【摘要】 目的 探讨老年营养风险指数（GNRI）对2型糖尿病（T2DM）患者骨质疏松症的预测价值。方法 选择2019年6月至2021年6月温州医科大学附属第二医院内分泌科收治的T2DM患者737例，分为骨质疏松症组225例和对照组512例，比较两组一般资料及骨代谢指标，计算GNRI，测量骨密度。采用Spearman秩相关分析GNRI与上述指标之间的相关性，同时以logistic回归分析GNRI与骨质疏松症发生的关系并应用ROC曲线评估GNRI对骨质疏松症的预测效能。结果 骨质疏松症组女性比例、BMI、甲状旁腺素（PTH）均高于对照组，而白蛋白、白蛋白校正钙、I型前胶原N-末端前肽（P1NP）、GNRI、平均骨密度均低于对照组，差异均有统计学意义（均P<0.05）。相关性分析显示校正年龄和BMI后，GNRI水平仍与平均骨密度正相关（P<0.05）。logistics回归分析显示GNRI与骨质疏松症的发生呈负相关，是骨质疏松症发生的独立保护因素（OR=0.807,P<0.05）。与BMI、白蛋白和白蛋白校正钙比较，GNRI的AUC最大，男性为0.818，女性为0.849。GNRI预测男性和女性骨质疏松症的最佳临界值分别为87.95和85.61，灵敏度分别为0.68和0.67，特异度分别为0.84和0.90。结论 T2DM患者中，GNRI水平与骨密度显著相关，是骨质疏松症发生的独立保护因素。GNRI可能是有效而简便的T2DM骨质疏松症预测指标。更多还原

【Abstract】 Objective To explore the predictive value of geriatric nutritional risk index(GNRI) for osteoporosis in patients with type 2 diabetes mellitus(T2DM). Methods A total of 737 patients with T2DM admitted to the Department of Endocrinology of the Second Affiliated Hospital of Wenzhou Medical University from June 2019 to June 2021 were enrolled in the study, including 512 cases with osteoporosis(osteoporosis group) and 225 cases without osteoporosis( control group). The bone mineral density was measured and the GNRI was calculated. The correlation between GNRI and bone metabolic indexes was analyzed with Spearman regression,and the relationship between GNRI and osteoporosis was analyzed with logistic regression. The predictive value of GNRI for osteoporosis was assessed with ROC curve. Results The proportion of females, BMI, and parathyroid hormone( PTH) level were significantly higher; while albumin, albumin corrected calcium, procollagen N-terminal propeptide( P1NP), mean bone mineral density and GNRI in osteroporosis group were significantly lower than those in control group( all P < 0. 05). After adjusting for age and BMI, the GNRI was positively correlated with mean bone mineral density and negatively correlated with the occurrence of osteoporosis( P < 0. 05), which was an independent protective factor for osteoporosis( OR=0. 807, P < 0. 05). ROC analysis showed that the area under curve( AUC) of GNRI for predicting osteoporosis was 0. 818 for men and 0. 849 for women, which was the highest among all indicators. The optimal cut-off values of GNRI for predicting osteoporosis in men and in women were87. 95 and 85. 61, with a sensitivity of 0. 68 and 0. 67 and a specificity of 0. 84 and 0. 90, r espectively. Conclusion In patients with T2DM, the GNRI is closely related to bone mineral density, and is an independent protective factor for the occurrence of osteoporosis, indicating that GNRI might be used as an effective and simple predic tor for osteoporosis in patients with T2DM.更多还原