胸、腰椎骨质疏松性骨折患者椎体骨铁含量、血清铁蛋白与骨密度的相关性
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摘要
目的探讨胸、腰椎骨质疏松性骨折患者椎体骨铁含量、血清铁蛋白与骨密度的相关性。方法回顾性分析2008年1月至2014年12月243例在苏州市第七人民医院因胸腰椎椎体骨折并接受手术治疗的患者的临床资料,其中男91例,女152例;年龄50~81岁,平均年龄62.5岁。患者入院后第2天留空腹血清标本测定血清铁蛋白和骨代谢指标并测量椎体骨密度;根据椎体骨密度检测值分为骨量减少组(-2.50.05),资料具有可比性。各变量与骨密度Pearson相关分析结果显示年龄、骨铁、血清铁蛋白、Ⅰ型原胶原氨基端延长肽、Ⅰ型胶原C端肽β降解产物与股骨颈骨密度相关系数r值分别为-0.712、-0.348、-0.323、-0.236、-0.227,与L_(1-4)骨密度相关系数r值分别-0.541、-0.206、-0.213、-0.184、-0.191,均呈负相关(P<0.05);体质量、体质量指数、转铁蛋白、总铁结合力与股骨颈骨密度相关系数r值分别为0.257、0.237、0.185、0.163,与L_(1-4)骨密度相关系数r值分别为0.361、0.335、0.204、0.197,均呈正相关(P<0.05)。骨铁、血清铁蛋白可进入股骨颈及腰椎L_(1-4)骨密度回归模型,股骨颈R~2=0.388,L_(1-4)R~2=0.374;骨铁和血清铁蛋白与腰椎骨密度呈负相关。结论胸腰椎骨质疏松性椎体骨折患者,椎体骨铁含量及血清铁蛋白含量越高,骨密度越低;骨铁及血清铁蛋白含量可能是胸腰椎骨质疏松性椎体骨折发生的危险因素之一。
Objective To explore the association among bone iron content,serum ferritin(SF) and bone mineral density in patients with thoracolumbar fractures. Methods A retrospective analysis was conducted in 243 patients with thoracotumbar fracture who were undergone percutaneous kyphoplasty from January 2008 to December 2014. Mean age of the patients(91 males and 152 females) was 62. 5 years(range: 50-81 years). The patients were assigned to osteopenia group and osteoporosis group based on the preoperative bone mineral density(BMD). Blood samples were collected to determine iron metabolism and bone turnover biomarkers after overnight fasting. Bone specimens were obtained for detecting bone iron contents and performing iron stain respectively after percutaneous kyphoplasty. Results There was no significant statistical significance between osteopenia group and osteoporosis group in gender,age,height,and weight(P > 0. 05). Pearson correlation analysis showed that the age,bone iron content,SF,serum procollagen type 1 N-terminal propeptide,and β-carboxy terminal telopeptide of collagen type 1 were negatively correlated with BMD at femoral neck(r =-0. 712,-0. 348、-0. 323,-0. 236,-0. 227; all P < 0. 05) and lumbar spine(r =-0. 541,-0. 206,-0. 213,-0. 184,-0. 191; all P < 0. 05); the weight,body mass index,transferrin,and total iron binding capacity were positively correlated with BMD at femoral neck and lumbar spine(P < 0. 05). Bone iron content combined with SF could be put into the regression models of BMD at femoral neck and lumbar spine(femoral neck R~2=0. 388,L_(1-4)R~2= 0. 374). Both bone iron content and SF were negatively correlated with BMD at lumbar spine(P <0. 05). Conclusion The higher the values of bone iron and serum iron protein content in osteoporotic vertebral fracture patients,the higher the degree in osteoporosisis. Iron accumulation and osteoporosis is significantly correlated.
Objective To explore the association among bone iron content,serum ferritin(SF) and bone mineral density in patients with thoracolumbar fractures. Methods A retrospective analysis was conducted in 243 patients with thoracotumbar fracture who were undergone percutaneous kyphoplasty from January 2008 to December 2014. Mean age of the patients(91 males and 152 females) was 62. 5 years(range: 50-81 years). The patients were assigned to osteopenia group and osteoporosis group based on the preoperative bone mineral density(BMD). Blood samples were collected to determine iron metabolism and bone turnover biomarkers after overnight fasting. Bone specimens were obtained for detecting bone iron contents and performing iron stain respectively after percutaneous kyphoplasty. Results There was no significant statistical significance between osteopenia group and osteoporosis group in gender,age,height,and weight(P > 0. 05). Pearson correlation analysis showed that the age,bone iron content,SF,serum procollagen type 1 N-terminal propeptide,and β-carboxy terminal telopeptide of collagen type 1 were negatively correlated with BMD at femoral neck(r =-0. 712,-0. 348、-0. 323,-0. 236,-0. 227; all P < 0. 05) and lumbar spine(r =-0. 541,-0. 206,-0. 213,-0. 184,-0. 191; all P < 0. 05); the weight,body mass index,transferrin,and total iron binding capacity were positively correlated with BMD at femoral neck and lumbar spine(P < 0. 05). Bone iron content combined with SF could be put into the regression models of BMD at femoral neck and lumbar spine(femoral neck R~2=0. 388,L_(1-4)R~2= 0. 374). Both bone iron content and SF were negatively correlated with BMD at lumbar spine(P <0. 05). Conclusion The higher the values of bone iron and serum iron protein content in osteoporotic vertebral fracture patients,the higher the degree in osteoporosisis. Iron accumulation and osteoporosis is significantly correlated.
引文
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[11]Kim BJ,Ahn SH,Bae SJ,et al.Iron overload accelerates bone loss in healthy postmenopausal women and middle-aged men:a 3-year retrospective longitudinal study[J].J Bone Miner Res,2012,27:2279-2290.
[12]张伟,王兵,张林林,等.绝经后股骨颈骨折股骨头骨铁含量、血清铁蛋白与骨密度相关性研究[J].中华骨科杂志,2014,34:39-47.
[13]徐又佳.降低“铁过载”:一个防治绝经后骨质疏松的新方案[J].中华骨质疏松和骨矿盐疾病杂志,2012,5:1-6.
[14]Li GF,Pan YZ,Sirois P,et al.Iron homeostasis in osteoporosis and its clinical implications[J].Osteoporos Int,2012,23:2403-2408.
[15]Cals MJ,Bories PN,Devanlay M,et al.Extensive laboratory assessment of nutritional status in fit,health-conscious,elderly people living in the Paris area.Research Group on Aging[J].J Am Coll Nutr,1994,13:646-657.
[16]Vasikaran S,Cooper C,Eastell R,et al.International Osteoporosis Foundation and International Federation of Clinical Chemistry and Laboratory Medicine position on bone marker standards in osteoporosis[J].Clin Chem Lab Med,2011,49:1271-1274.
[17]Martinez J,Olmos JM,Hernandez JL et al.Bone turnover markers in Spanish postmenopausal women:the Camargo cohort study[J].Clin Chim Acta,2009,409:70-74.
[18]Schnitzler CM,Schnaid E,Mac Phail AP,et al.Ascorbic acid deficiency,iron overload and alcohol abuse underlie the severe osteoporosis in black African patients with hip fractures—a bone histomorphometric study[J].Calcif Tissue Int,2005,76:79-89.
[19]Wieehula D,Jurkiewicz A,Loska K.An assessment of natural concentrations of selected metals in the bone tissues of the femur head[J].Sci Total Environ,2008,406:161-167.
[2]Jia P,Xu YJ,Zhang ZL,et al.Ferric ion could facilitate osteoclast differentiation and bone resorption through the production of reactive oxygen species[J].J Orthop Res,2012,30:1843-1852.
[3]Kim BJ,Lee SH,Koh JM,et al.The association between higher serum ferritin level and lower bone mineral density is prominent in women≥45 years of age(KNHANES 2008-2010)[J].Osteoporos Int,2013,24:2627-2637.
[4]徐又佳,林华.重视铁代谢在骨质疏松症诊治中的意义[J].中华医学杂志,2011,91:2223-2225.
[5]Kanis JA,Mc Closkey EV,Johansson H,et al.Case finding for the management of ostoporosis with FRAXassessment and intervention thresholds for the UK[J].Osteoporos Int,2008,19:1395-1408.
[6]Akesson K,Marsh D,Mitchell PJ,et al.Capture the Fracture:a Best Practice Framework and global campaign to break the fragility fracture cycle[J].Osteoporos Int,2013,24:2135-2152.
[7]Johnell O,Kanis JA.An estimate of the worldwide prevalence and disability associated with osteoporotic fractures[J].Osteoporos Int,2006,17:1726-1733.
[8]Lieberman IH,Dudeney S,Reinhardt MK,et al.Initial outcome and eficaey of“kyphoplasty”in the treatment of painful osteoporotic vertebral compression fractures[J].Spine,2001,26:1631-1638.
[9]纪泉,张良,王强,等.椎体成形术与椎体后凸成形术治疗骨质疏松性椎体压缩骨折的疗效比较[J].中华骨质疏松和骨矿盐疾病杂志,2013,6:28-33.
[10]刘新奇,叶福生,王永光,等.唑来膦酸治疗老年患者经皮椎体成形术后椎体再骨折的短期疗效[J].中华骨质疏松和骨矿盐疾病杂志,2015,8:48-52.
[11]Kim BJ,Ahn SH,Bae SJ,et al.Iron overload accelerates bone loss in healthy postmenopausal women and middle-aged men:a 3-year retrospective longitudinal study[J].J Bone Miner Res,2012,27:2279-2290.
[12]张伟,王兵,张林林,等.绝经后股骨颈骨折股骨头骨铁含量、血清铁蛋白与骨密度相关性研究[J].中华骨科杂志,2014,34:39-47.
[13]徐又佳.降低“铁过载”:一个防治绝经后骨质疏松的新方案[J].中华骨质疏松和骨矿盐疾病杂志,2012,5:1-6.
[14]Li GF,Pan YZ,Sirois P,et al.Iron homeostasis in osteoporosis and its clinical implications[J].Osteoporos Int,2012,23:2403-2408.
[15]Cals MJ,Bories PN,Devanlay M,et al.Extensive laboratory assessment of nutritional status in fit,health-conscious,elderly people living in the Paris area.Research Group on Aging[J].J Am Coll Nutr,1994,13:646-657.
[16]Vasikaran S,Cooper C,Eastell R,et al.International Osteoporosis Foundation and International Federation of Clinical Chemistry and Laboratory Medicine position on bone marker standards in osteoporosis[J].Clin Chem Lab Med,2011,49:1271-1274.
[17]Martinez J,Olmos JM,Hernandez JL et al.Bone turnover markers in Spanish postmenopausal women:the Camargo cohort study[J].Clin Chim Acta,2009,409:70-74.
[18]Schnitzler CM,Schnaid E,Mac Phail AP,et al.Ascorbic acid deficiency,iron overload and alcohol abuse underlie the severe osteoporosis in black African patients with hip fractures—a bone histomorphometric study[J].Calcif Tissue Int,2005,76:79-89.
[19]Wieehula D,Jurkiewicz A,Loska K.An assessment of natural concentrations of selected metals in the bone tissues of the femur head[J].Sci Total Environ,2008,406:161-167.
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