老年人群骨质疏松性椎体压缩骨折的影响因素及预后营养指数的预测价值

Factors influencing osteoporotic vertebral compression fractures in an elderly population and the predictive value of the prognostic nutritional index for it

目的调查老年人骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)的相关影响因素,为减少OVCF的发生确定重点关注人群,丰富理论依据。方法选取OVCF患者119例为OVCF组、同期主诉腰背痛的非OVCF患者119例为对照组,对两组患者进行年龄、性别、体质量指数(body mass index,BMI)、入院血液结果及骨密度(bone mineral density,BMD)等基本情况调查,通过单因素和多因素Logistic回归分析影响OVCF发生的风险因素,并计算独立影响因素的联合概率,绘制ROC曲线。结果单因素分析:OVCF组有更高的年龄、BMI、糖尿病人群构成比及更低的预后营养指数(prognostic nutritional index,PNI)、BMD(均为P<0.05);多因素分析:高PNI是OVCF发生的保护因素,高龄、低BMD、BMI≥28 kg/m^(2)、伴随糖尿病是OVCF发生的独立危险因素(均为P<0.05);PNI、BMD、年龄的线性趋势明显(P for tread<0.05);不同的性别中,各独立危险因素OR值方向一致,高BMD、PNI的OR<1,高龄、高BMI及伴随糖尿病的OR>1。ROC:相对无PNI组,五项独立因素联合概率ROC曲线:敏感度提高5.9%,AUC提高0.0451(P=0.0064)。结论PNI、BMD、年龄、BMI、伴随糖尿病是OVCF发生的独立影响因素,其中反映营养及免疫状况的PNI对OVCF有重要的预测价值。

Objective To investigate the risk factors for osteoporotic vertebral compression fractures(OVCF)in the elderly and to identify key populations of concern in order to reduce the occurrence of OVCF and enrich the theoretical basis.Methods A total of 119 patients with OVCF were selected as the OVCF group and during the same period,119 non-OVCF patients who complained of low back pain were selected as the control group.Age,sex,body mass index(BMI),admission blood results and bone mineral density(BMD)were investigated in the two groups respectively.ROC curves were plotted based on analyzing the univariate and multivariate logistic regression of risk factors affecting the occurrence of OVCF and calculating the the joint probabilities of independent influencing factors.Results Univariate analysis showed that the OVCF group had higher age,BMI,diabetic population constituent ratio and lower prognostic nutritional index(PNI),BMD(P<0.05).Multivariate analysis indicated that high PNI was a protective factor for the development of OVCF,and the independent risk factors of OVCF were the advanced age,low BMD,BMI≥28 kg/m^(2),and concomitant diabetes(P<0.05).The indicators of PNI,BMD and age showed a linear trend(P for tread<0.05).The ORs for each independent risk factor were in the same direction across sex,with high BMD and PNI,OR<1,and advanced age,high BMI and concomitant diabetes,OR>1.Compared with the no PNI group,the five independent factors combined probability ROC curve showed the sensitivity was increased by 5.9%and AUC by 0.0451(P=0.0064).Conclusion PNI,BMD,age,BMI,and concomitant diabetes are independent influencing factors for the occurrence of OVCF.Among them,PNI,which reflects nutritional and immune status,has important predictive value for OVCF.