Page 35 - 中国全科医学2022-18

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【Abstract】 Background People with diabetes mellitus are at increased risk of developing osteoporosis（OP），
especially those with postmenopausal type 2 diabetes mellitus（T2DM）. Chronic inflammation plays an important role in the
development of OP. Objective To explore the predictive value of neutrophil-to-lymphocyte ratio（NLR） and monocyte-to-
high-density lipoprotein cholesterol ratio（MHR） for OP in postmenopausal patients with T2DM. Methods Two hundred
and sixteen postmenopausal T2DM patients who were hospitalized in the Department of Endocrinology and Metabolism，the
First Affiliated Hospital of Zhengzhou University from January 2018 to January 2020 were chosen. Clinical data were obtained，
including blood routine and biochemical parameters（such as blood lipids and so on） in fasting venous blood，calculated NLR
and MHR，and bone mineral density（BMD）of lumbar spine L 1-4 ，left femoral neck and left hip measured by dual-energy X-ray
absorptiometry（DXA）. According to the BMD，the patients were divided into normal bone mass group（n=51），osteopenia
group（n=78）and OP group（n=87）. In addition，they were divided into 4 groups according to NLR quartiles（A1 to A4
group） and MHR quartiles（B1 to B4 group），with 54 cases in each. Spearman correlation was used to analyze the association
of NLR and MHR with BMD at lumbar spine L 1-4 ，left femoral neck and left hip. Multivariate Logistic regression analysis was
applied to explore the influencing factors of OP. Receiver operating curve（ROC） analysis was performed to evaluate the value
of NLR，MHR and their combination in predicting OP. Results NLR and MHR were increased in the osteopenia group than
the normal bone mass group（P<0.05）. Compared with the normal bone mass group and the osteopenia group，NLR and MHR
in the OP group were statistically significant increased（P<0.05）. Compared with A1 group，A3 group had decreased BMD at
lumbar spine L 1-4 ，left femoral neck and left hip，so did A4 group（P<0.05）. A4 group had decreased BMD at lumbar spine
L 1-4 ，and left hip than A2 group（P<0.05）. B1 group had higher BMD at lumbar spine L 1-4 ，left femoral neck and left hip than
did B2，B3，and B4 groups（P<0.05）. B4 group had decreased BMD at lumbar spine L 1-4 ，left femoral neck and left hip than
did B2 group（P<0.05）. B4 group also had decreased BMD at lumbar spine L 1-4 did B3 group（P<0.05）. Spearman correlation
analysis showed that both NLR and MHR were negatively correlated with BMD at lumbar spine L 1-4 ，left femoral neck and left hip
（P<0.001）. Multivariate Logistic regression analysis showed that long menopausal duration〔OR=1.092，95%CI（1.005，
1.186）〕，increased NLR〔OR=2.341，95%CI（1.453，3.770）〕and increased MHR〔OR=329.250，95%CI（21.421，
5 060.810）〕were independently associated with elevated risk of OP，while high BMI〔OR=0.806，95%CI（0.718，0.903）〕
was associated with decreased risk of OP（P<0.05）. ROC analysis demonstrated that in predicting OP，the area under the curve
（AUC） of NLR was 0.722，with 65.5% sensitivity and 72.1% specificity，and that of MHR was 0.709 with 52.9% sensitivity
and 79.8% specificity，and that of NLR with MHR was 0.787，with 81.6% sensitivity and 67.4% specificity. The AUC of NLR
with MHR was greater than that of NLR or MHR alone（Z=2.418，P<0.05；Z=2.893，P<0.05）. Conclusion Either NLR or
MHR could be used as a predictor of OP in postmenopausal T2DM patients，and the predictive efficiency and sensitivity of the
combination of them would be higher.
【Key words】 Diabetes mellitus，type 2；Osteoporosis，postmenopausal；Bone density；Neutrophil-to-lymphocyte
ratio；Monocyte-to-high-density lipoprotein cholesterol ratio；Inflammatory factor

骨质疏松症（OP）是一种以骨量减少、骨骼微结 胞比值（NLR）和单核细胞 / 高密度脂蛋白胆固醇比值
构遭到破坏、骨脆性增加和易发生骨折为特征的全身性 （MHR）是近年来新发现的炎性标志物，有研究表明
骨病 ［1］ 。OP 可发生于不同性别或年龄，尤以老年男性 NLR、MHR 对 OP 有一定的预测价值 ［4-5］ ，但其仅关注
和绝经后女性更多见。早期 OP 一般缺乏明显的临床表 某一个指标，本研究将 NLR、MHR 两个指标纳入分析，
现，仅表现为腰背部疼痛或全身骨痛，部分患者甚至在 评价 NLR、MHR 单独或联合检测对 OP 的预测价值，
出现脆性骨折等严重后果时才被发现。骨质疏松性骨折 为早期预防及诊断绝经后糖尿病性 OP 提供一定的参考
是导致中老年人残疾甚至死亡的重要原因之一。目前认 依据。
为糖尿病患者并发 OP 的风险明显增高，糖尿病性 OP 1 对象与方法
是指糖尿病在骨骼系统上发生的一种慢性并发症 ［2］ ， 1.1 研究对象 选取 2018 年 1 月至 2020 年 1 月于郑
其发病机制复杂，目前尚未完全阐明。绝经后 2 型糖尿 州大学第一附属医院内分泌及代谢性疾病科住院的 216
病（T2DM）患者是 OP 的高危人群，其兼具年龄高、 例绝经后 T2DM 患者。纳入标准：（1）符合 2017 年美
雌激素缺乏和糖尿病等多种危险因素，因此对绝经后 国糖尿病协会（ADA）相关诊断标准 ［6］ ；（2）自然绝
T2DM 患者进行 OP 的早期筛查显得极为重要。近年来 经且已绝经 1 年以上。排除标准：1 型糖尿病或其他类
研究发现，慢性炎症在 OP 的发生、发展中起重要作用， 型糖尿病、糖尿病急性并发症、其他内分泌系统疾病、
是引起 OP 的危险因素之一 ［3］ 。中性粒细胞 / 淋巴细 血液病、恶性肿瘤、急性感染、自身免疫性疾病、急性