骨质疏松患者血清25(OH)D，骨膜素、铁蛋白水平及其与骨折发生的相关性分析

目的　探究骨质疏松患者血清25-羟维生素D25(OH)D]，骨膜素、铁蛋白水平及其与骨折发生的相关性。方法　将2018年1月~2020年1月重庆市江津区中心医院收治的112例骨质疏松未骨折患者纳入骨质疏松组，同期收治的93例骨质疏松性骨折患者纳入骨质疏松性骨折组，另选同期体检健康者50例为对照组，比较三组血清25(OH)D，骨膜素、铁蛋白水平，采用spearman相关分析血清25(OH)D，骨膜素、铁蛋白水平与骨质疏松性骨折的相关性，采用Logistic回归分析骨质疏松性骨折的影响因素，采用受试者工作特征曲线（ROC）分析血清25(OH)D，骨膜素、铁蛋白水平对骨质疏松性骨折的预测价值。结果　骨质疏松性骨折组和骨质疏松组血清25(OH)D水平低于对照组，差异有统计学意义（Q=13.173，25.974，均P＜0.05）；骨质疏松性骨折组血清25(OH)D水平低于骨质疏松组，差异有统计学意义（均Q=16.497，P＜0.05）；骨质疏松性骨折组和骨质疏松组血清骨膜素、铁蛋白水平均高于对照组，差异有统计学意义（Q=23.520，20.182；15.753，10.880，均P＜0.05）；骨质疏松性骨折组血清骨膜素、铁蛋白水平高于骨质疏松组，差异有统计学意义（Q=10.302，12.037，均P＜0.05）；骨质疏松患者血清25(OH)D水平与骨折发生呈负相关（r=-0.569，P＜0.05）；骨质疏松患者血清骨膜素、铁蛋白水平与骨折发生呈正相关（r=0.437，0.490，均P＜0.05）；血清25(OH)D水平下降、血清骨膜素水平升高、血清铁蛋白水平升高是骨质疏松性骨折的危险因素（P＜0.05）；血清25(OH)D，骨膜素、铁蛋白水平联合预测骨质疏松性骨折的AUC为0.965，敏感度为90.30%，特异度为92.00%，准确度为91.20%。结论　血清25(OH)D水平下降及血清骨膜素和铁蛋白水平升高有助于骨质疏松性骨折风险的预测，临床应密切关注骨质疏松患者血清25(OH)D，骨膜素、铁蛋白水平，以降低骨质疏松性骨折发生率。

Serum Levels of 25(OH)D,Periostin and Ferritin in Patients with Osteoporosisand Their Correlation with Fracture

Objective　To analyze the serum levels of 25-hydroxyvitamin D 25(OH)D], periostin, ferritin levels in patients withosteoporosis and their correlation with fracture. Methods　112 osteoporosis patients, 93 osteoporotic fracture patients and 50healthy individuals in the Central Hospital of Jiangjin District, Chongqing from January 2018 to January 2020 were included, andseted as osteoporosis group, osteoporotic fracture group and control group, respectively. Serum 25(OH)D, periostin, and ferritinlevels were compared among three groups. Spearman correlation was used to analyze the correlation of serum 25(OH)D,periostein and ferritin levels with osteoporotic fracture; Logistic regression was used to analyze the influencing factors ofosteoporotic fracture, and receiver operating characteristic curve (ROC) was used to analyze the predictive value of serum25(OH)D, periostein and ferritin levels on osteoporotic fracture. Results　Serum 25(OH)D level among three groups was thelowest in osteoporotic fracture group, followed by osteoporosis group, and was the highest in control group, the difference werestatistically significant(Q=13.173, 25.974, 16.497, all P<0.05). Serum periostein and ferritin levels among three groups were thehighest in osteoporotic fracture group, followed by osteoporosis group, and were the lowest in control group, the difference werestatistically significant(Q=23.520, 20.182; 15.753, 10.880; 10.302, 12.437, all P<0.05). Serum 25(OH)D level of osteoporosispatients was negatively correlated with the occurrence of osteoporotic fracture (r=-0.569, P<0.05). Serum levels of periosteinand ferritin in osteoporosis patients were positively correlated with the occurrence of osteoporotic fractures (r=0.437, 0.490, allP<0.05). Decreased serum 25(OH)D level, elevated serum periostein level, and elevated serum ferritin level were risk factors forosteoporotic fracture (P<0.05). The AUC, sensitivity, specificity and accuracy of combined detection of 25(OH)D, periostein andferritin levels in the prediction of osteoporotic fractures were 0.965, 90.30, 92.00% and 91.20% respectively. Conclusion Decreased serum 25(OH)D level and elevated serum levels of periostein and ferritin can be used to predict the risk of osteoporoticfracture, moreover, it is of great significance to closely monitor serum 25(OH)D, periostein, and ferritin levels in patients withosteoporosis to reduce the incidence of osteoporotic fractures.