与原发性甲状旁腺功能亢进症患者椎体骨折风险相关的因素。
Factors associated with vertebral fracture risk in patients with primary hyperparathyroidism.
机构信息
Unit of Endocrinology and Metabolic DiseasesFondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Via Francesco Sforza 35, 20122 Milan, ItalyUnit of Endocrinology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Radiology'Fatebenefratelli and Oftalmico' Hospital, Milan, ItalyUnit of Radiology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Endocrinology and DiabetologyDepartment of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese, Milan, ItalyDepartment of Internal Medicine and Medical Disciplines'Sapienza' Rome University, Rome, ItalyDepartments of MedicinePhysiology, and Human Genetics, McGill University, Montreal, Quebec, CanadaDepartments of Laboratory Medicine and PathobiologyMedicine and Genetics, University of Toronto, Toronto, Ontario, Canada.
Unit of Endocrinology and Metabolic DiseasesFondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Via Francesco Sforza 35, 20122 Milan, ItalyUnit of Endocrinology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Radiology'Fatebenefratelli and Oftalmico' Hospital, Milan, ItalyUnit of Radiology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Endocrinology and DiabetologyDepartment of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese, Milan, ItalyDepartment of Internal Medicine and Medical Disciplines'Sapienza' Rome University, Rome, ItalyDepartments of MedicinePhysiology, and Human Genetics, McGill University, Montreal, Quebec, CanadaDepartments of Laboratory Medicine and PathobiologyMedicine and Genetics, University of Toronto, Toronto, Ontario, CanadaUnit of Endocrinology and Metabolic DiseasesFondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Via Francesco Sforza 35, 20122 Milan, ItalyUnit of Endocrinology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Radiology'Fatebenefratelli and Oftalmico' Hospital, Milan, ItalyUnit of Radiology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Endocrinology and DiabetologyDepartment of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese, Milan, ItalyDepartment of Internal Medicine and Medical Disciplines'Sapienza' Rome University, Rome, ItalyDepartments of MedicinePhysiology, and Human Genetics, McGill University, Montreal, Quebec, CanadaDepartments of Laboratory Medicine and PathobiologyMedicine and Genetics, University of Toronto, Toronto, Ontario, Canada.
出版信息
Eur J Endocrinol. 2014 Sep;171(3):399-406. doi: 10.1530/EJE-14-0343. Epub 2014 Jun 25.
OBJECTIVE
To examine factors, in addition to bone mineral density (BMD), such as the common calcium-sensing receptor (CASR) gene polymorphisms, associated with vertebral fracture (VFx) risk in primary hyperparathyroidism (PHPT).
DESIGN AND METHODS
A cross-sectional analysis of 266 Caucasian PHPT seen as outpatients. Serum calcium (sCa) phosphate metabolism parameters were measured. BMD was assessed by dual-energy X-ray absorptiometry (expressed as Z-score) at lumbar spine (Z-LS) and femoral neck, morphometric VFx by radiograph, and CASR A986S/R990G genotypes by PCR amplification and genomic DNA sequencing.
RESULTS
Fractured patients (n=100, 37.6%) had lower sCa (10.8±0.7 mg/dl) and Z-LS BMD (-1.0±1.44), higher age (61±10 years), and prevalence (51%) of ≥1 S alleles of the CASR A986S single-nucleotide polymorphism (SNP; AS/SS), than those not fractured (n=166, 11.2±1.0 mg/dl, -0.57±0.97, 58±13 years, and 38% AS/SS, respectively, P<0.05 for all comparisons). Logistic regression, with VFx as dependent variable, showed independent risks associated with increased age (OR 1.03, 95% CI 1.01-1.06, P=0.006), decreased sCa (OR 1.86, 95% CI 1.28-2.7, P=0.001), and Z-LS BMD (OR 1.4, 95% CI 1.12-1.7, P=0.002) and presence of AS/SS (OR 1.8, 95% CI 1.1-2.9, P=0.05). The presence of two out of three factors (age ≥58 years, sCa <10.8 and Z-LS BMD≤-1.0, and AS/SS genotype) gave an overall OR of 4.2 (95% CI 2.25-7.85, P<0.0001).
CONCLUSIONS
In PHPT, VFx is associated positively with age, negatively with sCa and spinal BMD, and presence of at least one copy of the CASR A986S SNP.
目的
研究除骨密度（BMD）以外的因素，如常见的钙敏感受体（CASR）基因多态性，与原发性甲状旁腺功能亢进症（PHPT）患者的椎体骨折（VFx）风险的相关性。
方法
对 266 例白人 PHPT 门诊患者进行横断面分析。检测血清钙（sCa）、磷代谢参数。采用双能 X 线吸收法（以腰椎骨密度 Z 分数表示）（Z-LS）和股骨颈评估 BMD，用 X 线片评估形态计量学 VFx，采用聚合酶链反应（PCR）扩增和基因组 DNA 测序检测 CASR A986S/R990G 基因型。
结果
骨折组患者（n=100，37.6%）的 sCa（10.8±0.7mg/dl）和 Z-LS 骨密度（-1.0±1.44）较低，年龄（61±10 岁）较大，CASR A986S 单核苷酸多态性（SNP）的至少 1 个 S 等位基因（AS/SS）的阳性率（51%）较高（分别为 n=166，11.2±1.0mg/dl，-0.57±0.97，58±13 岁，38% AS/SS，P<0.05）。以 VFx 为因变量的 logistic 回归分析显示，与 VFx 相关的独立风险因素包括年龄增加（OR 1.03，95%CI 1.01-1.06，P=0.006）、sCa 降低（OR 1.86，95%CI 1.28-2.7，P=0.001）、Z-LS 骨密度降低（OR 1.4，95%CI 1.12-1.7，P=0.002）和 AS/SS 基因型（OR 1.8，95%CI 1.1-2.9，P=0.05）。当三种因素中的两种同时存在（年龄≥58 岁、sCa<10.8 和 Z-LS BMD≤-1.0，以及 AS/SS 基因型）时，总体 OR 为 4.2（95%CI 2.25-7.85，P<0.0001）。
结论
在 PHPT 中，VFx 与年龄呈正相关，与 sCa 和脊柱 BMD 呈负相关，与 CASR A986S SNP 的至少一个拷贝存在相关。
Zotero 插件