胰岛素抵抗与绝经后骨质疏松椎体压缩骨折的相关性研究
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摘要
目的探讨绝经后骨质疏松椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)与胰岛素抵抗(insulin resistance,IR)的相关性。方法 2014年10月—2017年10月重庆市巴南区中医院骨科、内分泌科和老年科收治绝经后骨质疏松症(postmenopausal osteoporosis,PO)患者158例,分为单纯骨质疏松组(88例)和骨质疏松合并IR组(70例)。收集患者一般信息,骨密度采用双能X线吸收仪(dual energyX-ray absorptiometry,DEXA)测定,分别以测定值(g/cm2)和T值表示;椎体压缩骨折以X线和MRI判断为新鲜骨折,IR指数(HOMA-IR)采用稳态模型评估公式计算。结果骨质疏松合并IR组骨密度测定值和T值低于单纯骨质疏松组[(0. 61±0. 14) g/cm2vs.(0. 69±0. 09) g/cm2,-(3. 24±0. 22) g/cm2vs.-(2. 84±0. 11) g/cm2],且OVCF的发生率明显增高(51. 43%vs. 18. 18%),差异有统计学意义(P <0. 05)。进一步在骨质疏松合并IR组行亚组分析发现,随着HOMA-IR值升高,OVCF的发生率也进一步升高,而骨密度明显下降,差异有统计学意义(P <0. 05)。相关性分析表明HOMA-IR与OVCF发生率呈正相关(r=0. 415,P=0. 005),而与骨密度测定值呈负相关(r=-0. 315,P=0. 028),但与骨密度T值无明显相关性(r=0. 215,P=0. 184)。结论骨质疏松合并IR组的患者具有更高的骨折风险。IR可作为绝经后骨质疏松患者发生椎体骨折的危险因素,且与病情的严重程度密切相关,为今后临床预判绝经后女性发生OVCF提供了新思路。
Objective To investigate the correlation between insulin resistance (IR) and osteoporotic ver-tebral compression fracture (OVCF) in postmenopausal patients. Methods From Oct. 2014 to Oct. 2017,158 patients with postmenopausal osteoporosis (PO) admitted to the Department of Orthopedics,Endocrinology and Geri-atrics in our hospital were collected,who were divided into simple osteoporosis group (88 cases) and osteoporosiscombined with IR group (70 cases). General information of patients was collected; bone mineral density (BMD)was assessed by dual energy X-ray absorptiometry,which was expressed as BMD value (g/cm~2) and T score; OVCFwas assessed by X ray and magnetic resonance (MRI),which was identified as fresh fracture; homeostasis model as-sessment (HOMA) formula was used to assess the HOMA-IR. Results The BMD value and T score of patientswith osteoporosis combined with IR were significantly lower than those of patients with simple osteoporosis ((0. 61 ±0. 14) g/cm~2 vs.(0. 69 ± 0. 09) g/cm~2,-(3. 24 ± 0. 22)g/cm~2 vs.-(2. 84 ± 0. 11) g/cm~2). Furthermore,the in-cidence rate of OVCF beween the two groups was also statistically different (51. 43% vs. 18. 18%,P < 0. 05). Pre-liminary results suggested that patients with osteoporosis combined with IR had higher risk for bone fracture. Sub-group analysis in IR group further showed that with the elevation of HOMA-IR value,the incidence rate of OVCF wasfurther increased,but the BMD obviously decreased (P < 0. 05). Moreover,Pearson correlation analysis indicatedthat there was a significantly positive correlation between HOMA-IR and incidence rate of OVCF (r = 0. 415,P =0. 005). The result further demonstrated that HOMA-IR had a negative correlation with BMD value (r =-0. 315,P= 0. 028),but without significant correlation with T score (r = 0. 215,P = 0. 184). Conclusion PO patients in os-teoporosis combined with IR group have a higher risk of fracture. IR could be considered as a risk factor to predictthe prognosis of OVCF in PO patients,which is closely related to severity degree of PO.
Objective To investigate the correlation between insulin resistance (IR) and osteoporotic ver-tebral compression fracture (OVCF) in postmenopausal patients. Methods From Oct. 2014 to Oct. 2017,158 patients with postmenopausal osteoporosis (PO) admitted to the Department of Orthopedics,Endocrinology and Geri-atrics in our hospital were collected,who were divided into simple osteoporosis group (88 cases) and osteoporosiscombined with IR group (70 cases). General information of patients was collected; bone mineral density (BMD)was assessed by dual energy X-ray absorptiometry,which was expressed as BMD value (g/cm~2) and T score; OVCFwas assessed by X ray and magnetic resonance (MRI),which was identified as fresh fracture; homeostasis model as-sessment (HOMA) formula was used to assess the HOMA-IR. Results The BMD value and T score of patientswith osteoporosis combined with IR were significantly lower than those of patients with simple osteoporosis ((0. 61 ±0. 14) g/cm~2 vs.(0. 69 ± 0. 09) g/cm~2,-(3. 24 ± 0. 22)g/cm~2 vs.-(2. 84 ± 0. 11) g/cm~2). Furthermore,the in-cidence rate of OVCF beween the two groups was also statistically different (51. 43% vs. 18. 18%,P < 0. 05). Pre-liminary results suggested that patients with osteoporosis combined with IR had higher risk for bone fracture. Sub-group analysis in IR group further showed that with the elevation of HOMA-IR value,the incidence rate of OVCF wasfurther increased,but the BMD obviously decreased (P < 0. 05). Moreover,Pearson correlation analysis indicatedthat there was a significantly positive correlation between HOMA-IR and incidence rate of OVCF (r = 0. 415,P =0. 005). The result further demonstrated that HOMA-IR had a negative correlation with BMD value (r =-0. 315,P= 0. 028),but without significant correlation with T score (r = 0. 215,P = 0. 184). Conclusion PO patients in os-teoporosis combined with IR group have a higher risk of fracture. IR could be considered as a risk factor to predictthe prognosis of OVCF in PO patients,which is closely related to severity degree of PO.
引文
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[16]杜桂迎,余卫,林强,等.WHO双能X线吸收仪骨质疏松症诊断标准及其相关问题[J].中华骨质疏松和骨矿盐疾病杂志,2016,9(3):330-338.
[2]Beaudart C,Biver E,Bruyere O,et al.Quality of life assessment in musculo-skeletal health[J].Aging Clin Exp Res,2018,30(5):413-418.
[3]Ballane G,Cauley JA,Luckey MM,et al.Worldwide prevalence and incidence of osteoporotic vertebral fractures[J].Osteoporos Int,2017,28(5):1531-1542.
[4]Beall DP,Chambers MR,Thomas S,et al.Prospective and multicenter evaluation of outcomes for quality of life and activities of daily living for balloon kyphoplasty in the treatment of vertebral compression fractures:the EVOLVE trial[J].Neurosurg,2019,84(1):169-178.
[5]刘帼静,呼晓雷,何发忠,等.2型糖尿病骨质疏松研究进展[J].中国药理学通报,2016,32(10):1333-1336.
[6]熊雪松,余显霞.2型糖尿病与骨质疏松症相关性研究进展[J].中国骨质疏松杂志,2017,23(1):130-135.
[7]韩晓清,金晖,钟钰,等.2型糖尿病患者骨骼肌量与骨折风险的相关性[J].中华骨质疏松和骨矿盐疾病杂志,2017,10(3):231-238.
[8]Ma C,Tonks KT,Center JR,et al.Complex interplay among adiposity,insulin resistance and bone health[J].Clin Obes,2018,8(2):131-139.
[9]刘波,冯大雄.胰岛素抵抗与椎体成形术后新发骨折风险的相关性研究[J].重庆医学,2018,47(10):1354-1356.
[10]王宁,刘玉杰.骨质疏松的发病机制与危险因素[J].中国骨质疏松杂志,2013,19(5):537-540.
[11]Walsh JS,Vilaca T.Obesity,Type 2 diabetes and bone in adults[J].Calcif Tissue Int,2017,100(5):528-535.
[12]周方圆,杨宇峰,石岩.2型糖尿病胰岛素与胰岛素抵抗信号转导通路研究进展[J].辽宁中医药大学学报,2016,18(11):71-73.
[13]张劼.2型糖尿病患者维生素D对胰岛素抵抗及骨代谢的影响及其可能的机制[D].南方医科大学,2017.
[14]郭斌.骨质疏松性脊柱骨折的临床进展研究[J].世界最新医学信息文摘,2017,17(39):123.
[15]张晓刚,赵希云,宋敏,等.骨质疏松性椎体压缩骨折的生物力学研究进展[J].医用生物力学,2017,32(2):199-204.
[16]杜桂迎,余卫,林强,等.WHO双能X线吸收仪骨质疏松症诊断标准及其相关问题[J].中华骨质疏松和骨矿盐疾病杂志,2016,9(3):330-338.