血清单核细胞/高密度脂蛋白胆固醇比值、尿白蛋白/肌酐比值对糖尿病肾病患者发生骨质疏松的评估价值

Serum monocyte/high-density lipoprotein cholesterol ratio and urinary albumin/creatinine ratio in evaluating osteoporosis in diabetic nephropathy patients

目的探讨血清单核细胞/高密度脂蛋白胆固醇比值(monocyte-to-HDL cholesterol ratio,MHR)、尿微量白蛋白和肌酐比值(albumin-to-creatinine ratio,ACR)对糖尿病肾病(diabetic nephropathy,DN)患者发生骨质疏松的评估价值。方法选择2019年6月至2022年6月于杭州市第九人民医院治疗的117例DN患者作为研究对象。收集并记录所有患者的性别、年龄、身高、体重,计算身体质量指数(body mass index,BMI);检测并记录所有患者的血钙(calcium,Ca)、血磷(phosphorus,P)、甲状旁腺激素(parathyroid hormone,PTH)、单核细胞计数(monocyte count,M)、高密度脂蛋白(high-density lipoprotein,HDL-C)、尿微量白蛋白和肌酐,计算MHR和ACR,MHR=M/HDL-C,ACR=尿微量白蛋白/肌酐。采用双能X线骨密度仪检测腰椎(L1~L4)骨密度,将117例患者分为骨质疏松组和非骨质疏松组。结果117例DN患者中,骨质疏松者为47例,非骨质疏松者70例。骨质疏松组的女性比例显著高于非骨质疏松组,BMI和腰椎骨密度显著低于非骨质疏松组,PTH、MHR和ACR显著高于非骨质疏松组,差异有统计学意义(统计值=2.36、4.33、3.99、13.25、9.58;P=0.017、<0.001、<0.001、<0.001、<0.001)(P均<0.05)。多因素二元Logistic回归分析结果显示,女性、MHR和ACR是DN患者发生骨质疏松的独立危险因素(P均<0.05)。Spearman相关性分析结果显示MHR及ACR均与腰椎骨密度呈显著负相关关系,差异有统计学意义(r=0.524 vs 0.497,P=0.004 vs 0.009)。ROC曲线分析结果显示MHR、ACR评估DN患者发生骨质疏松的曲线下面积(area under the curve,AUC)分别为0.870(0.809~0.931)和0.849(0.792~0.905),血清MHR联合尿ACR评估DN患者发生骨质疏松的AUC为0.927(0.891~0.964)。结论血清MHR和尿ACR可作为DN患者发生骨质疏松的评估指标,且两者联合评估效能更优。

Objective To investigate the value of serum monocyte/high-density lipoprotein cholesterol ratio(MHR)and urinary albumin/creatinine ratio(ACR)in the evaluation of osteoporosis in diabetic nephropathy patients.Methods Diabetic nephropathy patients treated in Hangzhou Ninth People’s Hospital from Jun.2019 to Jun.2022 were selected.Gender,age,height and weight of all patients were collected and recorded,and body mass index(BMI)was calculated.Blood calcium(Ca),blood phosphorus(P),parathyroid hormone(PTH),monocyte count(M),high density lipoprotein(HDL-C),urinary microalbumin and creatinine were measured and recorded in all patients.MHR and ACR were calculated,MHR=M/HDL-C,ACR=urinary microalbumin/creatinine.Lumbar spine bone mineral density(L1-L4)was measured by dual-energy X-ray absorptiometry,which was divided into osteoporosis group and non-osteoporosis group.Results Among the 117 diabetic nephropathy patients,47 cases were osteoporotic and 70 cases were non-osteoporotic.The proportion of women in osteoporosis group was significantly higher than that in non-osteoporosis group,and BMI,PTH,MHR,ACR and bone mineral density were significantly higher than those in non-osteoporosis group,with statistical significance(all P<0.05).Multivariate binary Logistic regression analysis showed that female,MHR and ACR were independent risk factors for osteoporosis in diabetic nephropathy patients(all P<0.05).Spearman correlation analysis showed that serum MHR and ACR were negatively correlated with lumbar bone density,with statistical significance(r=0.524 and 0.497,P=0.004 and 0.009,respectively).ROC curve analysis showed that the area under the curve(AUC)of serum MHR and ACR for evaluating osteoporosis in diabetic nephropathy patients was 0.870(0.809-0.931)and 0.849(0.792-0.905),respectively.The AUC of serum MHR combined with ACR for osteoporosis in diabetic nephropathy patients was 0.927(0.891-0.964).Conclusion Serum MHR and ACR can be used as the evaluation indexes of osteoporosis in diabetic nephropathy patients,and their combined efficacy is better.