高龄老人骨转换代谢标志物与肾功能的相关性研究

doi:10.3877/cma.j.issn.2095-3216.2023.05.004

目的

探讨高龄老人骨转换标志物与肾功能的相关性。

方法

采用横断面研究设计，选取2015至2021年在某院健康体检的474例高龄老人，根据肾小球滤过率分为肾功能正常组和肾功能异常组。采用JASP 16.0.0软件进行统计分析，多因素Logistic回归分析骨转换代谢标志物与肾功能的相关性。

结果

474例老年人平均年龄为(78.52±3.17)岁，男性患者占比61.8%，男性肾功能受损率显著低于女性肾功能受损率(37.4%比62.6%，P<0.001)。校正年龄、性别、身体质量指数、舒张压、总胆固醇、空腹血糖、同型半胱氨酸、25-羟维生素D3、Ⅰ型前胶原氨基端前肽(PINP)、β胶原降解产物(β-CTX)、全段甲状旁腺激素和骨钙素等因素后，多因素Logistic回归分析结果显示，25-羟维生素D3水平与肾功能受损患病率呈负相关(P<0.05)。与β-CTX≤0.36 pg/ml组相比，β-CTX>0.37 pg/ml组的肾功能受损患病率增加(P<0.05)，而高尿酸血症患病率则降低(P<0.05)。在女性患者中，25-羟维生素D3下降和β-CTX升高与肾功能受损显著相关(P<0.05)。

结论

较高水平的β-CTX和较低水平的25-羟维生素D3与高龄老人肾功能下降有关。

关键词: 骨转换代谢, 肾功能, 高龄, 相关性

Objective

To explore the relationship between markers of bone turnover metabolism and renal function in the elderly people.

Methods

A cross-sectional study design was conducted, and 474 elderly individuals who underwent health examinations at the hospital from 2015 to 2021 were selected. Based on their glomerular filtration rates, the subjects were divided into the normal renal function group and the abnormal renal function group. Statistical analysis was conducted with the JASP 16.0.0 software, and multivariate logistic regression analysis was conducted to investigate the relationship between bone turnover metabolic markers and renal function.

Results

The average age of the 474 elderly people was 78.52±3.17 years old, with a male population accounting for 61.8%. The renal dysfunction rate in the male was significantly lower than that in the female 37.4% vs 62.6%, P<0.001). After adjusting for age, gender, body mass index, diastolic blood pressure, total cholesterol, fasting blood glucose, homocysteine, 25-hydroxyvitamin D3, procollagen type 1 amino-terminal propeptide (PINP), β-cross-linked C-telopeptide of type I collagen (β-CTX), intact parathyroid hormone, and osteocalcin, the results of multivariate logistic regression analysis showed that higher level of 25-hydroxyvitamin D3 (P<0.05) were associated with a lower incidence of renal dysfunction in the elderly people. Compared to the group with β-CTX ≤ 0.36 pg/ml, the group with β-CTX>0.37 pg/ml showed a higher incidence of renal dysfunction (P<0.05) and a lower incidence of hyperuricemia (P<0.05). In the female population, 25-hydroxyvitamin D3 decrease and β-CTX increase were correlated with the renal dysfunction (P<0.05).

Conclusion

Higher level of β- CTX and lower level of 25-hydroxyvitamin D3 were associated with the decreased renal function in the elderly people.

Key words: Bone turnover metabolism, Renal function, Elderly, Correlation

图1 高龄体检患者肾功能指标相关性注：横坐标和纵坐标分别是尿酸、GFR、血清肌酐、PINP、β-CTX、全段甲状旁腺激素、骨钙素、维生素D₃，坐标方格内数字代表不同变量之间的r相关系数，蓝色方格代表r相关系数为正值，粉色方格代表r相关系数为负值，颜色越深表示r相关系数的绝对值越高

表1 不同肾功能的高龄老人基本特征

	肾功能正常(n＝228)	肾功能受损(n＝246)	t//Z/χ²值	P值
年龄(岁)	78.75±3.09	78.3±3.24	1.513	0.131
性别[n(%)]			129.163	<0.001
男	201(88.2)	92(37.4)
女	27(11.8)	154(62.6)
身体质量指数(kg/m²)	25.24±2.98	25.01±3.43	0.781	0.435
收缩压(mmHg)	137.56±16.9	138.07±19.53	－0.304	0.761
舒张压(mmHg)	80.89±12.83	80.87±11.86	0.018	0.986
空腹血糖(mmol/L)	6.02±1.39	6.3±1.98	－1.797	0.073
总胆固醇(mmol/L)	4.20±1.04	4.51±0.98	－3.385	0.001
高密度脂蛋白胆固醇(mmol/L)	1.23±0.32	1.42±0.38	－5.699	<0.001
叶酸(mmol/L)	10.94±5.88	10.83±5.30	0.216	0.829
同型半胱氨酸(μmol/L)	16.53±6.63	13.51±4.92	5.662	<0.001
血红蛋白(g/L)	137.3±15.03	134.28±14.2	2.251	0.025
尿酸(μmol/L)	372.88±84.68	297.05±73.09	10.457	<0.001
血清肌酐(μmol/L)	94.99±23.7	60.59±8.13	21.446	<0.001
钙(g/L)	2.32±0.11	2.31±0.10	1.098	0.273
25-羟维生素D₃(ng/ml)	23.84±8.84	21.67±7.90	2.819	0.005
PINP (μg/L)	38.17(30.15~48.50)	43.92(32.69~57.29)	－3.593	<0.001
β-CTX (pg/ml)	0.36±0.19	0.44±0.28	－3.796	<0.001
全段甲状旁腺激素(pg/ml)	46.37(34.16~58.82)	41.90(32.93~58.44)	－1.106	0.269
骨钙素(μg/L)	15.32±7.07	16.6±10.50	－1.535	0.125

表1 不同肾功能的高龄老人基本特征

	肾功能正常(n＝228)	肾功能受损(n＝246)	t//Z/χ²值	P值
年龄(岁)	78.75±3.09	78.3±3.24	1.513	0.131
性别[n(%)]			129.163	<0.001
男	201(88.2)	92(37.4)
女	27(11.8)	154(62.6)
身体质量指数(kg/m²)	25.24±2.98	25.01±3.43	0.781	0.435
收缩压(mmHg)	137.56±16.9	138.07±19.53	－0.304	0.761
舒张压(mmHg)	80.89±12.83	80.87±11.86	0.018	0.986
空腹血糖(mmol/L)	6.02±1.39	6.3±1.98	－1.797	0.073
总胆固醇(mmol/L)	4.20±1.04	4.51±0.98	－3.385	0.001
高密度脂蛋白胆固醇(mmol/L)	1.23±0.32	1.42±0.38	－5.699	<0.001
叶酸(mmol/L)	10.94±5.88	10.83±5.30	0.216	0.829
同型半胱氨酸(μmol/L)	16.53±6.63	13.51±4.92	5.662	<0.001
血红蛋白(g/L)	137.3±15.03	134.28±14.2	2.251	0.025
尿酸(μmol/L)	372.88±84.68	297.05±73.09	10.457	<0.001
血清肌酐(μmol/L)	94.99±23.7	60.59±8.13	21.446	<0.001
钙(g/L)	2.32±0.11	2.31±0.10	1.098	0.273
25-羟维生素D₃(ng/ml)	23.84±8.84	21.67±7.90	2.819	0.005
PINP (μg/L)	38.17(30.15~48.50)	43.92(32.69~57.29)	－3.593	<0.001
β-CTX (pg/ml)	0.36±0.19	0.44±0.28	－3.796	<0.001
全段甲状旁腺激素(pg/ml)	46.37(34.16~58.82)	41.90(32.93~58.44)	－1.106	0.269
骨钙素(μg/L)	15.32±7.07	16.6±10.50	－1.535	0.125

表2 骨转换标志物与肾功能下降多因素的相关性分析

	B值	标准误差	瓦尔德	显著性	OR值	95%CI
25-羟维生素D3	－0.036	0.014	6.631	0.011	0.965	0.938~0.992
PINP	0.007	0.005	2.239	0.135	1.007	0.998~1.017
β-CTX	0.849	0.271	9.791	0.002	2.337	1.373~3.978
男性
25-羟维生素D3	－0.028	0.017	2.674	0.102	0.972	0.940~1.006
PINP	0.011	0.011	0.984	0.321	1.011	0.990~1.033
β-CTX	0.784	0.341	5.279	0.022	2.190	1.122~4.274
女性
25-羟维生素D3	－0.060	0.024	6.106	0.013	0.942	0.898~0.988
PINP	－0.016	0.016	0.958	0.328	0.984	0.954~1.016
β-CTX	1.463	0.580	6.362	0.012	4.321	1.386~13.473

表2 骨转换标志物与肾功能下降多因素的相关性分析

	B值	标准误差	瓦尔德	显著性	OR值	95%CI
25-羟维生素D3	－0.036	0.014	6.631	0.011	0.965	0.938~0.992
PINP	0.007	0.005	2.239	0.135	1.007	0.998~1.017
β-CTX	0.849	0.271	9.791	0.002	2.337	1.373~3.978
男性
25-羟维生素D3	－0.028	0.017	2.674	0.102	0.972	0.940~1.006
PINP	0.011	0.011	0.984	0.321	1.011	0.990~1.033
β-CTX	0.784	0.341	5.279	0.022	2.190	1.122~4.274
女性
25-羟维生素D3	－0.060	0.024	6.106	0.013	0.942	0.898~0.988
PINP	－0.016	0.016	0.958	0.328	0.984	0.954~1.016
β-CTX	1.463	0.580	6.362	0.012	4.321	1.386~13.473

表3 骨转换标志物与高尿酸血症多因素的相关性分析

	B值	标准误差	瓦尔德	P值	OR值	95%CI
25-羟维生素D3	0.031	0.017	3.186	0.074	1.031	0.997~1.067
PINP	－0.002	0.015	0.014	0.906	0.998	0.970~1.028
β-CTX	－4.469	1.393	10.300	0.001	0.011	0.001~0.176
肾功能正常
25-羟维生素D3	0.013	0.021	0.386	0.534	1.013	0.972~1.056
PINP	－0.015	0.018	0.711	0.399	0.985	0.951~1.020
β-CTX	-3.693	1.628	5.150	0.023	0.025	0.001~0.604
肾功能异常
25-羟维生素D3	0.004	0.057	0.005	0.944	1.004	0.898~1.123
PINP	0.014	0.011	1.682	0.195	1.014	0.993~1.036
β-CTX	－10.811	4.480	5.824	0.016	0.010	0.000~0.131
男性
25-羟维生素D3	0.033	0.020	2.610	0.106	1.033	0.993~1.075
PINP	－0.012	0.019	0.413	0.521	0.988	0.952~1.025
β-CTX	－3.982	1.616	6.069	0.014	0.019	0.001~0.443
女性
25-羟维生素D3	－0.001	0.069	0.000	0.993	0.999	0.873~1.144
PINP	0.034	0.029	1.309	0.253	1.034	0.976~1.095
β-CTX	－11.427	5.091	5.038	0.025	0.010	0.000~0.235

表3 骨转换标志物与高尿酸血症多因素的相关性分析

	B值	标准误差	瓦尔德	P值	OR值	95%CI
25-羟维生素D3	0.031	0.017	3.186	0.074	1.031	0.997~1.067
PINP	－0.002	0.015	0.014	0.906	0.998	0.970~1.028
β-CTX	－4.469	1.393	10.300	0.001	0.011	0.001~0.176
肾功能正常
25-羟维生素D3	0.013	0.021	0.386	0.534	1.013	0.972~1.056
PINP	－0.015	0.018	0.711	0.399	0.985	0.951~1.020
β-CTX	-3.693	1.628	5.150	0.023	0.025	0.001~0.604
肾功能异常
25-羟维生素D3	0.004	0.057	0.005	0.944	1.004	0.898~1.123
PINP	0.014	0.011	1.682	0.195	1.014	0.993~1.036
β-CTX	－10.811	4.480	5.824	0.016	0.010	0.000~0.131
男性
25-羟维生素D3	0.033	0.020	2.610	0.106	1.033	0.993~1.075
PINP	－0.012	0.019	0.413	0.521	0.988	0.952~1.025
β-CTX	－3.982	1.616	6.069	0.014	0.019	0.001~0.443
女性
25-羟维生素D3	－0.001	0.069	0.000	0.993	0.999	0.873~1.144
PINP	0.034	0.029	1.309	0.253	1.034	0.976~1.095
β-CTX	－11.427	5.091	5.038	0.025	0.010	0.000~0.235

[1]	王善志，朱永俊，唐文庄，等. 中国成人及老年人群慢性肾脏病患病率Meta分析[J]. 中国老年学杂志，2017, 37(21): 5384-5388.
[2]	Li S, Zhan J, Wang Y, et al. Association between renal function and bone mineral density in healthy postmenopausal Chinese women [J]. BMC Endocr Disord, 2019, 19(1): 146.
[3]	Nitta K, Yajima A, Tsuchiya K. Management of osteoporosis in chronic kidney disease [J]. Intern Med, 2017, 56(24): 3271-3276.
[4]	Pazianas M, Miller PD. Osteoporosis and chronic kidney disease-mineral and bone disorder (CKD-MBD): back to basics [J]. Am J Kidney Dis, 2021, 78(4): 582-589.
[5]	Hsu CY, Chen LR, Chen KH. Osteoporosis in patients with chronic kidney diseases: a systemic review [J]. Int J Mol Sci, 2020, 21(18): 6846.
[6]	上海慢性肾脏病早发现及规范化诊治与示范项目专家组. 慢性肾脏病筛查诊断及防治指南[J]. 中国实用内科杂志，2017, 37(1): 28-34.
[7]	孙颖，陈爱群，李文婵，等. 肾小球滤过率评估公式在老年人群中的应用[J]. 中华老年医学杂志，2021, 40(6): 738-744.
[8]	Liu M, He Y, Jiang B, et al. Association between serum uric acid level and metabolic syndrome and its sex difference in a Chinese community elderly population [J]. Int J Endocrinol, 2014, 2014: 754678.
[9]	Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey [J]. Lancet, 2012, 379(9818): 815-822.
[10]	Masaki H, Imanishi Y, Naka H, et al. Bazedoxifene improves renal function and increases renal phosphate excretion in patients with postmenopausal osteoporosis [J]. J Bone Miner Metab, 2020, 38(3): 405-411.
[11]	Hampson G, Elder GJ, Cohen-Solal M, et al. A review and perspective on the assessment, management and prevention of fragility fractures in patients with osteoporosis and chronic kidney disease [J]. Endocrine, 2021, 73(3): 509-529.
[12]	Wang Y, Yang S, Zhou Q, et al. Effects of vitamin D supplementation on renal function, inflammation and glycemic control in patients with diabetic nephropathy: a systematic review and meta-analysis [J]. Kidney Blood Press Res, 2019, 44(1): 72-87.
[13]	Xie L, Hu X, Li W, et al. A retrospective study of end-stage kidney disease patients on maintenance hemodialysis with renal osteodystrophy-associated fragility fractures [J]. BMC Nephrol, 2021, 22(1): 23.
[14]	李学宇，朱昀，张帆. 老年不同肾功能患者血清胱抑素C与骨转换标志物的相关性[J]. 中华老年医学杂志，2021, 40(11): 1392-1395.
[15]	Han W, Bai XJ, Han LL, et al. Association between the age-related decline in renal function and lumbar spine bone mineral density in healthy Chinese postmenopausal women [J]. Menopause, 2018, 25(5): 538-545.
[16]	Han W, Bai X, Han L, et al. Association between higher serum uric acid levels within the normal physiological range and changes of lumbar spine bone mineral density in healthy Chinese postmenopausal women: a longitudinal follow-up study [J]. Menopause, 2021, 28(10): 1157-1165.
[17]	Lin KM, Lu CL, Hung KC, et al. The paradoxical role of uric acid in osteoporosis [J]. Nutrients, 2019, 11(9): 2111.
[18]	Lane NE, Parimi N, Lui LY, et al. Association of serum uric acid and incident nonspine fractures in elderly men: the osteoporotic fractures in men (MrOS) study [J]. J Bone Miner Res, 2014, 29(7): 1701-1707.
[19]	Ahn SH, Lee SH, Kim BJ, et al. Higher serum uric acid is associated with higher bone mass, lower bone turnover, and lower prevalence of vertebral fracture in healthy postmenopausal women [J]. Osteoporos Int, 2013, 24(12): 2961-2970.

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Relationship between markers of bone turnover metabolism and renal function in the elderly people

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Relationship between markers of bone turnover metabolism and renal function in the elderly people