老年营养风险指数对老年2型糖尿病患者骨质疏松的预测价值分析

Analysis of the Predictive Value of the Geriatric Nutritional Risk Index for Osteoporosis in Elderly Patients with Type 2 Diabetes Mellitus

目的:通过评估老年营养风险指数(GNRI),探讨其与老年T2DM患者骨密度相关性和预测价值。方法:选取2019年1月至2022年6月就诊的老年T2DM患者445例,收集所有患者的一般资料、骨密度资料及相关血液生化指标,计算老年营养风险指数得分。根据GNRI分为无营养风险组(GNRI>98,n=283)、低营养风险组(92≤GNRI≤98,n=95)、中-高营养风险组(GNRI<92,n=67)。采用spearman相关分析骨密度与上述指标的相关性,二分类logistic回归分析老年T2DM患者GNRI与骨质疏松症的关系。运用受试者工作特征(ROC)曲线分析GNRI对骨质疏松症的预测价值。结果:无营养风险组、低营养风险组、中-高营养风险组的年龄和骨质疏松患病率逐渐增高,组间比较差异有统计学意义(P<0.001)。无营养风险组、低营养风险组、中-高营养风险组总蛋白(TP)、血清白蛋白(ALB)、血清钙水平、股骨颈BMD、腰椎BMD、全髋BMD依次降低,组间比较差异有统计学意义(P<0.05)。spearman相关分析结果显示,GNRI与所有部位BMD均呈正相关(r=0.211、0.183、0.180,P<0.001)。二分类logistic回归分析结果显示,GNRI是骨质疏松发生的独立保护因素[OR=-0.155,95%CI(0.753,0.974),P<0.05]。ROC曲线分析结果显示,GNRI诊断骨质疏松的敏感性43.43%,特异性74.32%,约登指数17.76%,最佳截断值为98.282。结论:老年T2DM患者GNRI水平与各部位BMD均呈正相关;GNRI是发生骨质疏松症的独立保护因素,同时可能是老年T2DM患者骨质疏松发生的有效预测指标。

Objective:To investigate the relationship between the Geriatric Nutrition Risk Index(GNRI)and bone mineral density in elderly patients with T2DM and the predictive value of GNRI for osteoporosis in elderly patients with type 2 diabetes.Methods:A total of 445 elderly patients with T2DM attending the First Affiliated Hospital of Chengdu Medical College from January 2019 to June 2022 were retrospectively selected,and the general data,bone mineral density data and relevant blood biochemical indexes of the study subjects were collected to calculate the geriatric nutritional risk index(GNRI)score.According to GNRI,they were divided into non-nutritional risk group(GNRI>98,n=283),low nutritional risk group(92≤GNRI≤98,n=95),and medium-high nutritional risk group(GNRI<92,n=67).Spearman correlation was used to analyze the correlation between BMD and the above indexes,and dichotomous logistic regression was used to analyze the relationship between GNRI and osteoporosis in elderly T2DM patients.The predictive value of GNRI for osteoporosis was analyzed using subject work characteristic(ROC)curves.Results:The age and prevalence of osteoporosis gradually increased in the non-nutrition risk group,low-nutrition risk group,and medium-high nutrition risk group,with statistically significant differences between the groups(P<0.001).Total protein(TP),serum albumin(ALB),serum calcium level,femoral neck BMD,lumbar spine BMD,and total hip BMD decreased sequentially in the non-nutrition risk group,low-nutrition risk group,and medium-high nutrition risk group,and the difference between the groups was statistically significant(P<0.05).spearman correlation results showed that GNRI was positively correlated with BMD at all sites(r=0.211,0.183,0.180,P<0.001).The results of dichotomous logistic regression analysis showed that GNRI was an independent protective factor for the development of osteoporosis[OR=-0.155,95%CI(0.753,0.974),P<0.05].The results of ROC curve analysis showed that GNRI had 43.43%sensitivity,74.32%specificity and 17.76%Yordon index for the diagnosis of osteoporosis.The best cut-off value was 98.282.Conclusion:GNRI levels in elderly T2DM patients were positively correlated with BMD at all sites;GNRI is an independent protective factor for the development of osteoporosis and may also be a valid predictor of the development of osteoporosis in elderly T2DM patients.