老年髋部骨折患者血清戊糖素、RAGE、sRAGE水平与骨密度的关系

doi:10.3877/cma.j.issn.2096-0263.2021.02.007

中华老年骨科与康复电子杂志 ›› 2021, Vol. 07 ›› Issue (02) : 105 -110. doi: 10.3877/cma.j.issn.2096-0263.2021.02.007

所属专题：文献；

髋部骨折

老年髋部骨折患者血清戊糖素、RAGE、sRAGE水平与骨密度的关系

高俊¹, 蔡林秀², 张曦¹, 王娟³, 李春梅³, 胡继红⁴^,^†(

)

^1. 213003　常州市中医医院骨科
^2. 210046　南京中医药大学研究生院
^3. 213003　常州市中医医院骨科检验科
^4. 213003　常州市第二人民医院I期临床实验中心

收稿日期:2020-08-06 出版日期:2021-04-05
通信作者: 胡继红
基金资助:
常州市卫生计生委青年人才科技项目(QN201721)

Correlation between the serum levels of pentosidine, RAGE, sRAGE and bone mineral density in elderly patients with hip fracture

Jun Gao¹, Linxiu Cai², Xi Zhang¹, Juan Wang³, Chunmei Li³, Jihong Hu⁴^,^†()

^1. Department of Orthopaedics, Changzhou Chinese Traditional Medicine Hospital Affiliated to Chinese Traditional Medical University of Nanjing, Changzhou 213003, China
^2. School of graduate, Nanjing University of Traditional Chinese Medicine, Nanjing, 210046, China
^3. Department of Laboratory Medicine, Changzhou, Chinese Traditional Medicine Hospital Affiliated to Chinese Traditional Medical University of Nanjing, Changzhou 213003, China
^4. Department of Phase I Clinical Center, Changzhou NO.2 Hospital, Changzhou 213003, China

Received:2020-08-06 Published:2021-04-05
Corresponding author: Jihong Hu

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引用本文：

高俊, 蔡林秀, 张曦, 王娟, 李春梅, 胡继红. 老年髋部骨折患者血清戊糖素、RAGE、sRAGE水平与骨密度的关系[J]. 中华老年骨科与康复电子杂志, 2021, 07(02): 105-110.

Jun Gao, Linxiu Cai, Xi Zhang, Juan Wang, Chunmei Li, Jihong Hu. Correlation between the serum levels of pentosidine, RAGE, sRAGE and bone mineral density in elderly patients with hip fracture[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2021, 07(02): 105-110.

目的

了解老年髋部骨折患者血清戊糖素、晚期糖基化终末产物受体（RAGE）和sRAGE水平的状况，探讨这些指标与骨密度（BMD）正常、骨量减少和骨质疏松之间的关系。

方法

回顾性分析2018年01月至2019年06月，常州市中医医院治疗的老年髋部骨折66例患者，其中女性49例，男性17例，平均年龄（68±9）岁。患者常规检测L_2~4节段BMD的T值，依据BMD的T值不同将病例分为三组：骨密度正常组、骨量减少组和骨质疏松组。酶联免疫吸附测定血清戊糖素、RAGE、sRAGE水平，并检测生化指标血碱性磷酸酶（ALP）等的水平。分析血清戊糖素、RAGE、sRAGE水平与腰椎BMD的相关性。

结果

骨量减少组和骨质疏松组血清戊糖素、RAGE水平显著高于骨密度正常组相比（血清戊糖素三组间方差分析：F=10.779，P=0.000，骨量减少组与骨质疏松组血清戊糖素LSD两两比较P=0.116，骨量减少组与骨密度正常组血清戊糖素LSD两两比较P=0.006，骨质疏松组与骨密度正常组血清戊糖素LSD两两比较P=0.000；RAGE三组间方差分析F=11.331，P=0.000，骨量减少组与骨质疏松组RAGE LSD两两比较P=0.057，骨量减少组与骨密度正常组RAGE LSD两两比较P=0.010，骨质疏松组与骨密度正常组RAGE LSD两两比较P=0.000），骨量减少组和骨质疏松组sRAGE水平显著低于骨密度正常组（sRAGE三组间方差分析F=14.211，P=0.000，骨量减少组与骨质疏松组sRAGE LSD两两比较P=0.046，骨量减少组与骨密度正常组sRAGE LSD两两比较P=0.003，骨质疏松组与骨密度正常组sRAGE LSD两两比较P=0.000）；血清戊糖素、RAGE水平与腰椎BMD呈负相关性（r=-0.575，P=0.000；r=-0.446，P=0.000），血清sRAGE水平与腰椎BMD呈正相关性（r=0.618，P=0.000）。

结论

血清戊糖素、RAGE及sRAGE水平与腰椎BMD之间有显著的相关性，可作为临床骨质疏松症诊断的参考参数，值得临床开展应用。

关键词: 老年人, 髋骨折, 骨密度, 晚期糖基化终末产物

Objective

This study aims to explore the correlation of serum levels of pentosidine, receptor for advanced glycation end-product (RAGE) and soluble receptor for advanced glycation end-product (sRAGE) in elderly patients with hip fractures with their bone mass density (BMD).

Methods

A retrospective analysis was conducted for 66 elderly patients with hip fractures hospitalized in our Department of Orthopedics between January 2018 and June 2019. Dual-energy X-ray absorptiometry was used to measure the BMDs of the 2nd-4th lumbar; enzyme-linked immunosorbent assay was adopted to determine the levels of serum pentosidine, RAGE and sRAGE, and automatic biochemical analyzer was utilized to analyze the serum levels of alkaline phosphatase (ALP), tartrate-resistant acid phosphatase 5b (TRACP5b), osteocalcin (OC), calcium (Ca), and substance P (P). Based on their BMDs, all patients were divided into a normal bone mass group, an osteopenia group, and an osteoporosis group.

Results

Compared with the normal bone mass group, the levels of serum pentosidine and RAGE in osteopenia group and osteoporosis group were significantly higher (Analysis of variance among the three groups of serum pentosidine F=10.779, P=0.000. There were significant differences between the two groups (P=0.116, P=0.006, P=0.000). Analysis of variance among the three groups of serum pentosidine (F=11.331, P=0.000). There were significant differences between the two groups (P=0.057, P=0.010, P=0.000). The levels of sRAGE in osteopenia group and osteoporosis group were significantly lower (Analysis of variance among the three groups of serum sRAGE (F=14.211, P=0.000). There were significant differences between the two groups (P=0.046, P=0.003, P=0.000). There was a significant negative correlation between serum pentosidine level and lumbar BMD (r=-0.575, P=0.000), a significant negative correlation between serum RAGE level and lumbar BMD (r=-0.446, P=0.000), and a significant positive correlation between serum sRAGE level and lumbar BMD (r=0.618, P=0.000).

Conclusion

There is a significant correlation between serum pentosidine, RAGE, sRAGE levels and lumbar BMD, which can be used as a reference parameter for the diagnosis of osteoporosis and is worthy of clinical application.

Key words: Aged, Hip fractures, Bone mineral density, AGEs

表1 骨密度正常组、骨量减少组和骨质疏松组老年髋部骨折患者纳入人群一般特征

组别	例数	性别（例，男/女）	年龄（岁，±s）	骨折时间（天，±s）	BMI（kg/m²，±s）	ALP（U/L，±s）	TRACP5b（ug/L，±s）
骨密度正常组	24	7/17	67.45±10.63	2.15±0.52	24.14±1.68	64.09±10.43	4.58±1.1
骨量减少组	20	4/16	68.45±8.79	2.09±0.54	24.83±2.15	64.9±9.7	4.98±1.06
骨质疏松组	22	6/16	67.13±5.97	2.19±0.57	26.1±2.38	65.35±9.02	5.52±1.2
F/χ²值		0.512	0.144	0.059	5.180	0.010	4.024
P值		0.767	0.871	0.803	0.012	0.912	0.024
组别	例数	OC（ug/L，±s）	Ca（mmol/L，±s）	P（mmol/L，±s）	BMD（T值，±s）
骨密度正常组	24	6.4±1.08	2.37±0.06	1.17±0.11	0.38±0.78
骨量减少组	20	5.8±1.45	2.33±0.06	1.18±0.11	-1.4±0.38
骨质疏松组	22	5.59±0.84	2.34±0.07	1.22±0.18	-3.48±0.87
F/χ²值		2.156	2.448	0.846	5.182
P值		0.110	0.086	0.443	0.011

表1 骨密度正常组、骨量减少组和骨质疏松组老年髋部骨折患者纳入人群一般特征

组别	例数	性别（例，男/女）	年龄（岁，±s）	骨折时间（天，±s）	BMI（kg/m²，±s）	ALP（U/L，±s）	TRACP5b（ug/L，±s）
骨密度正常组	24	7/17	67.45±10.63	2.15±0.52	24.14±1.68	64.09±10.43	4.58±1.1
骨量减少组	20	4/16	68.45±8.79	2.09±0.54	24.83±2.15	64.9±9.7	4.98±1.06
骨质疏松组	22	6/16	67.13±5.97	2.19±0.57	26.1±2.38	65.35±9.02	5.52±1.2
F/χ²值		0.512	0.144	0.059	5.180	0.010	4.024
P值		0.767	0.871	0.803	0.012	0.912	0.024
组别	例数	OC（ug/L，±s）	Ca（mmol/L，±s）	P（mmol/L，±s）	BMD（T值，±s）
骨密度正常组	24	6.4±1.08	2.37±0.06	1.17±0.11	0.38±0.78
骨量减少组	20	5.8±1.45	2.33±0.06	1.18±0.11	-1.4±0.38
骨质疏松组	22	5.59±0.84	2.34±0.07	1.22±0.18	-3.48±0.87
F/χ²值		2.156	2.448	0.846	5.182
P值		0.110	0.086	0.443	0.011

图1~3 各组老年髋部骨折患者戊糖素、RAGE及sRAGE的比较

图6 各组老年髋部骨折患者sRAGE与腰椎BMD相关分析

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Correlation between the serum levels of pentosidine, RAGE, sRAGE and bone mineral density in elderly patients with hip fracture