骨质疏松性骨折患者循环同型半胱氨酸和甲状旁腺激素之间的非线性关系：基于医院队列的横断面研究

摘要(中文译文)

骨质疏松性骨折在老年人中频繁发生，且常伴有内分泌和代谢调节紊乱。甲状旁腺激素（PTH）是骨重塑的关键调节因子，而血浆同型半胱氨酸升高——一种已被确立的血管损伤和骨骼脆性标志物——已被认为与骨质疏松症相关。然而，这两种生化因素之间的相互作用尚未得到充分阐明。本研究调查了2，190例住院骨质疏松性骨折患者循环同型半胱氨酸与血清PTH浓度之间的联系，重点关注非线性关联和修饰性影响。入院时采集的空腹血样用于测定血浆同型半胱氨酸和完整PTH水平。采用多元回归和样条建模技术估计独立关系及潜在阈值效应，并进行考虑高血压、肾功能和镁状态的亚组分析。同型半胱氨酸与PTH呈独立正相关（P < 0.001）。观察到非线性剂量-反应关系，其中PTH随同型半胱氨酸升高而逐渐升高，直至约18 μmol/L，超过此点后升高更为陡峭，提示存在统计学显著的阈值。该关系在高血压、肾功能受损或低镁水平的患者中更为明显，表明血管应激、肾脏应激和矿物质失衡可能增强PTH活性。同型半胱氨酸水平升高可能与骨质疏松症个体中较高的PTH浓度相关。然而，同型半胱氨酸在代谢评估和风险分层中的临床相关性尚需进一步验证。

Abstract

Osteoporotic fractures are frequent among older adults and are often accompanied by disturbances in endocrine and metabolic regulation. Parathyroid hormone (PTH) serves as a key regulator of bone remodeling, while elevated plasma homocysteine-an established marker of vascular injury and skeletal fragility-has been implicated in osteoporosis. Yet, the interaction between these two biochemical factors remains insufficiently characterized. This study investigated the link between circulating homocysteine and serum PTH concentrations among 2,190 hospitalized patients with osteoporotic fractures, emphasizing nonlinear associations and modifying influences. Fasting blood samples obtained at admission were used to measure plasma homocysteine and intact PTH levels. Multiple regression and spline-based modeling techniques were employed to estimate independent relationships and potential threshold effects, with subgroup analyses considering hypertension, renal function, and magnesium status. Homocysteine demonstrated an independent, positive correlation with PTH (P < 0.001). A nonlinear dose-response relationship was observed, wherein PTH increased progressively with homocysteine up to about 18 μmol/L, followed by a sharper rise beyond this point, suggesting a statistically significant threshold. The relationship was more evident among patients with hypertension, impaired renal function, or low magnesium levels, indicating that vascular strain, renal stress, and mineral imbalance may heighten PTH activity. Elevated homocysteine levels may be associated with higher PTH concentrations in individuals with osteoporosis. However, the clinical relevance of homocysteine in metabolic assessment and risk stratification requires further validation.

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