摘要
目的分析血清骨保护素(osteoprotegerin,OPG)与慢性阻塞性肺疾病(chronic obstructive pulmonary,COPD)患者骨丢失和骨质疏松诊断的关系。方法收集2021年1月至2024年3月我院收治的95例疾病稳定的COPD患者,根据双能X射线吸收法(Dual-energy X-ray absorption method,DEXA)分为骨密度(bone density,BMD)正常组35例、BMD减少组37例和骨质疏松组23例,酶联免疫吸附测定法(enzyme-linked immunosorbent assay,ELISA)测定血清OPG的水平。结果BMD正常组体质量指数(body mass index,BMI)、用力肺活量(forced vital capacity,FVC)高于BMD减少和骨质疏松患者(P<0.05)。骨质疏松患者糖化血红蛋白(glycosylated hemoglobin,HbA1c)低于BMD正常和BMD减少组,第1秒用力呼气量(one second forced expiratory volume,FEV_(1))低于BMD正常组(P<0.05)。随着BMD的降低,腰椎BMD、T评分以及髋部BMD、T评分逐渐降低(P<0.001);血清OPG水平逐渐升高(F=23.257,P<0.001)。GOLD分级1~2级患者血清OPG水平(178.90±71.33)pg/ml低于GOLD分级3~4级患者(234.12±81.06)pg/ml(P<0.05)。Spearman相关性显示血清OPG水平与FEV_(1)(Rho=-0.205,P=0.046)、FEV_(1)/FVC(Rho=-0.236,P=0.022)、FEV_(25_75)(Rho=-0.226,P=0.028)呈微弱负相关性。将上述BMI、HbA1c、FVC、FEV_(1)、OPG作为自变量纳入多元线性回归方程,结果显示BMI、HbA1c、血清OPG与腰椎T值相关(P<0.05);而BMI、血清OPG还与髋部T值相关(P<0.05)。BMD正常组为对照,血清OPG诊断BMD减少的AUC为0.737(95%CI:0.617~0.857),截断值为187.01 pg/ml;以BMD正常和BMD减少患者为对照,血清OPG诊断骨质疏松的AUC为0.825(95%CI:0.741~0.909),截断值为206.39 pg/ml;以BMD减少组为对照,血清OPG诊断BMD减少的AUC为0.683(95%CI:0.550~0.815),截断值为187.01 pg/ml(P<0.05)。结论高血清OPG水平与COPD患者骨质疏松风险有关,因此OPG可能是这种COPD相关共病的生物标志物。
Objective To explore the relationship between serum osteoprotegerin(OPG)and the diagnosis of bone loss and osteoporosis in patients with chronic obstructive pulmonary disease(COPD).Methods From January 2021 to March 2024,ninety-five COPD patients with stable disease were recruited from Our hospital,and were divided into the normal bone mineral density(BMD)group(n=35),the reduced BMD group(n=37),and the osteoporosis group(n=23)according to the dual-energy X-ray absorptiometry(DEXA),and enzyme-linked immunosorbent assay(ELISA)was used to determine the serum OPG levels.Results Body mass index(BMI)and forceful lung capacity(FVC)were higher in the BMD normal group than in the BMD reduced and osteoporotic patients(P<0.05).Glycosylated hemoglobin(HbA1c)was lower in osteoporotic patients than in the BMD normal and reduced BMD groups,in addition to lower force expiratory volume in 1 second(FEV_(1))than in the BMD normal group(P<0.05).As BMD decreased,lumbar spine BMD and T scores as well as hip BMD and T scores gradually decreased(P<0.001);while serum OPG levels gradually increased(F=23.257,P<0.001).Serum OPG levels were significantly lower in patients with Global Initiative for Chronic Obstructive Lung Disease(GOLD)classification 1-2 than in patients with GOLD classification 3-4(t=-3.332,P=0.001).Spearman′s correlation showed a weak negative correlation between serum OPG levels and FEV_(1)(Rho=-0.205,P=0.046),FEV_(1)/FVC(Rho=-0.236,P=0.022),and FEV_(25_75)(Rho=-0.226,P=0.028).The above BMI,HbA1c,FVC,FEV_(1),and OPG were included as independent variables in the multiple linear regression equation,and the results showed that BMI,HbA1c,and serum OPG were independently correlated with lumbar spine T-scores(P<0.05);whereas,BMI and serum OPG were also independently correlated with hip T-scores(P<0.05).The BMD normal group was used as a control,and serum OPG diagnosed decreased BMD with an AUC was 0.737(95%CI:0.617~0.857),and the cutoff value was 187.01 pg/ml;with the patients with normal BMD and reduced BMD as the control,the AUC of serum OPG for diagnosing osteoporosis was 0.825(95%CI:0.741~0.909),and the cutoff value was 206.39 pg/ml;with the reduced BMD group as a control,the AUC of serum OPG for diagnosis of BMD reduction was 0.683(95%CI:0.550~0.815),and the cutoff value was 187.01 pg/ml;all P<0.05.Conclusion High serum OPG levels are associated with the risk of osteoporosis in COPD patients,therefore OPG may be a biomarker for this COPD related comorbidity.
作者
余辉
王双兰
吴庆能
杨昌其
彭峰扬
郭灯亮
张艺
崔丽
吴佳佳
Yu Hui;Wang Shuanglan;Wu Qingneng;Yang Changqi;Peng Fengyang;Guo Dengliang;Zhang Yi;Cui Li;Wu Jiajia(Department of Orthopedics,Macheng People′s Hospital(Hubei University of Science and Technology Affiliated Hospital),Macheng 438300,China;Department of Respiratory Medicine,Macheng People′s Hospital(Hubei University of Science and Technology Affiliated Hospital),Macheng 438300,China;Department of Respiratory and Critical Care Medicine,The First Affiliated Hospital of Hubei University of Science and Technology,Xianning 437100,China;Epartment of Respiratory Medicine,The First Affiliated Hospital of Changjiang University,Jingzhou 434000,China;Department of Respiratory and Critical Care Medicine,The First People′s Hospital of Wuxue City,Wuxue 435400,China)
出处
《中华肺部疾病杂志(电子版)》
2025年第4期546-551,共6页
Chinese Journal of Lung Diseases(Electronic Edition)
基金
湖北省卫生健康委员会科研项目(WJ2021M087)。
关键词
肺疾病
慢性阻塞性
骨保护素
骨质疏松
生物标记物
诊断
Chronic obstructive pulmonary disease
Osteoprotegerin
Osteoporosis
Biomarker
Diagnosis
