Duchenne型肌营养不良症椎体骨折的相关影响因素△

Factors associated with vertebral fractures in Duchenne muscular dystrophy

摘要:

［目的］ 探讨 Duchenne 型肌营养不良症 （Duchenne muscular dystrophy, DMD） 患者发生椎体骨折 （vertebral fracture, VF）的相关因素。［方法］回顾性分析 2021 年 7 月—2022 年 9 月就诊于解放军总医院 DMD 多学科联合门诊的 DMD 患者临床资料。依据是否存在 VF 分为 VF 组和非 VF 组，采用单项因素比较、二元多因素逻辑回归分析和受试者工作曲线（receiver op- erating characteristic, ROC） 分析 VF 的相关因素。［结果］纳入本研究的 93 例患儿均为男性，年龄 3.9~15.4 岁，平均（8.7±2.6） 岁；其中发生 VF 患儿 19 例，占 20.4%，非 VF 患儿 74 例，占 79.6%；激素治疗的患儿 56 例中，VF 为 17 例，30.4%，非 VF 为 39 例，占 69.6%。单项因素比较表明，VF 组服用激素时间、年龄、卧-立位时间显著大于非 VF 组，腰椎骨密度 Z（lumbar bone mineral density Z value, LBMD-Z）值显著低于非 VF 组，差异有统计学意义（P<0.05）。逻辑回归表明：服用激素时间（OR=2.880, P=0.001）、卧-立位时间 （OR=1.115, P=0.015） 是 DMD 患儿 VF 的独立危险因素，而 LBMD-Z 值 （OR=0.102, P<0.001），年龄 （OR=0.511, P=0.021） 是 VF 的保护性因素。ROC 曲线分析表明：LBMD-Z 值、服用激素时间的曲线面积 （aera under curve, AUC）为 0.7~0.9，有较好预测 VF 的价值。［结论］DMD 患者 VF 是多种因素共同作用的结果，对影响因素采取针对性措施，有助于减少 VF 的发生。

Abstract:

[Objective] To explore the factors related to vertebral fracture (VF) in Duchenne muscular dystrophy (DMD) in children. [Methods] A retrospective study was conducted on the clinical data of DMD patients who admitted to the multidisciplinary joint outpatient de- partment of DMD in General Hospital of PLA from July 2021 to September 2022. The children were divided into VF group and non-VF group according to the presence or absence of VF. The factors related to VF were analyzed by univariate comparison, binary multiple logic analysis and receiver operating characteristic (ROC) . [Results] A total of 93 children were included in this study, and all of them were male, aged from 3.9 to 15.4 years old with an average age of (8.7±2.6) years old. Among them, 19 cases proved VF, accounting for 20.4%; while the remaining 74 cases were of non-VF, accounting for 79.6%. Among them, 56 children were treated with hormone therapy, 17 cases (30.4%) were with VF and 39 cases (69.6%) were with non-VF. In term of univariate comparison, the VF group had significantly greater the time of hormone taking, age and supine-standing position time, whereas significantly less lumbar bone mineral density Z value (LBMD-Z) than the non-VF group, with statistical significance (P＜0.05) . As results of logistic regression, hormone taking duration (OR=2.880, P=0.001) and supine-standing time (OR=1.115, P=0.015) were independent risk factors for VF, while LBMD-Z value (OR=0.102, P＜0.001) , age (OR=0.511, P=0.021) was the protective factor for VF. In term of receiver operating characteristic (ROC) analysis, the aera under curve (AUC) of LBMD-Z value and hor- mone administration duration ranged from 0.7 to 0.9, which had a good value in predicting VF. [Conclusion] The VF in DMD patients is the result of the combined action of multiple factors. Targeted measures to the impacting factors might be helpful to reduce the occurrence of VF.