨质疏松患者作为对照组,行骨代谢、骨密度检查及雌二醇、SM4D、骨钙素、铁调素水平检测,比较两组以上指标差异。分析雌二醇、SM4D、骨钙素、铁调素水平与骨代谢、骨密度指标的相关性,采用logistics回归分析PMO的危险因素。结果与对照组比较,观察组年龄、Ⅰ型前胶原氨基端前肽(PINP)、骨钙素N端中分子(N-MID)、Ⅰ型胶原羧基端肽β特殊序列(β-CTX)、SM4D水平更高,L1~4和左股骨颈骨密度、25-羟基维生素D[25-(OH)D]、钙离子及雌二醇、铁调素、骨钙素水平更低(P<0.05)。观察组雌二醇、铁调素、骨钙素水平与PINP、N-MID、β-CTX水平呈负相关,与25-(OH)D、钙离子、L1~4骨密度、左股骨颈骨密度水平呈正相关(P<0.05)。观察组SM4D水平与PINP、N-MID、β-CTX水平呈正相关,与25-(OH)D、钙离子、L1~4骨密度、左股骨颈骨密度水平呈负相关(P<0.05)。受试者工作特征(ROC)曲线显示,当雌二醇的截断值为72.73 pmol/L、SM4D为1.00μg/L、骨钙素为6.50μg/L、铁调素为38.54μg/L时,联合检测的曲线下面积明显大于单项检测(P<0.05)。logistic回归分析显示,年龄、PINP、N-MID、β-CTX、SM4D、骨钙素水平升高,L1~4骨密度、左股骨颈骨密度、25-(OH)D、钙离子、雌二醇、铁调素水平下降是POM发生的独立危险因素(P<0.05)。结论雌二醇、SM4D、骨钙素、铁调素均可作为预测PMO发生的指标。

Objective To investigate the predictive value of serum estradiol(E2),4D homodimer(SM4D),osteocalcin,hepcidin for postmenopausal osteoporosis(PMO),and to analyze risk factors.Methods A total of 109 female patients with PMO who were outpatients or hospitalized in this hospital from February 2019 to February 2021 were selected as the study subjects(the observation group),and clinically relevant data were collected.In the same period,67 postmenopausal non osteoporotic patients were included as the control group.All of whom were examined for bone metabolic,bone mineral density and the levels of E2,SM4D,osteocalcin,hepcidin were compared between the two groups.The correlations between the levels of estradiol,SM4D,osteocalcin,hepcidin and bone metabolism and bone mineral density were analyzed.Logistics regression was used to analyze the risk factors of PMO.Results Compared with the control group,the age,procollagen typeⅠN-terminal propetide(PINP),N-terminal intermediate molecule of osteocalcin(N-MID),βisomer of the C-terminal telopeptide of typeⅠcollagen(β-CTX)and SM4D levels in the observation group were higher(P<0.05),and the bone mineral density,25-hydroxy vitamin D[25-(OH)D],calcium ion,estradiol,hepcidin and osteocalcin levels of L1-4 and left femoral neck were lower in the observation group(P<0.05).In the observation group,the levels of E2,hepcidin and osteocalcin were negatively correlated with the levels of PINP,N-MID andβ-CTX,and positively correlated with 25-(OH)D,calcium ion,bone mineral density of L1-4 and bone mineral density of left femoral neck.In the observation group,the level of SM4D was positively correlated with the levels of PINP,N-MID andβ-CTX,and negatively correlated with 25-(OH)D,calcium ion,L1-4 bone mineral density and left femoral neck bone mineral density(BMD)(P<0.05).The receiver operating characteristic(ROC)curve showed that the area under the curve of combined detection was significantly larger than that of single detection when the cutoff value of estradiol was 72.73 pmol/L,SM4D was 1.00μg/L,osteocalcin was 6.50μg/L and hepcidin was 38.54μg/L(P<0.05).Logistic regression analysis showed that age,PINP,N-MID,β-CTX,SM4D and osteocalcin levels increased,while L1-4 bone mineral density,left femoral neck bone mineral density,25-(OH)D,calcium,estradiol and ferritin levels decreased were the independent risk factors for PMO(P<0.05).Conclusion E2,SM4D,osteocalcin,hepcidin are effective predictors of PMO.