象山县成人25羟维生素D水平及其与骨转换标志物和骨密度的相关性分析

鲍红丹; 周雅芬; 史琼瑶; 郭婧怡; 章振林; 高超

doi:10.16766/j.cnki.issn.1674-4152.003830

象山县成人25羟维生素D水平及其与骨转换标志物和骨密度的相关性分析

doi: 10.16766/j.cnki.issn.1674-4152.003830

1.
宁波市第四医院内分泌科, 浙江宁波 315700
2.
上海交通大学医学院附属第六人民医院临床研究中心，上海 200233
3.
上海交通大学医学院附属第六人民医院骨质疏松和骨病专科上海市骨疾病临床研究中心，上海 200233

基金项目:

国家自然科学基金青年基金项目 81900808

详细信息

通讯作者:
高超，E-mail：gcflight@126.com

中图分类号: R591.44 R68
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出版历程
- 收稿日期: 2024-02-01
- 网络出版日期: 2025-02-13

Analysis of 25-hydroxyvitamin D levels and its association with bone turnover markers and bone mineral density in Xiangshan County adults

1.
Department of Endocrinology, Ningbo Fourth People' s Hospital, Ningbo, Zhejiang 315700, China

摘要

摘要: 目的了解宁波市象山县成人25羟维生素D[25(OH)D]水平和缺乏情况，分析25(OH)D水平与骨转换标志物(BTMs)、骨密度(BMD)的关系。方法 2020年8—11月招募来自宁波市象山县的志愿者3 117例，其中男性1 122例，女性1 995例，年龄为22~95岁。采集研究对象血清样本进行25(OH)D、BTMs检测，采用双能X线吸收仪测定研究对象的腰椎、股骨颈及全髋部BMD。结果研究人群25(OH)D不足比例为39.7%(1 236/3 117)，25(OH)D缺乏比例为9.1%(284/3 117)。按年龄分组后，在小于50岁人群中，男女25(OH)D缺乏比例均最高，分别为11.1%(21/189)和31.0%(139/449)。按性别分组后，25(OH)D水平与Ⅰ型胶原羧基端肽β特殊序列(β-CTX)水平均呈负相关关系(男性：r=-0.161，P < 0.001；女性：r=-0.069，P=0.002)。男性25(OH)D水平与股骨颈BMD(β=0.001，P=0.019)、全髋部BMD(β=0.001，P=0.034)呈正相关关系。结论宁波市农村地区25(OH)D缺乏和不足仍较为普遍，尤其是 < 50岁的女性，需引起重视，并及早调整生活方式或使用维生素D补充剂。此外，本研究发现人群中25(OH)D水平与BMD呈正相关关系，与β-CTX呈负相关关系。
- 25羟维生素D /
- 骨转换标志物 /
- 骨密度
Abstract: Objective To investigate the level and deficiency of 25-hydroxyvitamin D [25(OH)D] in adults living in Xiangshan County, Ningbo City, and to analyze the association between 25(OH)D levels with bone turnover markers (BTMs) and bone mineral density (BMD). Methods From August to November 2020, 3 117 volunteers were recruited from Xiangshan County, Ningbo City, including 1 122 males and 1 995 females, with an age range of 22-95 years old. Serum samples were collected for 25(OH)D and BTMs detection. BMD of the lumbar spine, femoral neck, and total hip of the subjects were measured by dual-energy X-ray absorptiometry. Results The proportion of 25(OH)D insufficiency and deficiency in the study population was 39.7% (1 236/3 117) and 9.1% (284/3 117), respectively. After grouping by age, the proportion of 25(OH)D deficiency was highest in men and women under 50 years of age, with 11.1% (21/189) and 31.0% (139/449), respectively. After grouping by gender, 25(OH)D levels were negatively associated with special sequence β carboxyterminal peptide of collagen Ⅰ (β-CTX) levels in men and women (male: r=-0.161, P < 0.001; female: r=-0.069, P=0.002). In addition, 25(OH)D levels were positively associated with femoral neck BMD (β=0.001, P=0.019) and total hip BMD (β=0.001, P=0.034) in men. Conclusion 25(OH)D deficiency and insufficiency are still common in rural areas of Ningbo City, especially among women younger than 50 years old. The results suggest that these people need to pay more attention to their 25(OH)D levels and adjust their lifestyle or use vitamin D supplements early. In addition, 25(OH)D levels were found to be positively associated with BMD and negatively associated with β-CTX levels in this study population.
- 25-hydroxyvitamin D /
- Bone turnover markers /
- Bone mineral density

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表 1 研究人群基本信息、血清25(OH)D及骨转换标志物水平和各部位骨密度情况

Table 1. Demographic information, serum 25(OH)D, bone turnover marker levels, and bone mineral density across different regions in the study population

项目	总人群(n=3 117)	男性(n=1 122)	女性(n=1 995)	统计量	P值
年龄(x±s，岁)	61.40±14.71	63.45±14.43	60.25±14.75	-5.868^a	< 0.001
BMI(x±s)	23.32±3.34	23.61±2.91	23.16±3.55	-3.819^a	< 0.001
身高(x±s，cm)	162.06±7.53	168.73±6.04	158.31±5.39	-48.010^a	< 0.001
体重(x±s，kg)	61.39±10.50	67.33±9.79	58.05±9.35	-25.808^a	< 0.001
25(OH)D[M(P₂₅, P₇₅)，ng/mL]	31(25，38)	38(30，47)	28(23，34)	-24.090^b	< 0.001
维生素D水平分布[例(%)]				-17.774^b	< 0.001
< 20 ng/mL	284(9.1)	39(3.5)	245(12.3)
20~30 ng/mL	1 236(39.7)	271(24.1)	965(48.4)
≥30 ng/mL	1 597(51.2)	812(72.4)	785(39.3)
ALP[M(P₂₅, P₇₅)，U/L]	69(57，83)	68(58，81)	69(56，84)	-0.288^b	0.773
P1NP[M(P₂₅, P₇₅)，ng/mL]	50.68(38.65，66.91)	45.49(35.34，58.60)	54.48(40.93，71.02)	-11.561^b	< 0.001
β-CTX[M(P₂₅, P₇₅)，ng/mL]	0.12(0.07，0.18)	0.12(0.08，0.17)	0.12(0.07，0.19)	-0.252^b	0.801
L_1~4BMD(x±s，g/cm²)	0.92±0.18	1.00±0.16	0.88±0.17	-19.806^a	< 0.001
股骨颈BMD(x±s，g/cm²)	0.72±0.14	0.78±0.13	0.68±0.13	-19.795^a	< 0.001
全髋部BMD(x±s，g/cm²)	0.86±0.14	0.93±0.13	0.81±0.13	-24.293^a	< 0.001
注：^a为t值，^b为Z值。

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表 2 不同性别和年龄段血清25(OH)D水平及缺乏程度分布

Table 2. Distribution of serum 25(OH)D levels and deficiency severity across genders and ages

年龄分组	例数	25(OH)D [M(P₂₅, P₇₅)，ng/mL]	H值	P值	维生素D[例(%)]			H值	P值
年龄分组	例数	25(OH)D [M(P₂₅, P₇₅)，ng/mL]	H值	P值	< 20 ng/mL	20~30 ng/mL	≥30 ng/mL	H值	P值
总人群			468.565	< 0.001				390.120	< 0.001
< 50	638	24(19, 29)			160(25.1)	348(54.5)	130(20.4)
≥50~70	1 678	32(26, 39)			97(5.8)	611(36.4)	970(57.8)
>70	801	34(28, 43)			27(3.4)	277(34.6)	497(62.0)
男性			195.656	< 0.001				169.595	< 0.001
< 50	189	27(23, 33)			21(11.1)	103(54.5)	65(34.4)
≥50~70	581	39(32, 47)			12(2.1)	110(18.9)	459(79.0)
>70	352	42(33, 50)			6(1.7)	58(16.5)	288(81.8)
女性			283.998	< 0.001				232.007	< 0.001
< 50	449	22(19, 27)			139(31.0)	245(54.6)	65(14.5)
≥50~70	1 097	30(25, 35)			85(7.7)	501(45.7)	511(46.6)
>70	449	30(25, 36)			21(4.7)	219(48.8)	209(46.5)

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表 3 25(OH)D和BTMs的偏相关分析

Table 3. Partial correlation analysis of 25(OH)D and BTMs

项目	ALP(U/L)	P1NP(ng/mL)	β-CTX(ng/mL)
总人群
r值	-0.026	-0.091	-0.128
P值	0.141	< 0.001	< 0.001
男性
r值	-0.010	-0.059	-0.161
P值	0.743	0.050	< 0.001
女性
r值	0.017	-0.010	-0.069
P值	0.447	0.664	0.002
注：校正年龄、身高、体重。

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表 4 25(OH)D水平与BMD的多元线性回归分析

Table 4. Multiple linear regression analysis of 25(OH)D levels and BMD

项目	L_1~4 BMD			全髋部BMD			股骨颈BMD
项目	β	t值	P值	β	t值	P值	β	t值	P值
总人群25(OH)D	0.001	5.121	< 0.001	0.002	7.294	< 0.001	0.001	6.303	< 0.001
男性25(OH)D	< 0.001	0.767	0.443	0.001	2.127	0.034	0.001	2.351	0.019
女性25(OH)D	< 0.001	0.127	0.899	0.001	1.639	0.101	0.001	1.771	0.077
注：多元线性模型校正年龄、身高、体重；模型中各变量均为连续变量，均以实际值赋值。

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