血清戊糖素水平和骨小梁分数影响2型糖尿病患者椎体骨折的严重程度

Serum pentosidine level and trabecular bone score affect the severity of vertebral fractures in type 2 diabetes patients

背景:研究显示,2型糖尿病患者可以在骨密度正常范围甚至较高的情况下发生骨折,因此,在2型糖尿病患者中骨质量比骨密度预测骨折风险的作用更大。目的:评估血清戊糖素水平和骨小梁分数与2型糖尿病患者椎体骨折压缩程度的相关性。方法:选择2021年1月至2022年6月复旦大学附属上海市第五人民医院收治的骨质疏松性胸腰椎骨折患者80例,包括40例2型糖尿病患者和40例非糖尿病患者。收集所有患者的一般信息,包括性别、年龄、体质量指数、骨代谢生化指标等;采用双能X射线吸收仪检测患者骨密度,根据测量获得的图像使用TBS Insight?软件计算脊柱骨小梁分数;采用高效液相色谱法测定患者血清中戊糖素水平;使用Genant半定量分型对所有患者脊柱骨折压缩程度进行分级,分析各种变量因素与椎体骨折压缩程度的相关性。结果与结论:(1)糖尿病组患者的血清戊糖素水平高于非糖尿病组(P<0.05),骨小梁分数值低于非糖尿病组(P<0.05),两组腰椎骨密度、髋关节骨密度、严重骨折压缩占比比较差异均无显著性意义(P>0.05);(2)Spearman单因素相关分析结果显示,椎体骨折严重程度与糖化血红蛋白、血清戊糖素水平存在显著的正相关关系(r=0.310,0.796,P=0.005,0.000),椎体骨折严重程度与骨小梁分数之间存在显著的负相关关系(r=-0.915,P=0.000);(3)结果显示,骨小梁分数和血清戊糖素水平可作为一种评价骨质量的方法,两者与骨质疏松性椎体骨折严重程度显著相关。

BACKGROUND:Type 2 diabetes patients have been shown to experience fractures in the normal range or even higher bone mineral density.Therefore,bone quality plays a more important role in predicting fracture risk than bone mineral density in type 2 diabetes patients.OBJECTIVE:To evaluate the correlation of serum pentosidine level and trabecular bone score with the severity of vertebral fractures in type 2 diabetes patients.METHODS:Eighty patients with with osteoporotic thoracolumbar fractures were selected from Shanghai Fifth People’s Hospital,Fudan University from January 2021 to June 2022,including 40 patients with type 2 diabetes and 40 patients without diabetes.General information about all patients,including gender,age,body mass index,and biochemical markers of bone metabolism,was collected.Bone mineral density was measured by dual-energy X-ray absorptiometry,and the trabecular bone fraction of the spine was calculated using TBS Insight?software from the images obtained from the measurement.The concentration of pentosidine in serum of patients was determined by high performance liquid chromatography.The degree of spinal fracture compression in all patients was graded using the Genant semi-quantitative classification.The correlation between various variables and the degree of vertebral fracture compression was analyzed.RESULTS AND CONCLUSION:(1)Compared with the non-diabetes group,the serum pentosidine level was significantly increased(P<0.05)and the trabecular bone score was significantly decreased in the diabetes group(P<0.05).There was no significant difference between the two groups in the lumbar bone mineral density,hip bone mineral density,and the proportion of severe fracture compression(P>0.05).(2)Spearman correlation analysis showed that the severity of vertebral fracture was positively correlated with glycosylated hemoglobin and serum pentosidine levels(r=0.310,0.796,P=0.005,0.000).There was a significant negative correlation between vertebral fracture severity and trabecular bone score(r=-0.915,P=0.000).(3)These findings suggest that trabecular bone score and serum pentosidine levels,which can be used as a measure of bone quality,are significantly associated with the severity of osteoporotic vertebral fractures.