绝经后健康体检女性血浆同型半胱氨酸与骨密度的关系

Association between plasma homocysteine level and bone mineral density in healthy postmenopausal women

目的探究绝经女性同型半胱氨酸(homocysteine,Hcy)水平与骨密度的关系,为骨质疏松的预防提供基础依据。方法采用简单随机抽样法,选取824名健康绝经女性,测量血浆Hcy等生化指标及评估四个部位(腰椎、股骨颈、大粗隆、全髋)骨密度。采用线性回归分析Hcy与骨密度的关系,并探讨Hcy对骨质疏松预测截断值。结果各部位骨密度水平随着Hcy升高而降低。在低年龄段(43~<57岁)血浆Hcy与腰椎(β=-0.008,95%CI:-0.013~-0.003)、全髋(β=-0.006,95%CI:-0.010~-0.001)骨密度成负相关,在高年龄段(57~80岁),Hcy与腰椎(β=-0.010,95%CI:-0.013~-0.006)、股骨颈(β=-0.006,95%CI:-0.009~-0.002)、大粗隆(β=-0.004,95%CI:-0.007~-0.001)、全髋(β=-0.007,95%CI:-0.010~-0.004)骨密度均成负相关。受试者工作特征曲线结果显示,Hcy对骨质疏松预测的截断值水平为10.85 umol/L(灵敏度:55.7%,特异度:75.9%,曲线下面积:0.713,P<0.01)。结论血浆Hcy水平与绝经女性腰椎、股骨颈、大粗隆、全髋部位骨密度成负相关。Hcy是骨质疏松的独立危险因素,当Hcy水平≥10.85μmol/L时,可作为骨质疏松较好的预测因子。

Objective To explore the association between plasma homocysteine(Hcy)level and bone mineral density(BMD)in postmenopausal women,so as to provide basic evidence for the prevention of osteoporosis.Methods A total of 824 healthy postmenopausal women were selected using simple random sampling method.Their plasma Hcy level,among other biochemical indexes,and BMD at four sites(lumbar spine,femoral neck,greater trochanter and total hip)were measured.Linear regression was used to analyze the association between Hcy and bone mineral density,and to explore the predictive cut-off value of Hcy for osteoporosis.Results The level of bone mineral density at the studied sites decreased with the rise of Hcy level.In 43-<57 years age group,the plasma Hcy level was negatively correlated with the bone mineral density of the lumbar spine(β=-0.008,95%CI:-0.013,-0.003)and the total hip(β=-0.006,95%CI:-0.010,-0.001).In 57-80 years age group,Hcy level was negatively correlated with the BMD of the lumbar spine(β=-0.010,95%CI:-0.013,-0.006),femoral neck(β=-0.006,95%CI:-0.009,-0.002),greater trochanter(β=-0.004,95%CI:-0.007,-0.001),and total hip(β=-0.007,95%CI:-0.010,-0.004).According to the receiver operating characteristic(ROC)curve,the cut-off value of plasma Hcy level for osteoporosis prediction is 10.85 umol/L(sensitivity:55.7%,specificity:75.9%,area under the curve:0.713,P<0.01).ConclusionsThe level of plasma Hcy is negatively correlated with the BMD of lumbar spine,femoral neck,greater trochanter and total hip in postmenopausal women.Hcy may be an independent risk factor for osteoporosis.A Hcy level being 10.85 umol/L or higher may be a good predictor of osteoporosis.