绝经后2型糖尿病患者骨质疏松症影响因素分析及列线图模型构建

Analysis of influencing factors of osteoporosis in postmenopausal patients with type 2 diabetes mellitus and construction of nomogram model

目的探讨绝经后2型糖尿病患者骨质疏松症(OP)的影响因素,并尝试建立绝经后2型糖尿病患者OP列线图预测模型。方法回顾性选取2022年9月1日至2023年9月1日于山西省人民医院内分泌科住院治疗的绝经后2型糖尿病患者335例作为研究对象。根据患者骨密度将其分为骨质疏松组(176例,占52.5%)和非骨质疏松组(159例,占47.5%)。对绝经后2型糖尿病患者合并OP的影响因素,采用单因素分析及logistic回归分析;并以后者为基础构建绝经后2型糖尿病患者合并OP的列线图预测模型;受试者工作特征(ROC)曲线分析该列线图模型的预测效能,校准曲线分析其准确性。结果与非骨质疏松组比较,骨质疏松组年龄大,糖尿病病程长,β胶原特殊序列(β-CTX)水平高,身体质量指数(BMI)低、血磷水平低,差异有统计学意义(P<0.05)。年龄(OR=1.095,P<0.01)、糖尿病病程(OR=1.055,P<0.01)、β-CTX(OR=1.003,P<0.01)、BMI(OR=0.875,P<0.01)、血磷(OR=0.187,P=0.023)为绝经后2型糖尿病患者合并OP的影响因素。ROC曲线分析结果显示,构建的列线图模型预测绝经后2型糖尿病合并OP的曲线下面积(AUC)为0.770。校准曲线分析结果显示,该列线图模型的校准曲线接近于理想曲线。结论高BMI、高血磷为绝经后2型糖尿病合并OP的保护因素,年龄大、糖尿病病程长、β-CTX水平高为其危险因素;基于上述影响因素构建的列线图模型对绝经后2型糖尿病患者合并OP有较好的预测价值。

Objective To explore the influencing factors of osteoporosis(OP)in postmenopausal patients with type 2 diabetes mellitus(T2DM),and try to establish a predictive model of nomogram in developing OP in postmenopausal patients with T2DM.Methods A total of 335 postmenopausal patients with T2DM hospitalized in the Department of Endocrinology of Shanxi Provincial People s Hospital from September 1,2022 to September 1,2023 were selected retrospectively as the study subjects.According to bone mineral density,the patients were divided into osteoporosis group(176 cases,52.5%)and non-osteoporosis group(159 cases,47.5%).Univariate analysis and logistic regression analysis were used to analyze the influencing factors of OP in postmenopausal patients with T2DM,and a nomogram prediction model of OP in postmenopausal patients with T2DM was constructed based on the latter,the receiver operating charateristics(ROC)curve was used to analyze the predictive performance of the nomogram model,and the accuracy of the nomogram model was analyzed by the calibration curve.Results Compared with the non-osteoporosis group,the osteoporosis group had older age,longer duration of diabetes,higher level ofβ-isomerized C-terminal telopeptides of typeⅠcollagen(β-CTX),lower body mass index(BMI)and lower serum phosphorus level(P<0.05).Age(OR=1.095,P<0.01),duration of diabetes(OR=1.055,P<0.01),β-CTX(OR=1.003,P<0.01),BMI(OR=0.875,P<0.01),and serum phosphorus(OR=0.187,P=0.023)were the influencing factors of OP in postmenopausal patients with T2DM.ROC curve analysis results showed that the area under curve(AUC)of the constructed nomogram model for predicting OP in postmenopausal patients with T2DM was 0.770.The calibration curve analysis results showed that the calibration curve of the nomogram model was close to the ideal curve.Conclusion High BMI and high phosphorus are protective factors of OP in postmenopausal patients with T2DM,while old age,long duration of diabetes and high level ofβ-CTX are risk factors.The nomogram model based on the above influencing factors has good predictive value for OP in postmenopausal patients with T2DM.