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目的 探讨2型糖尿病(T2DM)合并甲状腺功能亢进(甲亢)患者破骨细胞核因子κB受体活化因子配基(RANKL)水平对骨质疏松(OP)的预测价值。方法 选择T2DM合并甲亢患者236例随机分为训练集组(157例)和测试集组(79例)。依据训练集患者是否合并OP分为OP组(n=68)和非OP组(n=89),经过年龄校准，比较两组一般资料和实验室指标，采用Logistic回归法分析T2DM合并甲亢患者出现OP的影响因素。通过曲线拟合和阈值效应分析确定RANKL和骨保护素(OPG)/RANKL与T2DM合并甲亢患者发生OP的关系。根据多因素分析结果利用R3.6.0软件建立T2DM合并甲亢患者发生OP的预测模型，并采用受试者工作特征(ROC)曲线、一致性指数(C-index)和校准图对预测模型进行验证。结果 骨钙素、RANKL是T2DM合并甲亢患者发生OP的独立危险因素(P<0.05),OPG/RANKL和促甲状腺激素(TSH)为其保护因素(P<0.05)。RANKL与T2DM合并甲亢患者发生OP的关联强度存在非线性剂量-反应关系，随着RANKL的升高，OP风险增加。根据多因素分析结果构建列线图预测模型并对模型进行验证，训练集的C-index为0.836(95%CI:0.723～0.895),测试集C-index为0.845(95%CI:0.705～0.872),校准图中实际曲线与理想曲线较为贴合。ROC曲线结果显示，训练集列线图模型的曲线下面积(AUC)为0.836(95%CI:0.708～0.902),测试集的AUC为0.845(95%CI:0.698～0.897),表明该模型具有较强的预测能力。结论 RANKL是T2DM合并甲亢患者并发OP的独立危险因素，OPG/RANKL是独立保护因素。RANKL升高会增加患者发生OP的概率，因此可将RANKL水平作为临床评估T2DM合并甲亢患者是否发生OP的指标之一。
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基本信息:
中图分类号:R581.1;R580;R587.2
引用信息:
[1]黎俊森,黎培爱.2型糖尿病合并甲亢患者破骨细胞核因子κB受体活化因子配基水平对骨质疏松的预测价值[J].中国老年学杂志,2025,45(23):5646-5651.