Gremlin-1、SUA及骨代谢指标表达水平与骨质疏松患者疾病严重程度的相关性及其联合诊断价值分析

The Correlation between the Expression Levels of Gremlin-1,SUA,and Bone Metabolism Indicators and the Severity of Osteoporosis in Patients and their Combined Diagnostic Value Analysis

目的:探讨Gremlin-1、血尿酸(SUA)及骨代谢指标表达水平与骨质疏松患者疾病严重程度的相关性及其联合诊断价值。方法:选取我院2019年1月到2020年12月收治的80例骨质疏松患者,对所有患者依照双X线吸收法诊断结果进行严重程度分组,将骨密度-2.5<T<-1患者分为骨量减少组(n=23),将骨密度T≤-2.5患者分为骨质疏松症组(n=37),将骨密度T≤-2.5,且发生过骨质疏松性骨折的患者分为严重骨质疏松症组(n=20)。对比三组患者Gremlin-1、SUA表达水平与骨代谢指标表达水平,采用Spearman相关分析Gremlin-1、SUA及骨代谢指标表达水平与骨质疏松患者疾病严重程度的相关性。最后建立ROC曲线,Gremlin-1、SUA及骨代谢指标联合对骨质疏松症的诊断价值。结果:三组患者Gremlin-1、SUA水平对比差异显著,骨量减少组Gremlin-1高于骨质疏松症组和严重骨质疏松症组,SUA低于骨质疏松症组和严重骨质疏松症组(P<0.05);三组患者维生素D3[25-(OD)-D3]、β-胶原特殊序列(β-CTX)、甲状旁腺激素(PTH)、I型前胶原N端肽(N-terminal peptide of type I procollagen,PINP)、骨钙素(OC)相关骨代谢指标水平对比差异显著,骨量减少组25-(OD)-D3、PINP、OC高于骨质疏松症组和严重骨质疏松症组,β-CTX、PTH低于骨质疏松症组和严重骨质疏松症组(P<0.05);SUA(r=-0.636)、β-CTX(r=00.626)、PTH(r=0.625)的表达与骨质疏松患者疾病严重程度呈正相关,Gremlin-1(r=-0.452)、25-(OD)-D3(r=-0.462)、PINP(r=-0.622)、OC(r=-0.426)的表达与骨质疏松患者疾病严重程度呈负相关(P<0.05);Gremlin-1、SUA及骨代谢指标联合对骨质疏松症诊断的曲线下面积为0.688,敏感度为92.53%、特异度为87.49%,显著高于单一指标诊断(P<0.05)。结论:Gremlin-1、SUA及骨代谢指标与骨质疏松病情严重程度具有密切关系,且联合诊断骨质疏松症敏感度及特异度较高。

Objective:To explore the correlation between the expression levels of Gremlin-1,Blood uric acid(SUA),and bone metabolism indicators with the severity of osteoporosis in patients and their combined diagnostic value.Method:80 patients with osteoporosis admitted to our hospital from January 2019 to December 2020 were selected.All patients were classified according to the severity of the double X-ray absorption(DXA)method diagnosis results.Patients with-2.5<T<-1 were divided into a low bone mass group(n=23),and patients with T≤-2.5 were divided into an osteoporosis group(n=37).Patients with T≤-2.5 and Patients who have experienced osteoporotic fractures are divided into the severe osteoporosis group(n=20).Compare the expression levels of Gremlin-1,SUA,and bone metabolism indicators among three groups of patients,and use Spearman correlation analysis to examine the correlation between the expression levels of Gremlin-1,SUA,and bone metabolism indicators with the severity of osteoporosis in patients.Finally,the ROC curve was established to evaluate the diagnostic value of the combination of Gremlin-1,SUA,and bone metabolism indicators for osteoporosis.Result:There were differences in the comparison of Gremlin-1 and SUA levels among the three groups,with Gremlin-1 higher in the low bone mass group than in the osteoporosis group and severe osteoporosis group,and SUA lower than in the osteoporosis group and severe osteoporosis group(P<0.05);the levels of vitamin D3[25-(OD)-D3],β-collagen special sequence(β-CTX),parathyroid hormone(PTH),N-terminal peptide of type I procollagen(PINP),and osteocalcin(OC)-related bone metabolism index levels were significantly different in comparison, and 25- (OD)-D3, PINP, and OC were higher in the low-bone group than in the osteoporosis groupand the severe osteoporosis group, and β-CTX, PTH were lower than those in the osteoporosis and severe osteoporosis groups (P<0.05);the expression of SUA (r = -0.636), β-CTX (r = 00.626), and PTH (r = 0.625) was positively correlated with disease severity inosteoporosis patients, and Gremlin-1 (r = -0.452), 25-(OD)-D3 (r = - 0.462), PINP (r = -0.622), and OC (r=-0.426) expression of expressionwas negatively correlated with the disease severity of osteoporosis patients (P<0.05);the area under the curve of the combination ofGremlin-1, SUA, and bone metabolism indexes for the diagnosis of osteoporosis was 0.688, with a sensitivity of 92.53% and specificityof 87.49%, which was higher than that of single index diagnosis (P<0.05). Conclusion: Gremlin-1, SUA, and bone metabolism indicatorsare closely related to the severity of osteoporosis, and the combined diagnosis of osteoporosis has high sensitivity and specificity.