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专家账号密码找回目的 探讨普通成年男性血清骨钙素（OC）水平与估算肾小球滤过率（eGFR）的关联。方法 本研究基于广西防城港地区男性健康与体检调查（FAMHES）队列开展分析。横断面分析纳入2009年基线数据共2 370例研究对象，采用多重线性回归及二元logistic回归分析基线血清OC水平［连续变量ln（OC）和四分位数组（根据基线血清OC水平的四分位数将研究对象分为Q1组、Q2组、Q3组及Q4组）］与基线eGFR及低eGFR［<90 mL/（min·1.73 m²）］的关联，并应用限制性立方样条（RCS）分析探索剂量-反应关系。在2011年队列研究的1 631例研究对象中进一步明确基线血清OC水平与随访2年结束时eGFR、ΔeGFR（eGFR₂₀₁₁-eGFR₂₀₀₉）、非快速eGFR下降［未发生eGFR年下降速率≥3 mL/（min·1.73 m²）］的关联。模型校正年龄、体重指数、生活方式及代谢因素等混杂变量，并通过敏感性分析及亚组分析验证结果的稳健性及异质性。结果 （1）横断面多因素回归分析结果显示，基线血清OC水平与基线eGFR呈负相关（β=-4.83，95%CI：-6.60～-3.05，P<0.001），而与基线低eGFR呈正相关（OR=1.79，95%CI：1.27～2.53，P<0.001）。相较于Q1组，Q2组、Q3组和Q4组eGFR分别降低2.53、3.72和4.93 mL/（min·1.73 m²）（P趋势<0.001）；Q2组、Q3组和Q4组低eGFR的OR分别为1.44、1.60和1.93（P趋势<0.001）。RCS分析显示，基线血清OC水平与基线eGFR存在非线性关联（P总体<0.001，P非线性=0.015），与基线低eGFR存在线性关联（P总体=0.002，P非线性=0.137）。敏感性分析和亚组分析均观察到一致性关联结果。（2）队列分析结果显示，基线血清OC水平与随访2年结束时eGFR（β=-2.17，95%CI：-3.95～-0.39，P=0.017）呈负相关，而与ΔeGFR（β=3.01，95%CI：1.16～4.86，P=0.001）、非快速eGFR下降（OR=2.34，95%CI：1.18～4.65，P=0.015）呈正相关。结论 在普通成年男性中，血清OC水平与eGFR之间存在复杂的双向关联模式：基线血清OC水平与基线eGFR呈独立的负相关，而较高的基线血清OC水平与随访2年结束时eGFR较基线回升幅度更大及eGFR快速下降风险降低相关，且高血压病史可能调节这一纵向关联。
内科 页码：245-253
作者机构：1 广西医科大学第一附属医院泌尿外科/广西医科大学泌尿科学研究所，广西南宁市 530021；2 广西医科大学基因组与个体化医学研究中心/广西基因组与个体化医学研究重点实验室/广西基因组与个体化医学研究协同创新中心，广西南宁市 530021；3 南宁市中医医院泌尿外科，广西南宁市 530001；4 广西医科大学第二附属医院泌尿外科，广西南宁市 530007；5 广西医科大学附属肿瘤医院泌尿外科，广西南宁市 530021；6 广西壮族自治区民族医院泌尿外科，广西南宁市 530001；7 广西医科大学附属肿瘤医院乳腺及骨软组织肿瘤内科，广西南宁市 530021；8 广西医科大学第一附属医院检验科，广西南宁市 530021；9 广西医科大学第一附属医院广西生殖医学研究中心，广西南宁市 530021；10 广西医科大学公共卫生学院，广西南宁市 530021
基金信息：国家自然科学基金面上项目（82270806）；广西科技创新平台计划项目（桂科LT2600640048）；广西重点研发项目（桂科AB21196022）；广西科技重大专项（桂科AA22096032，桂科AA22096030）；广西重点实验室运行补助项目（22-035-17） 共同第一作者：李家龙，黄胜珠，陆铮 通信作者：莫曾南，廖明
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Objective To investigate the association between serum osteocalcin (OC) level and estimated glomerular filtration rate (eGFR) in general adult male. Methods This study was based on the Fangchenggang Area Male Health and Examination Survey (FAMHES) cohort. The cross‑sectional analysis included 2 370 research subjects from the 2009 baseline data. Multiple linear regression and binary logistic regression were used to analyze the associations of baseline serum OC level—with continuous variable ln(OC) and quartile groups (Research subjects were divided into Q1, Q2, Q3 and Q4 groups according to the quartiles of baseline serum OC level)—with baseline eGFR and low eGFR (<90 mL/[min·1.73 m2]). Restricted cubic spline (RCS) analysis was applied to explore dose‑response relationships. According to the data of the 2011 cohort study involving 1 631 research subjects, the associations between baseline serum OC level and eGFR at the end of the 2‑year follow‑up, ΔeGFR (eGFR2011‑eGFR2009), and non‑rapid eGFR decline (no annual eGFR decline≥3 mL/[min·1.73 m2]) were further clarified. Models were adjusted for confounders including age, body mass index, lifestyle factors, and metabolic factors. Sensitivity analyses and subgroup analyses were performed to test the robustness and heterogeneity of the results. Results (1) Cross‑sectional multivariate regression analysis showed that baseline serum OC level was negatively associated with baseline eGFR (β=-4.83, 95% CI: -6.60 to -3.05, P<0.001), and positively associated with low baseline eGFR (OR=1.79, 95% CI: 1.27-2.53, P<0.001). Compared with the Q1 group, the Q2, Q3, and Q4 groups had eGFR decreases of 2.53, 3.72, and 4.93 mL/(min·1.73 m2), respectively (Ptrend<0.001); the ORs for low eGFR in the Q2, Q3, and Q4 groups were 1.44, 1.60, and 1.93, respectively (Ptrend<0.001). RCS analysis revealed a non‑linear association between baseline serum OC level and baseline eGFR (Poverall<0.001, Pnon‑linearity=0.015), but a linear association with low baseline eGFR (Poverall=0.002, Pnon‑linearity=0.137). Sensitivity and subgroup analyses observed consistent correlation results. (2) Cohort analysis showed that baseline serum OC level was negatively associated with eGFR at the end of the 2‑year follow‑up (β=-2.17, 95% CI: -3.95 to -0.39, P=0.017), but positively associated with ΔeGFR (β=3.01, 95% CI: 1.16 to 4.86, P=0.001) and non‑rapid eGFR decline (OR=2.34, 95% CI: 1.18 to 4.65, P=0.015). Conclusion In general adult male, there is a complex bidirectional association between serum OC level and eGFR: baseline serum OC level is independently negatively associated with baseline eGFR, while higher baseline OC levels are associated with a greater rebound in eGFR from baseline at the 2‑year follow‑up and a lower risk of rapid eGFR decline, and a history of hypertension may modulate this longitudinal association.
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