2型糖尿病患者肾功能障碍亚型与椎体骨折之间的关联：一项纵向研究
Associations Between Renal Dysfunction Subtypes and Vertebral Fracture in Patients with Type 2 Diabetes: A Longitudinal Study.
作者信息
Hu Nandong, Zhang Yiping, Wei Zicheng, Yu Rui, Zhang Yingying, Chen Xiao
机构信息
Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong Universty, Shanghai, 200127 People's Republic of China.
Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, People's Republic of China.
出版信息
Diabetes Metab Syndr Obes. 2025 Jun 11;18:1915-1924. doi: 10.2147/DMSO.S522430. eCollection 2025.
PURPOSE
Renal dysfunction and vertebral fracture are both common in patients with type 2 diabetes mellitus (T2DM). However, the association between renal dysfunction and vertebral fracture has rarely been evaluated longitudinally. In this longitudinal study, we evaluated the associations between different subtypes of renal dysfunction and vertebral fracture (VF) in patients with type 2 diabetes.
METHODS
This study recruited T2DM patients aged 50 years or older whose computed tomography (CT) imaging screening revealed no VFs from January 2019-December 2021. The participants were followed up annually until January 2024. The Genant score was used to define new-onset VFs. The renal dysfunction phenotypes were as follows: no renal dysfunction, estimated glomerular filtration rate (eGFR) decline or proteinuria, and eGFR decline + proteinuria. Cox proportional hazards models were used to assess the association between renal dysfunction and VF.
RESULTS
A total of 135 patients developed new VFs over a median follow-up period of two years. A total of 270 patients without fractures were matched according to follow-up time and body mass index. Bone CT attenuation (HU) (adjusted hazard ratio (HR) = 0.97, 95% confidence interval (CI) 0.99-0.99) was independently associated with VF. eGFR decline or proteinuria and eGFR decline + proteinuria were associated with VF (adjusted HR = 1.98, 95% CI 1.35-2.92; adjusted HR = 2.53, 95% CI 1.30-4.92). Subgroup analyses revealed associations in women, patients without accompanying neuropathy, patients without vascular lesions, and patients who did not receive insulin therapy. The addition of renal dysfunction improved the area under the curve of the clinical model from 0.817 (95% CI: 0.78-0.85) to 0.839 (95% CI: 0.80-0.87) (p < 0.05).
CONCLUSION
Renal dysfunction was associated with VF in patients with T2DM. The addition of renal dysfunction improved the ability of bone mass to predict VF.
目的
肾功能不全和椎体骨折在2型糖尿病（T2DM）患者中均很常见。然而，肾功能不全与椎体骨折之间的关联很少得到纵向评估。在这项纵向研究中，我们评估了2型糖尿病患者不同亚型的肾功能不全与椎体骨折（VF）之间的关联。
方法
本研究招募了年龄在50岁及以上的T2DM患者，这些患者在2019年1月至2021年12月期间的计算机断层扫描（CT）成像筛查显示无椎体骨折。参与者每年接受随访，直至2024年1月。使用Genant评分来定义新发椎体骨折。肾功能不全的表型如下：无肾功能不全、估计肾小球滤过率（eGFR）下降或蛋白尿，以及eGFR下降+蛋白尿。使用Cox比例风险模型评估肾功能不全与椎体骨折之间的关联。
结果
在中位随访期两年内，共有135例患者发生了新发椎体骨折。根据随访时间和体重指数，共匹配了270例无骨折的患者。骨CT衰减（HU）（调整后风险比（HR）=0.97，95%置信区间（CI）0.99 - 0.99）与椎体骨折独立相关。eGFR下降或蛋白尿以及eGFR下降+蛋白尿与椎体骨折相关（调整后HR = 1.98，95% CI 1.35 - 2.92；调整后HR = 2.53，95% CI 1.30 - 4.92）。亚组分析显示在女性、无伴随神经病变的患者、无血管病变的患者以及未接受胰岛素治疗的患者中存在关联。加入肾功能不全因素后，临床模型的曲线下面积从0.817（95% CI：0.78 - 0.85）提高到0.839（95% CI：0.80 - 0.87）（p < 0.05）。
结论
肾功能不全与T2DM患者的椎体骨折相关。加入肾功能不全因素提高了骨量预测椎体骨折的能力。
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