摘要
目的:骨质疏松症(osteoporosis,OP)是一种慢性代谢性疾病,会严重影响患者的生活质量,其早期诊断对于改善患者预后具有重要意义。胰岛素抵抗(insulin resistance,IR)会导致机体内环境紊乱,影响骨代谢。胰岛素抵抗代谢评分(metabolic score for insulin resistance,METS-IR)、甘油三酯葡萄糖-体重指数(triglyceride glucose-body mass index,TyG-BMI)则是IR的有效代替指标。本研究探讨METS-IR、TyG-BMI与不同部位骨密度(bone density,BMD)的相关性,分析二者预测非糖尿病中老年人群OP发生的价值。方法:回顾性分析430例在成都医学院第一附属医院就诊的非糖尿病中老年人群的临床资料,并根据BMD的T值将其分为OP组(n=205)与非OP组(n=225)。采用Spearman相关性分析探讨METS-IR、TyG-BMI与不同部位BMD的相关性;采用二分类Logistic回归分析探讨METSIR、TyG-BMI与OP的关系;采用受试者操作特征(receiver operator characteristic,ROC)曲线分析METS-IR、TyG-BMI预测OP发生的价值。结果:Spearman相关性分析结果显示,METS-IR、TyG-BMI与腰椎BMD(r=0.266,P<0.001;r=0.101,P=0.036)、股骨颈BMD(r=0.252,P<0.001;r=0.158,P=0.001)和全髋BMD(r=0.342,P<0.001;r=0.179,P<0.001)均呈正相关。二分类Logistic回归分析显示METS-IR[OR=0.949(95%CI 0.916~0.984),P=0.004]、TyG-BMI[OR=0.989(95%CI 0.979~0.999),P=0.026]是OP发生的保护因素,年龄[OR=1.062(95%CI 1.037~1.088),P<0.001]是OP发生的危险因素。相较于男性,女性发生OP的风险更高[OR=3.281(95%CI 1.865~5.771),P<0.001]。ROC曲线分析结果显示,METS-IR预测OP的曲线下面积(area under the curve,AUC)为0.639(95%CI 0.587~0.692),其最佳截断值为36.62,敏感度为53.2%,特异度为72.9%;TyG-BMI预测OP的AUC为0.569(95%CI 0.515~0.623),其最佳截断值为151.20,敏感度为40.0%,特异度为71.6%。结论:非糖尿病中老年人群METS-IR、TyG-BMI与不同部位BMD均呈显著正相关。METS-IR、TyG-BMI作为OP的独立保护因素,均对非糖尿病中老年人群OP发生具有一定的预测价值。
Objective:Osteoporosis(OP)is a chronic metabolic disease that severely affects quality of life.Early diagnosis is crucial for improving patient outcomes.Insulin resistance(IR)leads to internal environment disturbances and affects bone metabolism.The metabolic score for insulin resistance(METS-IR)and triglyceride glucose-body mass index(TyG-BMI)are effective surrogate indicators for IR.This study aims to explore the correlation of METS-IR and TyG-BMI with bone mineral density(BMD)at different anatomical sites and assess their predictive value for OP in non-diabetic middle-aged and elderly individuals.Methods:Clinical data from 430 non-diabetic middle-aged and elderly patients treated at Chengdu Medical College Affiliated First Hospital from January 2019 to December 2023 were retrospectively analyzed.According to the T-score of BMD,subjects were divided into the OP group(n=205)and non-OP group(n=225).Spearman correlation was used to analyze associations between METS-IR,TyG-BMI,and BMD at various sites.Binary logistic regression was applied to assess the relationship between METS-IR,TyG-BMI,and OP.Receiver operating characteristic(ROC)curve analysis was used to evaluate the predictive value of METS-IR and TyG-BMI for OP.Results:Spearman correlation analysis showed that both METS-IR and TyG-BMI were positively correlated with lumbar spine BMD(r=0.266,P<0.001;r=0.101,P=0.036),femoral neck BMD(r=0.252,P<0.001;r=0.158,P=0.001),and total hip BMD(r=0.342,P<0.001;r=0.179,P<0.001).Binary logistic regression analysis revealed that METS-IR[OR=0.949(95%CI 0.916 to 0.984),P=0.004]and TyG-BMI[OR=0.989(95%CI 0.979 to 0.999),P=0.026]were protective factors against OP,while age[OR=1.062(95%CI 1.037 to 1.088),P<0.001]and female sex[OR=3.281(95%CI 1.865 to 5.771),P<0.001]were risk factors.ROC curve analysis showed that the AUC for METS-IR in predicting OP was 0.639(95%CI 0.587 to 0.692),with an optimal cutoff of 36.62,sensitivity of 53.2%,and specificity of 72.9%.For TyG-BMI,the AUC was 0.569(95%CI 0.515 to 0.623),with an optimal cutoff of 151.20,sensitivity of 40.0%,and specificity of 71.6%.Conclusion:METS-IR and TyG-BMI are positively correlated with BMD at multiple sites in non-diabetic middle-aged and elderly individuals.As independent protective factors against OP,both indicators have certain predictive value for OP in this population.
作者
朱茜
周艳
孙思露
陶思敏
席小燕
蒋涛
张海宇
李慧
ZHU Qian;ZHOU Yan;SUN Silu;TAO Simin;XI Xiaoyan;JIANG Tao;ZHANG Haiyu;LI Hui(School of Nursing,Chengdu Medical College,Chengdu 610500;Department of Bone and Soft Tissue Surgery,Sichuan Cancer Hospital,Chengdu 610041;Pancreatitis Center,West China Hospital,Sichuan University,Chengdu 610041;Department of Orthopaedics,First Affiliated Hospital of Chengdu Medical College,Chengdu 610500;Nursing Department,Second Affiliated Hospital of Chengdu Medical College•Nuclear Industry 416 Hospital,Chengdu 610051,China)
出处
《临床与病理杂志》
2025年第2期186-193,共8页
Journal of Clinical and Pathological Research
基金
四川养老与老年健康协同创新中心联合基金项目(YLKYYB2208)
四川基层社会风险防控治理研究中心项目(JCFXFK23-02A)
四川省社会科学重点研究基地老龄事业与产业发展研究中心项目(XJLL2022020)。
