青少年胰岛素抵抗与骨矿物质含量及骨代谢标志物的关系

刘建熹; 史龙凯; 陈琳琳; 许应丽; 丁文清

doi:10.16835/j.cnki.1000-9817.2025299

青少年胰岛素抵抗与骨矿物质含量及骨代谢标志物的关系

doi: 10.16835/j.cnki.1000-9817.2025299

宁夏医科大学公共卫生学院/宁夏环境因素与慢性病控制重点实验室，银川 750004

基金项目:

国家自然科学基金项目 82160614

详细信息

作者简介:
刘建熹(2000-)，男，宁夏银川人，在读硕士，主要研究方向为儿童青少年慢性病流行病学

通讯作者:
丁文清，E-mail：dwqdz@163.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 R726.8 TQ467.32
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出版历程
- 收稿日期: 2025-06-23
- 修回日期: 2025-08-08
- 刊出日期: 2025-10-25

Association of metabolic score for insulin resistance with bone mineral content and bone metabolic markers among adolescents

School of Public Health, Ningxia Medical University/Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan 750004, Ningxia Hui Autonomous Region, China

摘要

摘要: 目的分析青少年胰岛素抵抗代谢评分(METS-IR)与骨矿物质含量(BMC)、骨代谢标志物的关系，为早期识别和防治青少年骨相关疾病提供科学依据。方法 2017—2019和2023年，通过方便抽样与分层整群随机抽样相结合的方法抽取银川市1 414名12~18岁青少年进行问卷调查、体格测量和实验室检测，以获取青少年体质量指数、BMC、血清骨钙素(OC)、Ⅰ型胶原交联C末端肽(CTX)、钙(Ca)、METS-IR等数据，根据P₂₅、P₅₀、P₇₅将METS-IR分为Q1~Q4四组。使用Logistic回归模型结合限制性立方样条方法分析青少年METS-IR与BMC低下及骨代谢标志物低下的关系，通过受试者工作特征(ROC)曲线分析METS-IR对BMC低下的评估效果。结果青少年BMC、OC、CTX、Ca、METS-IR水平分别为(2.66±0.52)kg，(20.49±13.77)ng/mL，(2 460.89±1 818.96)pg/mL，(2.47±0.67)mmol/L，30.63±7.58；调整性别、年龄和体力活动水平后，METS-IR Q4组相较Q1组发生BMC低下和低CTX的风险降低[OR值(95%CI)分别为0.03(0.01~0.07)，0.45(0.32~0.65)]，发生低OC的风险升高[OR值(95%CI)=1.85(1.28~2.67)](P值均 < 0.05)；性别分层后，男、女生METS-IR Q4组相较Q1组发生BMC低下、低OC和低CTX的风险与总人群相似(P值均 < 0.05)；调整性别、年龄和体力活动水平后，METS-IR与BMC低下和低OC之间均存在非线性剂量-反应关系(P_总趋势值均 < 0.01，P_非线性值均=0.01)，与低CTX存在线性剂量-反应关系(P_总趋势 < 0.01，P_非线性=0.72)。ROC曲线结果显示，METS-IR对BMC低下的评估效果最佳(AUC=0.85，95%CI=0.82~0.88，P < 0.01)。结论 METS-IR评分高的学生BMC低下和低CTX的风险较低，但低OC的风险较高；且METS-IR是早期预测BMC低下的可靠指标。
- 胰岛素抵抗 /
- 骨矿物质含量 /
- 回归分析 /
- 青少年
Abstract: Objective To investigate the relationship of metabolic score for insulin resistance (METS-IR) with bone mineral content (BMC) and bone metabolic markers levels among adolescents, so as to provide a scientific foundation for the early identification and prevention of bone-related diseases. Methods From 2017 to 2019 and 2023, a total of 1 414 adolescents aged 12-18 years from Yinchuan were selected using a method combining convenient sampling with stratified cluster random sampling. The data of basic information, body mass index, BMC, serum osteocalcin (OC), type Ⅰ collagen cross-linked C-terminal peptide (CTX) and calcium (Ca), METS-IR among adolescents were obtained by questionnaire survey, physical measurement and laboratory examination, and METS-IR was divided into four groups Q1-Q4 according to P₂₅, P₅₀ and P₇₅. Logistic regression models combined with restricted cubic splines were employed to analyze the relationship between METS-IR and low BMC as well as low bone metabolic markers. The receiver operating characteristic (ROC) curve was used to evaluate METS-IR effectiveness in diagnosing low BMC. Results The levels of BMC, OC, CTX, Ca and METS-IR in the surveyed adolescents were (2.66±0.52)kg, (20.49±13.77)ng/mL, (2 460.89±1 818.96)pg/mL, (2.47±0.67)mmol/L, 30.63±7.58. After adjusting for gender, age and physical activity level, METS-IR in Q4 group had a reduced risk of low BMC and low CTX [OR (95%CI)=0.03(0.01-0.07), 0.45(0.32-0.65)] and an elevated risk of low OC [OR (95%CI)=1.85(1.28-2.67)], compared with the Q1 group (all P < 0.05). Gender-stratified analyses revealed similar trends for both males and females (all P < 0.05). Non-linear dose-response relationships were observed between METS-IR and low BMC (P_{total trend} < 0.01, P_{non-linearity}=0.01), as well as low OC (P_{total trend} < 0.01, P_{non-linearity}=0.01), while a linear relationship was detected with low CTX (P_{total trend} < 0.01, P_{non-linearity}=0.72). ROC curves revealed that METS-IR had the best diagnostic performance for low BMC (AUC=0.85, 95%CI=0.82-0.88, P < 0.01). Conclusions Higher METS-IR score is linked to reduced risk of low BMC and CTX but increase risk of low OC among adolescents. These findings suggest METS-IR is a reliable indicator for assessing BMC and early predicting bone health risk among adolescents.
- Insulin resistance /
- Bone mineral content /
- Regression analysis /
- Adolescent
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

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图 1 青少年METS-IR与骨代谢标志物低下的剂量反应关系

Figure 1. Dose-response relationship between METS-IR and low bone metabolic markers among adolescents

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图 2 青少年IR替代标志物评估BMC低下的ROC曲线

Figure 2. ROC curve of IR substitution marker for evaluating low BMC among adolescents

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表 1 不同性别青少年METS-TR和骨指标比较(x ±s)

Table 1. Comparison of METS-TR and bone indicators between male and female adolescents(x ±s)

性别	人数	METS-IR	BMC/ kg	OC/ (ng·mL^-1)	CTX/ (pg·mL^-1)	Ca/ (mmol·L^-1)
男	817	30.96±7.79	2.86±0.53	22.39±14.17	2 260.42±1 698.99	2.47±0.72
女	597	30.16±7.28	2.38±0.36	17.88±12.76	2 735.24±1 939.46	2.46±0.59
合计	1 414	30.63±7.58	2.66±0.52	20.49±13.77	2 460.89±1 818.96	2.47±0.67

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表 2 青少年METS-IR与骨指标的Logistic回归分析[OR值(95%CI)]

Table 2. Logistic regression analysis of METS-IR and bone indexes among adolescents[OR(95%CI)]

组别	自变量	BMC	OC	CTX	Ca
总人群	Q2	0.28(0.19~0.43)^#	1.25(0.86~1.83)	0.83(0.59~1.15)	0.84(0.60~1.17)
(n=1 414)	Q3	0.18(0.11~0.28)^#	1.85(1.28~2.67)^#	0.77(0.55~1.07)	1.05(0.76~1.45)
	Q4	0.03(0.01~0.07)^#	1.85(1.28~2.67)^#	0.45(0.32~0.65)^#	1.15(0.83~1.58)
男生	Q2	0.21(0.09~0.48)^#	1.35(0.77~2.38)	0.90(0.59~1.39)	1.00(0.64~1.55)
(n=817)	Q3	0.06(0.02~0.21)^#	2.01(1.18~3.44)^#	0.82(0.53~1.27)	1.04(0.67~1.60)
	Q4	0.05(0.01~0.17)^#	1.73(1.03~2.91)^#	0.55(0.36~0.85)^#	1.14(0.75~1.72)
女生	Q2	0.33(0.20~0.53)^#	1.21(0.73~2.01)	0.69(0.41~1.17)	0.70(0.42~1.15)
(n=597)	Q3	0.22(0.13~0.37)^#	1.72(1.04~2.84)^#	0.67(0.40~1.14)	1.05(0.65~1.70)
	Q4	0.02(0.01~0.07)^#	2.00(1.17~3.41)^#	0.29(0.14~0.57)^#	1.16(0.69~1.95)
注：自变量以Q1为参照; 调整了性别、年龄、体力活动水平，^#P < 0.05。

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