原发性干燥综合征合并骨质疏松的临床特征、危险因素分析及预测模型构建OA
Osteoporosis in primary Sjögren's syndrome:clinical features,risk factor analysis,and development of a predictive model
目的 探讨原发性干燥综合征(primary Sjögren's syndrome,pSS)合并骨质疏松症(osteoporosis,OP)的临床特征、危险因素分析及预测模型构建.方法 回顾性分析282 例 pSS 患者的临床资料,根据患者双能X 线吸收测量仪(dual energy X-ray absorptionmetry,DXA)检查的腰椎、髋部骨密度T 值分为pSS-OP 组(n=108)和 pSS 组(n=174),比较两组患者临床特征和实验室指标,并进行危险因素分析,构建预测模型.结果 pSS-OP组 年 龄、病 程、红 细 胞 沉 降 率(erythrocyte sedimentation rate,ESR)、免 疫 球 蛋 白(immunoglobulin,Ig)G、IgA、类风湿因子(rheumatoid factor,RF)、白细胞介素(interleukin,IL)-10、肿瘤坏死因子-α(tumor necrosis factorα,TNFα)、IL-17A、IL-6、干扰素-γ(interferon-γ,INF-γ)较 pSS 组升高,25-羟基维生素 D[25-Hydroxyvitamin D,25(OH)D]、补体 C3、补体 C4 较 pSS 组降低(均 P＜0.05).Logistic回归分析结合受试者工作特征(receiver operating characteristic,ROC)曲线显示,年龄≥50.5 岁[曲线下面积(area under the curve,AUC)=0.75]、病程≥3.5 年(AUC=0.79)、ESR≥35.5 mm/h(AUC=0.57)、RF≥27.9 IU/mL(AUC=0.63)、IL-17A≥1.5 pg/mL(AUC=0.62)、25(OH)D≤15.78 ng/mL(AUC=0.67)、合并肌痛/疲劳、肾小管酸中毒、焦虑抑郁是 pSS 发生 OP 的独立危险因素.基于此构建的预测模型 C 指数为0.91(0.88～0.95),且校正曲线趋近于理想曲线.结论 高龄、长病程、高炎症状态及维生素 D 缺乏是 pSS 患者发生 OP 的重要危险因素,基于此构建的列线图预测模型能有效预测 pSS 患者合并 OP 的高风险群体.
Objective To investigate the clinical characteristics,risk factors,and construct predictive models for osteoporosis in patients with primary Sjögren's syndrome(pSS).Methods A retrospective analysis was conducted on 282 patients diagnosed with pSS.Patients were categorized into two groups based on dual-energy X-ray absorptiometry(DXA)measurements of lumbar spine and hip T-scores:pSS with osteoporosis(pSS-OP,n=108)and pSS without oste-oporosis(pSS,n=174).Comparative analyses were utilized to assess differences in clinical features and laboratory pa-rameters between the two groups.Subsequently,independent risk factors for osteoporosis in pSS were determined through multivariate logistic regression,leading to the development of a predictive nomogram.Results Patients in the pSS-OP group showed significantly elevated levels of age,disease duration,erythrocyte sedimentation rate(ESR),immunoglob-ulin(Ig)G,IgA,rheumatoid factor(RF),interleukin(IL)-10,tumor necrosis factorα(TNF-α),IL-17A,IL-6,and interferon-γ(IFN-γ),while exhibiting significantly reduced levels of 25-hydroxyvitamin D[25(OH)D],com-plement C4,and complement C3 compared to the pSS group(P＜0.05 for all).Multivariate logistic regression analysis,in conjunction with receiver operating characteristic(ROC)curve evaluation,identified the following inde-pendent risk factors for osteoporosis in pSS patients:Demographic/clinical factors including age≥50.5 years[area un-der the curve(AUC)=0.75],disease duration≥3.5 years(AUC=0.79),presence of myalgia/fatigue,renal tubular acidosis,and anxiety/depression.Laboratory markers such as ESR≥35.5 mm/h(AUC=0.57),RF≥27.9 IU/mL(AUC=0.63),IL-17A≥1.5 pg/mL(AUC=0.62),and 25(OH)D≤15.78 ng/mL(AUC=0.67)were also identified.The predictive model derived from these variables exhibited robust discriminative capacity,with a C-index of 0.91(95%CI 0.88-0.95).Calibration analysis demonstrated a close alignment between predicted and observed proba-bilities,as indicated by the calibration curve closely approximating the ideal line.Conclusion In patients with pSS,ad-vanced age,prolonged disease duration,increased inflammatory activity,and vitamin D deficiency were identified as sig-nificant risk factors for osteoporosis.A nomogram prediction model,integrating these factors,exhibited high discriminative ability(C-index:0.91)and accurate calibration,indicating its potential for clinical use in identifying pSS patients at ele-vated risk of osteoporosis.
高雅静;白炜;李正芳;武丽君
830001 乌鲁木齐,新疆医科大学||830001 乌鲁木齐,新疆维吾尔自治区人民医院风湿免疫科830001 乌鲁木齐,新疆维吾尔自治区人民医院风湿免疫科||830001 乌鲁木齐,新疆类风湿关节炎临床医学研究中心||100730 北京,中国医学科学院北京协和医院风湿免疫科830001 乌鲁木齐,新疆维吾尔自治区人民医院风湿免疫科||830001 乌鲁木齐,新疆类风湿关节炎临床医学研究中心830001 乌鲁木齐,新疆维吾尔自治区人民医院风湿免疫科||830001 乌鲁木齐,新疆类风湿关节炎临床医学研究中心
医药卫生
原发性干燥综合征骨质疏松临床特征危险因素列线图
primary Sjögren's syndromeosteoporosisclinical featuresrisk factorscolumn chart
《中华骨质疏松和骨矿盐疾病杂志》 2026 (2)
174-182,9
新疆常见自身免疫病诊断评估关键技术研发及应用(2022B03002-1)国家自然科学基金(82260326)
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