血清铁调素铁蛋白结合FRAX评分预测绝经后骨质疏松症患者骨折风险的价值

Value analysis of serum hepcidin and ferritin combined with FRAX score in predicting fracture risk of patients with postmeno⁃pausal osteoporosis

目的 探讨血清铁调素、铁蛋白结合骨折风险评估工具(FRAX)评分对绝经后骨质疏松症(PMOP)患者骨折风险的预测价值。方法 选取2018年6月至2022年1月巴中市中心医院收治的PMOP患者352例作为研究对象,根据其就诊时是否发生骨折分为骨折组(91例)和未骨折组(261例)。两组患者入院后治疗前均检测血清铁调素、铁蛋白水平,评估FRAX评分,采用logistic回归分析PMOP患者骨折的危险因素,并绘制受试者工作特征(ROC)曲线分析血清铁调素、铁蛋白水平、FRAX评分单独及联合对PMOP患者骨折风险的预测效能。结果 骨折组年龄≥60岁、生育次数≥2次、有脆性骨折史占比及铁蛋白水平、FRAX评分均高于未骨折组(P<0.05),初潮年龄、绝经年限均大于未骨折组(P<0.05),有雌激素使用史占比、腰椎L1~4骨密度和血清铁调素水平均低于未骨折组(P<0.05),差异均有统计学意义;经logistic回归分析显示有脆性骨折史、绝经年限长、腰椎L1~4骨密度降低、血清铁调素水平降低、铁蛋白水平升高、FRAX评分高均是PMOP患者骨折的独立危险因素(P<0.05);雌激素使用史是保护因素(P<0.05)。血清铁调素、铁蛋白水平结合FRAX评分预测PMOP患者骨折风险的灵敏度、特异度、曲线下面积(AUC)分别为94.51%、91.57%、0.955,灵敏度和AUC均高于单独预测(P<0.05),特异度均与单独预测结果差异无统计学意义(P>0.05)。结论 血清铁调素水平降低、铁蛋白水平与FRAX评分升高均是PMOP患者骨折发生的危险因素,三者均可作为PMOP患者骨折风险的预测指标,且联合的预测效能更好。

Objective To explore the predictive value of serum hepcidin and ferritin levels combined with the score of fracture risk as-sessment tool(FRAX)for bone fracture risks in postmenopausal osteoporosis(PMOP)patients.Methods A total of 352 patients with PMOP treated in Sichuan Bazhong Central hospital from June 2018 to January 2022 were selected as the research objects,and they were divided into fracture group(91 cases)and non fracture group(261 cases)according to whether they had fracture at the time of treatment.The serum hepci-din and ferritin levels were measured and the FRAX scores were evaluated in the two groups after admission and before treatment.Logistic re-gression was used to analyze the risk factors of fracture in patients with PMOP,and the receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of serum hepcidin and ferritin levels and FRAX scores alone and in combination for fracture risks in patients with PMOP.Results In the fracture group,the proportions of patients with age≥60 years old,number of births≥2 and the history of brittle fracture as well as the serum hepcidin level and FRAX score were higher than those in the non fracture group(P<0.05),and the menarche age,menopause years of patients were higher than those in the non fracture group(P<0.05),but the proportion of patients with history of estrogen use,the bone mineral density of lumbar vertebrae L1~4 and the serum hepcidin level were lower than those in the non fracture group(P<0.05).Logistic regression analysis showed that history of brittle fracture,long menopausal years,decrease of bone mineral density of lumbar ver-tebrae L1~4 and serum hepcidin level,increase of serum ferritin level and high FRAX scores were independent risk factors of fracture in PMOP patients(P<0.05),while having the history of estrogen use was the protective factor(P<0.05).The sensitivity,specificity and the area under the curve(AUC)of joint prediction of serum hepcidin and ferritin levels and FRAX scores for fracture risks in PMOP patients was 94.51%,91.57%and 0.955 respectively.The sensitivity and AUC of the combined prediction was higher those of single prediction(P<0.05),but the the specificity was not statistically different from that of single prediction(P>0.05).Conclusions The decrease of serum hepcidin level as well as the increases of serum ferritin levels and FRAX scores are all the risk factors of bone fracture in patients with PMOP,and all the three can be used as the prediction indicators of fracture risks in patients with PMOP,and the combined prediction efficiency is better.