血清雌激素铁调素 t-PINP/β-CTX比值联合预测老年女性骨质疏松患者骨折风险的价值

doi:10.3969/j.issn.1006-6233.2024.12.026

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Abstract Objective: To investigate the combined value of serum estrogen (E₂), ferriregulation (Hepcidin) and the ratio of total type I collagen amino terminal prolongating peptide (t-PINP)/Type I collagen carboxy-terminal peptide β special sequence (β-CTX) in predicting fracture risk in elderly women with osteoporosis (OP).Methods: A total of 205 elderly female OP patients from January 2021 to June 2023 were selected and divided into fracture group and non-fracture group according to whether they had fractures during the 1-year follow-up period. Venous blood samples were collected from both groups on the admission morning of the patient. The levels of serum E₂, Hepcidin, serum t-PINP, and β-CTX were detected using chemiluminescence. Baseline data, serum E₂, Hepcidin, and t-PINP/β-CTX ratio levels were compared between the two groups. The predictive value of serum E₂, Hepcidin, and t-PINP/β-CTX for fracture risk was analyzed.Results: After a year of follow-up, the contact of 4 patients were lost, and a total of 201 patients completed the follow-up. Among them, 63 cases had fractures and 138 cases had no fractures, with a fracture incidence at 31.34%. Patients with and without fractures were included in the fracture group and non-fracture group, respectively. The age, menopausal years, history of fragility fractures, and history of estrogen use in the fracture group were higher than those in the non-fracture group, while the bone mineral density of the hip, lumbar spine, and Wald triangle area was lower than that in the non-fracture group (P<0.05). The serum E₂, Hepcidin, and t-PINP/β-CTX ratios in the fracture group were (25.65±4.63) pg/mL, (76.16±15.82) ng/mL, and (126.50±15.25), respectively, which were lower than those in the non-fracture group (32.71±5.09) pg/mL, (102.43±18.90) ng/mL, and (152.68±20.10). The t-PINP and β-CTX were (60.72±6.57) ng/mL and (0.48±0.10) ng/mL, respectively, which were higher than those in the non-fracture group (56.49±5.03) ng/mL and (0.37±0.08) ng/mL (t=9.378, 9.600, 5.007, 8.342, 9.196, all P<0.001). Serum E₂, Hepcidin, and t-PINP/β-CTX ratio were positively correlated with bone mineral density in the hip, lumbar spine, and Wald triangle area (r=0.622, 0.641, 0.658, 0.609, 0.617, 0.634, 0.710, 0.729, 0.746, all P<0.001). Serum E₂, Hepcidin and t-PINP/β-CTX ratio were still independent influencing factors for fracture in elderly female OP patients before and after controlling for age, menopause years, fragility fracture history, estrogen use history and other factors (P<0.05). Serum E₂, Hepcidin and t-PINP/β-CTX ratios predicted the fracture AUC of elderly female OP patients to be 0.810, 0.789 and 0.760, respectively, and the optimal cut-off values were 27.77 pg/mL, 88.49 ng/mL and 142.52, respectively. Sensitivity was 68.25%, 76.19%, 73.02%, and specificity was 76.81%, 74.64%, 74.64%, respectively. The AUC of fracture predicted by the combination of the three methods was 0.918 (95%CI: 0.871-0.952), the sensitivity was 87.30%, and the specificity was 83.33%, which was significantly better than that predicted by the three methods alone (P<0.05).Conclusion: Serum E₂, Hepcidin and t-PINP/β-CTX ratios are significantly correlated with bone mineral density in elderly female OP patients, and are independent influencing factors for fracture occurrence, and the combined value of predicting fracture risk is reliable.

Key words： Elderly women Osteoporosis Estrogen Ferrimodulin Total type I collagen amino terminal extension peptide Special sequence of carboxy-terminal peptide β of type I collagen Fracture risk

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2024.12.026 OR http://www.hbyxzzs.cn/EN/Y2024/V30/I12/2078

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