糖化血红蛋白变异指数对骨质疏松性椎体压缩性骨折合并2型糖尿病患者继发邻近椎体压缩性骨折的预测分析

Predictive analysis of hemoglobin glycation index for secondary adjacent vertebral compression fracture in osteoporotic vertebral compression fracture patients with type 2 diabetes mellitus

目的探讨糖化血红蛋白(HbA1c)变异指数(HGI)对骨质疏松性椎体压缩性骨折(OVCF)合并2型糖尿病(T2DM)患者在经皮椎体成形术(PVP)后继发邻近椎体压缩性骨折(AVCF)的影响和预测作用。方法2018年6月—2021年6月采用PVP治疗OVCF合并T2DM患者67例,根据术后1年是否发生AVCF分为AVCF组(n=21)和非AVCF组(n=46)。绘制受试者工作特征(ROC)曲线分析HGI对术后AVCF的预测作用,并对PVP术后发生AVCF的独立危险因素进行logistic回归分析,绘制Kaplan-Meier风险曲线,分析HGI对术后AVCF发生的影响。结果HGI预测PVP术后发生AVCF的ROC曲线下面积(AUC)为0.929(95%置信区间为0.864~0.994,P<0.05),约登指数最大值为0.745,最佳界值为0.237%,灵敏度为0.810,特异度为0.935。单因素分析发现,AVCF组高HGI、更低的骨密度T值、高HbA1c值、胸椎骨折、高骨水泥注入量、未佩戴支具的患者PVP术后AVCF发生率高于非AVCF组,差异均有统计学意义(P<0.05)。对上述6个因素进一步行多因素logistic回归分析发现,高HGI、更低的骨密度T值、高HbA1c值是PVP术后发生AVCF的独立危险因素。Kaplan-Meier风险曲线分析发现,高HGI患者PVP术后AVCF发生率高于低HGI患者(Lon-Rank=54.411,P<0.05)。结论高HGI、更低的骨密度、高HbA1c值是OVCF合并T2DM患者术后发生AVCF的独立危险因素。高HGI对AVCF的发生具有一定预测价值。

Objective To investigate the influence and prediction of hemoglobin glycation(HbAlc)index(HCI)on adjacent vertebral compression fracture(AVCF)after percutaneous vertebroplasty(PVP)in patients with osteoporotic vertebral compression fracture(OVCF)with type 2 diabetes mellitus(T2DM).Methods From June 2018 to June 2021,67 patients with OVCF and T2DM were treated with PVP,and divided into AVCF group(n=21)and non AVCF group(n=46)based on whether occurred AVCF at postoperative 1 year.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive effect of HGI on postoperative AVCF,and the independent risk factors for AVCF after PVP were analyzed by logistic regression,and the influence of HGI on postoperative AVCF was analyzed by drawing Kaplan-Meier risk curve.Results The area under the curve(AUC)of HGI for predicting AVCF after PVP surgery was 0.929(95%confidence interval was 0.864-0.994,P<0.05),and the maximum value of Yoeden index was 0.745,and the best cut-off value was 0.237%,and the sensitivity was 0.810,and the specificity was 0.935.Univariate analysis showed that the incidence of AVCF after PVP in patients with high HGI,lower bone mineral density T value,high HbAlc value,thoracic fracture,high bone cement injection amount and no brace wearing was higher than that in non-AVCF group,and the differences were statistically significant(P<0.05).Multivariate logistic regression analysis of the above 6 factors showed that high HGI,lower bone mineral density T value and high HbAlc value were independent risk factors for AVCF after PVP.Kaplan-Meier risk curve analysis showed that the incidence of AVCF after PVP in patients with high HGI was higher than that in patients with low HGI(Lon-Rank=54.411,P<0.05).Conclusions High HCI,lower bone mineral density and high HBAlc value are independent risk factors for postoperative AVCF in patients with OVCF and T2DM.High HGI can predict the occurrence of AVCF.