绝经后骨质疏松症患者血清几丁质酶壳三糖苷酶、血管活性肠肽水平与骨密度及骨代谢标志物的相关性研究

目的　探讨绝经后骨质疏松症（postmenopausal osteoporosis, PMOP） 患者血清几丁质酶壳三糖苷酶1（Chitortiosidase 1, CHIT1），血管活性肠肽（vasoactive intestinal peptide, VIP）水平与骨密度及骨代谢标志物的相关性。方法　纳入厦门大学附属东南医院2017 年12 月～ 2020 年12 月收治的PMOP 患者60 例为PMOP 组，取同期于医院体检的绝经后妇女60 例为对照组，比较两组血清CHIT1 和VIP 水平、腰椎L1-4 和股骨颈的骨密度、甲状旁腺素（parathyroid hormone, PTH）、I 型羧基端交联端肽胶原（type I collage cross-linked-telopeptide, CTX）和I 型前胶原氨基端前肽（procollagen I N-terminal peptide, PINP）水平，分析上述指标的相关性，观察PMOP 发生的影响因素。结果　PMOP 组血清CHIT1（9.64±2.25），CTX（0.52±0.13mg/L），PINP（60.84±23.51 mg/L） 水平高于对照组（5.83±1.26nmol/mol/h，0.25±0.07mg/L, 39.83±12.52mg/L），血清VIP（161.32±27.86 pg/ml），PTH（10.49±2.52pmol/L）水平以及腰椎L1-4（0.74±0.13g/cm2），股骨颈的骨密度（0.62±0.0.14g/cm2）低于对照组（302.61±43.92pg/ml，15.19±4.64pmol/L，1.19±0.16g/cm2，0.88±0.12g/cm2）， 差异均有统计学意义（t=6.110 ～ 21.042，均P=0.000）。PMOP 患者血清CHIT1 水平与血清PTH，腰椎L1-4，股骨颈的骨密度呈负相关（r=-0.327，-0.479，-0.485，均P ＜ 0.05），与血清CTX，PINP 水平呈正相关（r=0.482，0.423，均P ＜ 0.05），血清VIP 水平与血清PTH，腰椎L1-4，股骨颈的骨密度呈正相关（r=0.515，0.482，0.535，均P=0.000），与血清CTX，PINP 水平呈负相关（r= -0.414，-0.386，均P ＜ 0.05）。Logistic 回归分析提示，CHIT1 ＞ 7.73nmol/mol/h 是PMOP 发生的危险因素，而VIP ＞ 231.97pg/ml，腰椎L1-4 骨密度＞ 0.97g/cm? 是预防PMOP 发生的保护性因素（P ＜ 0.05）。结论　PMOP 患者血清CHIT1 水平增高，而VIP 水平降低，且二者均与腰椎L1-4，股骨颈骨密度以及骨代谢标志物有相关性，临床有望将二者作为评估PMOP 病情的辅助指标。

Correlation between Serum Levels of Chitotriosidase1, Vasoactive Intestinal Peptide and Bone Mineral Density and Bone Turnover Indicators in Postmenopausal Osteoporosis Patients

Objective　To explore the correlation between serum levels of chitotriosidase1 (CHIT1) and vasoactive intestinal peptide (VIP), bone metabolic markers and bone turnover indicators in postmenopausal osteoporosis (PMOP) patients. Methods　 60 PMOP patients admitted to the Southeast Hospital of Xiamen University from December 2017 to December 2020 were included in the PMOP group, and 60 postmenopausal women who received physical examination in the hospital during the same period were selected as the control group. The levels of serum CHIT1, VIP, lumbar L1-4, bone mineral density of femoral neck, parathyroid hormone (PTH), type I collage cross-linked-telopeptide（CTX） and procollagen Ⅰ N-terminal peptide（PINP） were compared between the two groups. The correlation of the above indexes were analyzed, and the influencing factors of PMOP were observed. Results　The levels of serum CHIT1（9.64±2.25nmol/mol/h）, CTX（0.52±0.13mg/L） and PINP （60.84±23.51mg/L） in the PMOP group were higher than those in the control group（5.83±1.26nmol/mol/h, 0.25±0.07mg/ L, 39.83±12.52mg/L）. The levels of serum VIP（161.32±27.86pg/ml）, PTH（10.49±2.52pmol/L） and bone mineral density of lumbar spine L1-4（0.74±0.13g/cm2）, femoral neck （0.62±0.0.14g/cm2） were lower than those in the control group（302.61±43.92pg/ml, 15.19±4.64pmol/L, 1.19±0.16g/cm2, 0.88±0.12g/cm2）, the differences were statistically significant (t=6.110~21.042, all P=0.000). Serum CHIT1 levels in PMOP patients were negatively correlated with serum PTH and bone mineral density of lumbar spine L1-4, femoral neck（r=-0.327, -0.479, -0.485, all P ＜ 0.05）, and positively correlated with serum CTX and PINP levels(r=0.482, 0.423, all P ＜ 0.05). Serum VIP levels were positively correlated with serum PTH and bone mineral density of lumbar spine L1-4, femoral neck(r=0.515, 0.482, 0.535, all P=0.000), and negatively correlated with serum CTX and PINP levels (r=-0.414, -0.386, all P ＜ 0.05). Logistic regression showed that CHIT1 > 7.73 nmol / mol / h was a risk factor for PMOP, while VIP > 231.97 pg / ml and lumbar spine L1-4 bone mineral density> 0.97 g/cm? were protective factors for PMOP (P<0.05). Conclusion　Serum CHIT1 levels in PMOP patients increased, while VIP levels decreased, and both of them were correlated with bone mineral density of lumbar spine L1-4, femoral neck and bone metabolic markers, which are expected to be used as auxiliary indicators in clinical evaluation of PMOP disease.