血清肌酐胱抑素C比值与糖尿病合并骨折的临床分析

Clinical analysis of serum creatinine cystatin c ratio and diabetes complicated with fractures

目的探讨血肌酐胱抑素C比值(creatinine/cystatin C,Cr/CysC)与糖尿病患者骨折风险的关系,为评估糖尿病患者骨折发生风险提供依据。方法前瞻性选取2019年4月至2021年4月于商丘市第一人民医院就诊的2型糖尿病(type 2 diabetes,T2DM)患者216例,根据是否合并骨折分为骨折组(56例)和无骨折组(160例)。收集两组基线资料、临床一般资料、实验室、影像学资料,采用肌氨酸氧化酶法检测血清肌酐(Cr)含量,采用免疫比浊法测定血清胱抑素C(CysC)水平,并计算两者比值,对年龄、性别、体重指数、糖尿病病程等进行倾向性评分匹配后,采用多因素Logistic回归分析评价影响糖尿病患者骨折风险的影响因素,并采用限制性立方样条评价Cr/CysC与糖尿病骨折风险间的关系。结果两组经倾向性评分匹配后有42组配对成功(每组42例),匹配后基线资料对比差异无统计学意义(P>0.05)。骨折组晚期糖基化终末产物(advanced glycation end-products,AGEs)(129.13±37.51)ng/ml、血清碱性磷酸酶(alkaline phosphatase,ALP)(97.50±23.80)U/L较无骨折组(108.41±29.33)ng/ml、(84.35±25.66)U/L高;Cr/CysC(0.87±0.15)、四肢骨骼肌量(19.58±3.99)kg较无骨折组(0.99±0.21)、(21.81±4.38)kg低(P<0.05)。多因素Logistic回归分析显示:四肢骨骼肌量(OR=0.865,95%CI 0.761~0.985)、Cr/CysC(OR=0.048,95%CI 0.002~0.933)为糖尿病合并骨折的保护因素;ALP(OR=1.023,95%CI 1.002~1.044)、AGEs(OR=1.022,95%CI 1.006~1.039)糖尿病合并骨折的危险因素(均P<0.05),限制性立方样条显示Cr/CysC与糖尿病合并骨折间呈显著非线性关系(P<0.05)。结论Cr/CysC与糖尿病患者骨折发生相关,可作为糖尿病合并骨折发生的潜在预测因子。

Objective To explore the relationship between the ratio of serum creatinine and cystatin C(Creatinine/Cystatin C,Cr/CysC)and the risk of fracture in diabetic patients,and to provide a basis for evaluating the risk of fracture in diabetic patients.Methods Prospectively selected 216 patients with type 2 diabetes(T2DM)who were treated in our hospital from Apr.2019 to Apr.2021.Among them,they were divided into fracture group(56 cases)and non-fracture group(160 cases)according to whether they were combined with fractures.Collected two groups of baseline data,general clinical data,laboratory,imaging data,use sarcosine oxidase method to detect serum creatinine(Cr)content,use immunoturbidimetric method to determine serum cystatin C(CysC)level,and calculate The ratio of the two,After matching the propensity scores for age,gender,body mass index,diabetes course,etc.,multi-factor Logistic regression analysis was used to evaluate the influencing factors of fracture risk in diabetic patients,and the restrictive cubic spline was used to evaluate the relationship between Cr/CysC and diabetic fracture risk.Relationship.Results After the two groups were matched by propensity scores,42 groups were successfully matched,and there was no statistically significant difference in baseline data after matching(P>0.05);Compared with the fracture group,the AGEs(129.13±37.51)ng/mL andALP(97.50±23.80)U/L in the fracture group were higher than those in the non-fracture group(108.41±29.33)ng/mL,(84.35±25.66)U/L higher;Cr/CysC(0.87±0.15),limb skeletal muscle mass(19.58±3.99)kg were higher than those in the non-fracture group(0.99±0.21),(21.81±4.38)kg low(P<0.05);Multivariate logistic regression analysis showed that the skeletal muscle mass of extremities(OR=0.865,95%CI0.761~0.985)and Cr/CysC(OR=0.048,95%CI0.002~0.933)were protective factors for diabetes complicated with fractures;ALP(OR=1.023,95%CI1.002~1.044),AGEs(OR=1.022,95%CI1.006~1.039)risk factors for diabetes and fracture(all P<0.05),Restricted cubic spline showed a significant non-linear relationship between Cr/CysC and diabetic fractures(P<0.05).Conclusion Cr/CysC is related to the occurrence of fractures in diabetic patients and can be used as a potential predictor of the occurrence of diabetic fractures.