Duchenne型肌营养不良症椎体骨折的相关影响因素

Factors associated with vertebral fractures in Duchenne muscular dystrophy

[目的]探讨Duchenne型肌营养不良症(Duchenne muscular dystrophy,DMD)患者发生椎体骨折(vertebral fracture,VF)的相关因素。[方法]回顾性分析2021年7月—2022年9月就诊于解放军总医院DMD多学科联合门诊的DMD患者临床资料。依据是否存在VF分为VF组和非VF组,采用单项因素比较、二元多因素逻辑回归分析和受试者工作曲线(receiver op⁃erating characteristic,ROC)分析VF的相关因素。[结果]纳入本研究的93例患儿均为男性,年龄3.9~15.4岁,平均(8.7±2.6)岁;其中发生VF患儿19例,占20.4%,非VF患儿74例,占79.6%;激素治疗的患儿56例中,VF为17例,30.4%,非VF为39例,占69.6%。单项因素比较表明,VF组服用激素时间、年龄、卧-立位时间显著大于非VF组,腰椎骨密度Z(lumbar bone mineral density Z value,LBMD-Z)值显著低于非VF组,差异有统计学意义(P<0.05)。逻辑回归表明:服用激素时间(OR=2.880,P=0.001)、卧-立位时间(OR=1.115,P=0.015)是DMD患儿VF的独立危险因素,而LBMD-Z值(OR=0.102,P<0.001),年龄(OR=0.511,P=0.021)是VF的保护性因素。ROC曲线分析表明:LBMD-Z值、服用激素时间的曲线面积(aera under curve,AUC)为0.7~0.9,有较好预测VF的价值。[结论]DMD患者VF是多种因素共同作用的结果,对影响因素采取针对性措施,有助于减少VF的发生。

[Objective]To explore the factors related to vertebral fracture(VF)in Duchenne muscular dystrophy(DMD)in children.[Methods]A retrospective study was conducted on the clinical data of DMD patients who admitted to the multidisciplinary joint outpatient de⁃partment of DMD in General Hospital of PLA from July 2021 to September 2022.The children were divided into VF group and non-VF group according to the presence or absence of VF.The factors related to VF were analyzed by univariate comparison,binary multiple logic analysis and receiver operating characteristic(ROC).[Results]A total of 93 children were included in this study,and all of them were male,aged from 3.9 to 15.4 years old with an average age of(8.7±2.6)years old.Among them,19 cases proved VF,accounting for 20.4%;while the remaining 74 cases were of non-VF,accounting for 79.6%.Among them,56 children were treated with hormone therapy,17 cases(30.4%)were with VF and 39 cases(69.6%)were with non-VF.In term of univariate comparison,the VF group had significantly greater the time of hormone taking,age and supine-standing position time,whereas significantly less lumbar bone mineral density Z value(LBMD-Z)than the non-VF group,with statistical significance(P<0.05).As results of logistic regression,hormone taking duration(OR=2.880,P=0.001)and supine-standing time(OR=1.115,P=0.015)were independent risk factors for VF,while LBMD-Z value(OR=0.102,P<0.001),age(OR=0.511,P=0.021)was the protective factor for VF.In term of receiver operating characteristic(ROC)analysis,the aera under curve(AUC)of LBMD-Z value and hor⁃mone administration duration ranged from 0.7 to 0.9,which had a good value in predicting VF.[Conclusion]The VF in DMD patients is the result of the combined action of multiple factors.Targeted measures to the impacting factors might be helpful to reduce the occurrence of VF.