脂代谢及维生素D缺乏与绝经后骨质疏松的相关性及其预测价值研究

李燕; 高诗奇; 邓代华; 邹晋梅; 杨静; 罗家昂

脂代谢及维生素D缺乏与绝经后骨质疏松的相关性及其预测价值研究

Study on the correlation of lipid metabolism and vitamin D deficiency with postmenopausal osteoporosis and their predictive value

摘要

摘要:
目的： 探讨脂代谢和维生素D缺乏与绝经后骨质疏松（PMOP）发生的相关性，并分析其对PMOP发生的预测价值。
方法： 选取已绝经女性160例进行研究，采用双能X线评估骨密度（BMD），根据PMOP发生情况分为PMOP组和未PMOP组，比较2组骨代谢指标β–胶原特殊序列（β–CTx）、骨钙素（N–MID）和总1型胶原氨基端延长肽（TP1NP）、脂代谢指标总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL–C）和高密度脂蛋白胆固醇（HDL–C）及25羟维生素D25(OH)D水平等差异，采用多因素logistic回归分析影响PMOP发生的相关因素，并绘制ROC曲线分析脂代谢指标和25(OH)D水平对PMOP发生的诊断价值。
结果： 160例已绝经女性中，76例发生PMOP，84例未发生PMOP，骨质疏松发生率为47.5%；PMOP组年龄、绝经时长、产次≥2次者占比、β–CTx、N–MID和TP1NP水平均高于未PMOP组，有运动习惯者占比、股骨颈BMD值、髋部BMD值均低于未PMOP组，差异均有统计学意义（P ＜ 0.05～P ＜ 0.01）；PMOP组TC、TG和LDL–C表达水平均高于未PMOP组（P ＜ 0.05），HDL–C和25(OH)D水平均低于未PMOP组，差异均有统计学意义（P ＜ 0.05～P ＜ 0.01）；多因素logistic回归分析显示，年龄、绝经时长、产次、运动习惯、BMD、骨代谢指标（β–CTx、N–MID、TP1NP）、脂代谢指标（TC、TG、LDL–C、HDL–C）和25(OH)D水平均可能是影响PMOP发生的相关因素（P ＜ 0.01）；ROC分析显示，TC、TG、LDL–C、HDL–C和25(OH)D诊断PMOP发生的AUC分别为0.839、0.834、0.809、0.813、0.877，联合诊断AUC为0.976，敏感度和特异度分别为94.74%和73.81%。
结论： PMOP女性存在脂代谢异常和25(OH)D缺乏情况，联合检测脂代谢指标与25(OH)D水平对于早期诊断PMOP有一定参考价值。

Abstract:
Objective To explore the correlation between the lipid metabolism, vitamin D deficiency and occurrence of postmenopausal osteoporosis (PMOP), and analyze its predictive value for the occurrence of PMOP.
Methods A total of 160 postmenopausal women were selected for the study. Dual-energy X-ray was used to evaluate the bone mineral density (BMD), and they were divided into the PMOP group and non-PMOP group according to the occurrence of PMOP. The differences of the bone metabolism indicators β-collagen specific sequence (β-CTx), osteocalcin (N-MID) and total type 1 collagen amino-terminal elongated peptide (TP1NP), lipid metabolism indicators total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) and 25-hydroxyvitamins levels were compared between two groups. Multivariate logistic regression was used to analyze the related factors influencing the occurrence of PMOP, and the ROC curve was plotted to analyze the diagnostic value of lipid metabolism indicators and 25(OH)D levels for the occurrence of PMOP.
Results Among 160 postmenopausal women, 76 cases developed PMOP and 84 cases did not. The incidence of osteoporosis was 47.5%. The age, duration of menopause, proportion of those with ≥2 births, levels of β-CTx, N-MID and TP1NP in the PMOP group were all higher than those in the non-PMOP group, while the proportion of those with exercise habits, BMD value of femoral neck and BMD value of hip were all lower than those in the non-PMOP group, and the differences were statistically significant (P ＜ 0.05 to P ＜ 0.01). The expression levels of TC, TG and LDL-C in the PMOP group were all higher than those in non-PMOP grou, while the levels of HDL-C and 25(OH)D were all lower than those in the non-PMOP group, and the differences were statistically significant (P ＜ 0.05 to P ＜ 0.01). The results of multivariate logistic regression analysis showed that the age, duration of menopause, frequency of childbirth, exercise habits, BMD, bone metabolism indicators (β-CTx, N-MID, TP1NP), lipid metabolism indicators (TC, TG, LDL-C, HDL-C) and 25(OH)D levels might all be related factors affecting the occurrence of PMOP (P ＜ 0.01). The results of ROC analysis showed that the AUCs of TC, TG, LDL-C, HDL-C and 25(OH)D in diagnosing the occurrence of PMOP were 0.839, 0.834, 0.809, 0.813 and 0.877, respectively. The combined diagnosis AUC was 0.976, and the sensitivity and specificity were 94.74% and 73.81%, respectively.
Conclusions Women with PMOP have abnormal lipid metabolism and 25(OH)D deficiency. The combined detection of lipid metabolism indicators and 25(OH)D level has certain reference value for the early diagnosis of PMOP.

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