【作者】 贺斌；

【导师】 杨建东；

【作者基本信息】 大连医科大学 ， 外科学（专业学位）， 2019， 硕士

【摘要】 目的:探讨骨代谢生化指标、骨密度对绝经后骨质疏松女性,发生骨质疏松性椎体压缩骨折风险的评估价值。方法:根据纳入和排除标准,回顾性收集于苏北人民医院住院的269例绝经后骨质疏松女性的临床资料。其中,绝经后骨质疏松女性,合并椎体压缩骨折的患者133例;绝经后骨质疏松女性,无椎体压缩骨折的患者136例。记录并观察这些患者的一般资料,包括:年龄、身高、体重、身体质量指数(BMI),以及骨骼矿物质密度(BMD)、血清骨代谢生化指标:I型前胶原氨基端前肽(propeptide of type I procollagen,PINP)、骨钙素N端中分子片段(N-MID osteocalcin,N-MID),Ⅰ型胶原羧基末端肽(type I collagen C-terminal peptide,CTX),维生素D(Vitamin D)。分析骨密度、骨代谢指标对绝经后骨质疏松女性发生骨质疏松性椎体压缩骨折是否有评估价值。统计学方法:应用SPSS 24软件统计并分析数据,数值变量采用均数±标准差的形式表示,两组患者间比较用t检验(两组资料先进行方差齐性检验,方差齐,则用t检验;方差不齐,则选用校正t检验)。筛选出组间具有统计学差异的指标后,进一步运用二元Logistic回归模型分析各指标与绝经后骨质疏松女性发生骨质疏松性椎体压缩骨折风险之间的相关性,P<0.05认为差异具有统计学意义。结果:独立样本t检验分析结果显示:绝经后骨质疏松女性有椎体压缩骨折组与无椎体压缩骨折组比较,两组在一般资料上(年龄、身高、体重、BMI)无明显统计学差异(P>0.05)。两组患者的骨密度值(髋部骨密度和椎体骨密度)无明显统计学差异(P>0.05)。分析两组患者的血清骨代谢生化指标发现:两组患者的骨钙素N端中分子片段(N-MID osteocalcin,N-MID)的值无明显统计学差异(P>0.05),两组患者的I型前胶原氨基端前肽(propeptide of type I procollagen,PINP)、I型胶原羧基末端肽(type I collagen C-terminal peptide,CTX)、维生素D(Vitamin D)的值存在明显统计学差异(P<0.05)。进一步采用Logistic回归分析发现:绝经后骨质疏松女性患者,骨质疏松性椎体压缩骨折的发生与血清I型前胶原氨基端前肽(PINP)的浓度呈正相关(OR=1.068,95%Cl:1.048-1.089);与血清维生素D(Vitamin D)的浓度呈负相关(OR=0.961,95%Cl:0.931-0.992);与血清中Ⅰ型胶原羧基末端肽(CTX)的浓度无明显相关性(P>0.05)。结论1.绝经后骨质疏松女性,发生骨质疏松性椎体压缩骨折的风险与骨代谢标志物I型前胶原氨基端前肽(PINP)和维生素D(Vitamin D)存在显著的相关性。I型前胶原氨基端前肽(PINP)为危险性因素,维生素D(Vitamin D)为保护性因素。I型前胶原氨基端前肽(PINP)和维生素D(Vitamin D)对评估绝经后女性骨质疏松性椎体压缩骨折风险有应用价值。2.骨密度与绝经后骨质疏松女性是否发生骨质疏松椎体压缩骨折之间无明显的相关性,骨密度与骨代谢指标相结合可能有着更大的优势。更多还原

【Abstract】 Objective: To investigate the value of biochemical markers of bone metabolism and bone mineral density in the diagnosis of osteoporotic vertebral compression fractures in postmenopausal women with osteoporosis.Methods: According to the inclusion and exclusion criteria,the clinical data of 269 postmenopausal women with postmenopausal osteoporosis were retrospectively collected in the Subei Hospital.Among postmenopausal osteoporosis women,there are 133 patients with vertebral compression fractures and 136 patients without vertebral compression fractures.Record and observe general information about these patients,including: age,height,weight,BMI,and BMD,serum bone metabolism biochemical indicators: PINP,N-MID,CTX,vitamin D.Analysis of BMD and bone metabolism indicators for the evaluation of osteoporotic vertebral compression fractures in postmenopausal women with osteoporosis.Statistical methods: Statistical analysis was performed using SPSS 24 software.Numerical variables were expressed in the form of Mean ±SD.Comparison between groups was performed by t test(two sets of data were first tested for homogeneity of variance,if the variance is uniform t test was used;If the variance is not uniform,the calibration t test is used).After screening out the statistically significant differences between the groups,the binary logistic regression model was used to analyze the correlation between the indexes and the risk of osteoporotic vertebral compression fractures in postmenopausal women with osteoporosis.P<0.05 has statistical significant.Result: The results of independent sample t-test showed that there were no statistical significant differences in general data(age,height,weight,BMI)between the postmenopausal women with vertebral compression fractures and those without vertebral compression fractures(P>0.05).There was no significant difference in BMD(hip BMD and vertebral BMD)between the two groups(P>0.05).The serum biochemical markers of serum bone metabolism were analyzed in the two groups.The values of the N-MID in the two groups were not significantly different(P>0.05).There are statistical significant differences in the values of PINP,CTX,and vitamin D.(P<0.05).Logistic regression analysis found that: in postmenopausal women with osteoporosis,the occurrence of osteoporotic vertebral compression fracture was positively correlated with the serum concentration of PINP(OR=1.068,95% Cl :1.048-1.089);negatively correlated with serum concentration of vitamin D(OR=0.961,95% Cl: 0.931-0.992);no significant correlation with serum concentration of CTX,(P>0.05).Conclusion: 1.In postmenopausal women with postmenopausal osteoporosis,there is a significant association between the risk of osteoporotic vertebral compression fracture and the bone metabolism markers: PINP and Vitamin D.PINP is a risk factor,and vitamin D is a protective factor.PINP and Vitamin D have application value in assessing the risk of osteoporotic vertebral compression fracture in postmenopausal women.2.There was no significant correlation between bone mineral density and osteoporotic vertebral compression fracture in postmenopausal women with osteoporosis.Bone mineral density combined with bone metabolism indicators may have a greater advantage.更多还原