双能X线检查联合骨代谢指标在糖尿病合并骨质疏松患者中的应用价值

Application Value of Dual Energy X-Ray Examination Combined with Bone Metabolism Indexes in Patients with Diabetes Mellitus Complicated with Osteoporosis

目的探究双能X线检查联合骨代谢指标在糖尿病合并骨质疏松患者中的应用价值。方法前瞻性选择2020年3月至2022年3月我院收治的100例糖尿病患者作为研究对象,根据骨质疏松情况将患者分为骨质疏松组(n=58)和非骨质疏松组(n=42)。比较两组患者的一般资料、实验室指标、双能X线检查指标及骨代谢指标;采用多因素Logistic回归分析影响患者合并骨质疏松的因素;采用受试者工作特征(Receiver Operating Characteristic,ROC)曲线评价双能X线检查、骨代谢指标及二者联合对患者合并骨质疏松的诊断价值;根据多因素分析结果构建列线图预测模型并评价其预测效能。结果年龄>55岁、女性、糖化血红蛋白>9%、空腹C肽<1.58μg/mL、腰椎L1-4骨密度<0.96 g/cm^(2)、股骨颈骨密度<0.87 g/cm^(2)、骨钙素>14.02μg/L、β-胶原降解产物>0.32μg/L、Ⅰ型前胶原氨基端前肽>53.42μg/L、骨碱性磷酸酶>221.84 U/L是导致患者合并骨质疏松的独立危险因素(P<0.05);二者联合的ROC曲线下面积[0.871(95%CI:0.831~0.916)]、敏感度(92.13%)和特异性(82.22%)均明显高于双能X线检查[0.822(95%CI:0.783~0.867)、88.24%、76.12%]和骨代谢指标[0.747(95%CI:0.713~0.781)、81.54%、67.78%]单独诊断;列线图预测模型的准确度较高,有效性较好。结论双能X线检查及骨代谢指标对糖尿病患者合并骨质疏松均具有较高的诊断价值,且二者联合的诊断价值更高,年龄、性别、骨代谢指标等也均与患者合并骨质疏松有关,临床上应给予密切关注。

Objective To explore the application value of dual energy X-ray examination combined with bone metabolism index in patients with diabetes mellitus complicated with osteoporosis.Methods A total of 100 patients with diabetes treated in our hospital from March 2020 to March 2022 were prospectively selected as subjects.According to the situation of osteoporosis,the patients were divided into osteoporosis group(n=58)and non-osteoporosis group(n=42).The general data,laboratory indexes,dual-energy X-ray examination indexes and bone metabolism indexes of the two groups were compared.Multivariate Logistic regression was used to analyze the influencing factors of patients with osteoporosis.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of dual-energy X-ray examination,bone metabolism indexes and their combination in patients with osteoporosis.Based on the results of multi-factor analysis,the prediction model of line graph was constructed and its prediction efficiency was evaluated.Results Age>55 years old,female,glycated hemoglobin A1c>9%,fasting C-peptide<1.58μg/mL,lumbar vertebra L1-4 bone mineral density<0.96 g/cm2,femoral neck bone mineral density<0.87 g/cm2,osteocalcin>14.02μg/L,β-C-terminal telopeptide of type I collagen>0.32μg/L,procollagen type I N terminal propeptide>53.42μg/L,neonatal bone alkaline phosphatase>221.84 U/L were independent risk factors for osteoporosis in patients with osteoporosis.The area under the ROC curve of the two combination[0.871(95%CI:0.831-0.916)],sensitivity(92.13%)and specificity(82.22%)were significantly higher than those of dual-energy X-ray examination[0.822(95%CI:0.783-0.867),88.24%,76.12%]and bone metabolism index[0.747(95%CI:0.713-0.781),81.54%,67.78%].The accuracy of the line chart prediction model was high and the effectiveness was good.Conclusion Both dual energy X-ray examination and bone metabolism indexes have high diagnostic value in diabetic patients with osteoporosis,and the combination of them has higher diagnostic value.Age,gender,bone metabolism indexes are also related to patients with osteoporosis,which should be paid close attention to clinically.