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Article(id=1240375274399920189, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375270163673092, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202401293, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1705420800000, receivedDateStr=2024-01-17, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773658110475, onlineDateStr=2026-03-16, pubDate=1713974400000, pubDateStr=2024-04-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773658110475, onlineIssueDateStr=2026-03-16, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773658110475, creator=13701087609, updateTime=1773658110475, updator=13701087609, issue=Issue{id=1240375270163673092, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='8', pageStart='1345', pageEnd='1536', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773658109465, creator=13701087609, updateTime=1773658579758, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240377242795176417, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375270163673092, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240377242795176418, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375270163673092, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1420, endPage=1424, ext={EN=ArticleExt(id=1240375275515605116, articleId=1240375274399920189, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Relationship between dietary oxidative balance score and risk of osteoporosis in patients with chronic kidney disease, columnId=1240375107953161116, journalTitle=Modern Preventive Medicine, columnName=Nutrition and Foold Hygiene, runingTitle=null, highlight=null, articleAbstract=
Objective

To explored the relationship between the Dietary Oxidative Balance Score (DOBS) and the risk of developing osteoporosis in patients with chronic kidney disease (CKD) based on data from the National Health and Nutrition Examination Survey (NHANES).

Methods

The study population was selected from CKD patients aged 40 years and above in a total of four survey cycles of NHANES 2007—2008, 2009—2010, 2013—2014, and 2017—2018, and the association between DOBS and the risk of developing osteoporosis in CKD patients was assessed using weighted logistic regression, with smoothed curve fitting demonstrating the dose-response relationship between the two and subgroup analyses based on age and gender.

Results

A total of 2 281 participants were included in this study, and the fully adjusted model (Model 3) found that higher DOBS significantly reduced the risk of osteoporosis in CKD patients, with an OR of 0.400 (95% CI: 0.211-0.758) in the highest quartile group of DOBS (Q4) compared with Q1. Smoothed curve fitting revealed a negative linear dose-response relationship between DOBS and the prevalence of osteoporosis. Subgroup analysis revealed that the negative association between DOBS and osteoporosis was more significant in female and ≥65-year-old CKD patients, respectively.

Conclusion

In this study, we found that the relationship between DOBS and the risk of osteoporosis in CKD patients was linearly negatively correlated and showed gender and age differences, but further studies are needed to confirm this.

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目的

基于美国国家健康和营养调查数据（NHANES）探讨膳食氧化平衡评分（DOBS）与慢性肾脏病（CKD）患者骨质疏松症患病风险的关系。

方法

本研究人群选自NHANES 2007—2008、2009—2010、2013—2014、2017—2018共4个调查周期中40岁及以上CKD患者，采用加权logistic回归评估DOBS与CKD患者骨质疏松症患病风险的关联，采用平滑曲线拟合阐明二者之间的剂量-反应关系，并根据年龄和性别进行亚组分析。

结果

共纳入2281例参与者，完全调整模型（模型3）发现，较高的DOBS可显著降低CKD患者骨质疏松症患病风险，与Q1相比，DOBS的最高四分位数组（Q4）的OR值为0.400（95% CI：0.211~0.758）。平滑曲线拟合发现，DOBS与骨质疏松症的患病率呈负向线性剂量-反应关系。亚组分析发现，DOBS与骨质疏松症的负向关联分别在女性和≥65岁CKD患者中更显著。

结论

DOBS与CKD患者骨质疏松症患病风险关系呈线性负向相关，并表现出性别与年龄差异，但仍需进一步研究证实。

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王妤；E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=lMplrY6yuXNei06Dtu2GEw==, magXml=jAZAViTB4HMveJbCkdknqg==, pdfUrl=null, pdf=s8YGIbw0+3xOOw+xiEoNGQ==, pdfFileSize=677600, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=91Bxiv/6tO03oN4CDGDJnw==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=HlSYececdF9TZGRbdlV7Tg==, mapNumber=null, authorCompany=null, fund=null, authors=

黄宇婷（2001—），女，硕士在读，研究方向：慢性疾病照护与健康管理

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黄宇婷（2001—），女，硕士在读，研究方向：慢性疾病照护与健康管理

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黄宇婷（2001—），女，硕士在读，研究方向：慢性疾病照护与健康管理

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Journal of Orthopaedic Science, 2023: S0949-2658(23)00204., articleTitle=Independent and combined associations of dietary antioxidant intake with bone mineral density and risk of osteoporosis among elderly population in United States, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1240748858364457839, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375274399920189, xref=1., ext=[AuthorCompanyExt(id=1240748858372846448, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375274399920189, companyId=1240748858364457839, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=College of Nursing, Jinan University, Guangzhou, Guangdong 510632, China), AuthorCompanyExt(id=1240748858377040753, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375274399920189, companyId=1240748858364457839, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.暨南大学护理学院,广东 广州 510632)]), AuthorCompany(id=1240748858444149622, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375274399920189, xref=2., ext=[AuthorCompanyExt(id=1240748858452538231, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375274399920189, companyId=1240748858444149622, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.暨南大学附属第一医院校门诊)])], figs=[ArticleFig(id=1240748860897816594, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375274399920189, language=EN, label=Fig.1, caption=Flow chart of the study population screening, figureFileSmall=q0NOznotmGBhjRsW5Tb8xA==, figureFileBig=5K3yfxWU2lborAQt4hribw==, tableContent=null), ArticleFig(id=1240748861006868504, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375274399920189, language=CN, label=图1, caption=研究人群筛选流程图, figureFileSmall=q0NOznotmGBhjRsW5Tb8xA==, figureFileBig=5K3yfxWU2lborAQt4hribw==, tableContent=null), ArticleFig(id=1240748861107531804, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375274399920189, language=EN, label=Fig.2, caption=Dose-response relationship of DOBS and the risk of osteoporosis in patients with CKD, figureFileSmall=FX6wVfTZG1saYQYVsy9J/Q==, figureFileBig=N29c7hmPDBpGR1FKsY+PYA==, tableContent=null), ArticleFig(id=1240748861237555236, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375274399920189, language=CN, label=图2, caption=DOBS与CKD患者骨质疏松症患病风险的剂量-反应关系, figureFileSmall=FX6wVfTZG1saYQYVsy9J/Q==, figureFileBig=N29c7hmPDBpGR1FKsY+PYA==, tableContent=null), ArticleFig(id=1240748861338218539, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375274399920189, language=EN, label=Table 1, caption=

General situation analysis of the study subjects

, figureFileSmall=null, figureFileBig=null, tableContent=
项目总计
（n=2 281）		非骨质疏松症
（n=2 059）		骨质疏松症
（n=222）		P
年龄（岁，）65.9±11.365.1±11.473.6±7.5<0.001
性别[n（%）]<0.001
男性1 100（43.4）1 021（45.7）79（22.6）
女性1 181（56.6）1 038（54.3）143（77.4）
种族[n（%）]<0.001
墨西哥裔美国人266（5.6）247（5.9）19（3.3）
其他西班牙裔178（3.8）162（3.9）16（2.4）
非西班牙裔白人1 220（73.6）1 060（72.1）160（87.0）
非西班牙裔黑人478（11.2）462（12.1）16（3.1）
其他139（5.8）128（6.0）11（4.3）
教育水平[n（%）]0.693
高中以下642（19.5）573（19.3）69（21.5）
高中毕业或同等学历571（25.8）506（25.7）65（27.3）
大专及以上1063（54.6）975（55.0）88（51.2）
婚姻状况[n（%）]<0.001
有伴侣1 284（60.6）1 188（63.3）96（35.2）
无伴侣996（39.4）870（36.6）126（64.8）
收入与贫困基线比值[n（%）]<0.001
≤1.3615（18.1）549（18.1）66（17.7）
>1.3，<3.5935（38.9）832（37.5）103（51.1）
≥3.5561（37.1）525（38.4）36（24.9）
体力活动（min/wk，）291.0±222.2287.4±194.2323.9±394.60.176
体质指数（kg/m2，）29.8±6.330.1±6.226.8±5.9<0.001
酒精（g/d，）6.3±18.96.6±19.63.6±10.0<0.001
糖尿病[n（%）]0.133
是899（33.7）830（34.2）69（28.9）
否1 357（65.3）1 208（64.9）149（69.3）
心血管疾病[n（%）]<0.001
是641（25.1）554（23.5）87（39.4）
否1 638（74.9）1 503（76.5）135（60.6）
关节炎[n（%）]<0.001
是1 113（49.7）988（48.3）125（61.8）
否1 161（50.0）1 066（51.4）95（37.3）
癌症[n（%）]0.038
是473（22.0）410（21.3）63（28.5）
否1 806（77.8）1 647（78.5）159（71.5）
曾每日使用泼尼松/可的松[n（%）]0.570
是187（9.5）168（9.3）19（11.4）
否2 077（89.9）1 877（90.1）200（87.9）
骨质疏松症家族史[n（%）]0.008
是252（15.2）226（14.4）26（22.3）
否1 878（78.7）1 702（79.5）176（71.8）
可替宁（ng/ml，）47.2±120.848.2±122.637.7±102.60.159
血清钙（mmol/L，）2.4±0.12.4±0.12.3±0.10.065
磷（mmol/L，）1.2±0.21.2±0.21.3±0.2<0.001
碱性磷酸酶（IU/L，）74.5±25.573.7±24.981.9±29.8<0.001
尿酸（umol/L，）359.5±94.0361.2±94.0343.8±93.20.009
血红蛋白（g/L，）138.7±15.2139.1±15.4135.5±12.8<0.001
DOBS（）17.0±7.017.2±7.015.3±6.7<0.001
), ArticleFig(id=1240748861430493232, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375274399920189, language=CN, label=表1, caption=

研究对象的一般情况分析

, figureFileSmall=null, figureFileBig=null, tableContent=
项目总计
（n=2 281）		非骨质疏松症
（n=2 059）		骨质疏松症
（n=222）		P
年龄（岁，）65.9±11.365.1±11.473.6±7.5<0.001
性别[n（%）]<0.001
男性1 100（43.4）1 021（45.7）79（22.6）
女性1 181（56.6）1 038（54.3）143（77.4）
种族[n（%）]<0.001
墨西哥裔美国人266（5.6）247（5.9）19（3.3）
其他西班牙裔178（3.8）162（3.9）16（2.4）
非西班牙裔白人1 220（73.6）1 060（72.1）160（87.0）
非西班牙裔黑人478（11.2）462（12.1）16（3.1）
其他139（5.8）128（6.0）11（4.3）
教育水平[n（%）]0.693
高中以下642（19.5）573（19.3）69（21.5）
高中毕业或同等学历571（25.8）506（25.7）65（27.3）
大专及以上1063（54.6）975（55.0）88（51.2）
婚姻状况[n（%）]<0.001
有伴侣1 284（60.6）1 188（63.3）96（35.2）
无伴侣996（39.4）870（36.6）126（64.8）
收入与贫困基线比值[n（%）]<0.001
≤1.3615（18.1）549（18.1）66（17.7）
>1.3，<3.5935（38.9）832（37.5）103（51.1）
≥3.5561（37.1）525（38.4）36（24.9）
体力活动（min/wk，）291.0±222.2287.4±194.2323.9±394.60.176
体质指数（kg/m2，）29.8±6.330.1±6.226.8±5.9<0.001
酒精（g/d，）6.3±18.96.6±19.63.6±10.0<0.001
糖尿病[n（%）]0.133
是899（33.7）830（34.2）69（28.9）
否1 357（65.3）1 208（64.9）149（69.3）
心血管疾病[n（%）]<0.001
是641（25.1）554（23.5）87（39.4）
否1 638（74.9）1 503（76.5）135（60.6）
关节炎[n（%）]<0.001
是1 113（49.7）988（48.3）125（61.8）
否1 161（50.0）1 066（51.4）95（37.3）
癌症[n（%）]0.038
是473（22.0）410（21.3）63（28.5）
否1 806（77.8）1 647（78.5）159（71.5）
曾每日使用泼尼松/可的松[n（%）]0.570
是187（9.5）168（9.3）19（11.4）
否2 077（89.9）1 877（90.1）200（87.9）
骨质疏松症家族史[n（%）]0.008
是252（15.2）226（14.4）26（22.3）
否1 878（78.7）1 702（79.5）176（71.8）
可替宁（ng/ml，）47.2±120.848.2±122.637.7±102.60.159
血清钙（mmol/L，）2.4±0.12.4±0.12.3±0.10.065
磷（mmol/L，）1.2±0.21.2±0.21.3±0.2<0.001
碱性磷酸酶（IU/L，）74.5±25.573.7±24.981.9±29.8<0.001
尿酸（umol/L，）359.5±94.0361.2±94.0343.8±93.20.009
血红蛋白（g/L，）138.7±15.2139.1±15.4135.5±12.8<0.001
DOBS（）17.0±7.017.2±7.015.3±6.7<0.001
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Weighted logistic regression models for the association of DOBS andthe risk of osteoporosis in CKD patients

, figureFileSmall=null, figureFileBig=null, tableContent=
指标Model1Model2Model3
OR值（95% CI）P值OR值（95% CI）P值OR值（95% CI）P值
DOBS
Q11.001.001.00
Q20.866（0.452~1.658）0.6630.943（0.485~1.832）0.8620.931（0.511~1.694）0.814
Q30.798（0.455~1.401）0.4320.847（0.478~1.500）0.5690.854（0.475~1.535）0.598
Q40.435（0.240~0.790）0.0060.424（0.229~0.786）0.0060.400（0.211~0.758）0.005
P趋势<0.001<0.001<0.001
), ArticleFig(id=1240748861594071095, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375274399920189, language=CN, label=表2, caption=

DOBS与CKD患者骨质疏松症患病风险关联的加权logistic回归模型

, figureFileSmall=null, figureFileBig=null, tableContent=
指标Model1Model2Model3
OR值（95% CI）P值OR值（95% CI）P值OR值（95% CI）P值
DOBS
Q11.001.001.00
Q20.866（0.452~1.658）0.6630.943（0.485~1.832）0.8620.931（0.511~1.694）0.814
Q30.798（0.455~1.401）0.4320.847（0.478~1.500）0.5690.854（0.475~1.535）0.598
Q40.435（0.240~0.790）0.0060.424（0.229~0.786）0.0060.400（0.211~0.758）0.005
P趋势<0.001<0.001<0.001
), ArticleFig(id=1240748861694734393, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375274399920189, language=EN, label=Table 3, caption=

Subgroup analysis of the association between DOBS and the risk of osteoporosis in CKD patients（stratified by gender）

, figureFileSmall=null, figureFileBig=null, tableContent=
分组男性OR值（95% CI）P值女性OR值（95% CI）P值
DOBS
Q11.001.00
Q20.982（0.400~2.413）0.9690.950（0.451~2.003）0.894
Q30.895（0.334~2.396）0.8250.881（0.443~1.752）0.718
Q40.406（0.162~1.018）0.0550.391（0.176~0.869）0.021
P趋势<0.001<0.001
), ArticleFig(id=1240748861770231870, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375274399920189, language=CN, label=表3, caption=

DOBS与CKD患者骨质疏松症患病风险关联的亚组分析（性别分层）

, figureFileSmall=null, figureFileBig=null, tableContent=
分组男性OR值（95% CI）P值女性OR值（95% CI）P值
DOBS
Q11.001.00
Q20.982（0.400~2.413）0.9690.950（0.451~2.003）0.894
Q30.895（0.334~2.396）0.8250.881（0.443~1.752）0.718
Q40.406（0.162~1.018）0.0550.391（0.176~0.869）0.021
P趋势<0.001<0.001
), ArticleFig(id=1240748861879283778, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375274399920189, language=EN, label=Table 4, caption=

Subgroup analysis of the association between DOBS and the risk of osteoporosis in CKD patients（stratified by age）

, figureFileSmall=null, figureFileBig=null, tableContent=
分组≥65岁OR值（95% CI）P值<65岁OR值（95% CI）P值
DOBS
Q11.001.00
Q20.915（0.483~1.737）0.7871.789（0.417~7.667）0.434
Q30.834（0.448~1.552）0.5661.171（0.194~7.062）0.863
Q40.332（0.164~0.669）0.0022.080（0.289~14.992）0.467
P趋势<0.001<0.001
), ArticleFig(id=1240748861946392647, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375274399920189, language=CN, label=表4, caption=

DOBS与CKD患者骨质疏松症患病风险关联的亚组分析（年龄分层）

, figureFileSmall=null, figureFileBig=null, tableContent=
分组≥65岁OR值（95% CI）P值<65岁OR值（95% CI）P值
DOBS
Q11.001.00
Q20.915（0.483~1.737）0.7871.789（0.417~7.667）0.434
Q30.834（0.448~1.552）0.5661.171（0.194~7.062）0.863
Q40.332（0.164~0.669）0.0022.080（0.289~14.992）0.467
P趋势<0.001<0.001
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膳食氧化平衡评分与慢性肾脏病患者骨质疏松症患病风险的关系
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黄宇婷 1 , 王妤 2 , 李雅琴 1 , 何瑞瑶 1
现代预防医学 | 营养与食品卫生 2024,51(8): 1420-1424
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现代预防医学 | 营养与食品卫生 2024, 51(8): 1420-1424
膳食氧化平衡评分与慢性肾脏病患者骨质疏松症患病风险的关系
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黄宇婷1, 王妤2 , 李雅琴1, 何瑞瑶1
作者信息
  • 1.暨南大学护理学院,广东 广州 510632
  • 2.暨南大学附属第一医院校门诊

    • 黄宇婷（2001—），女，硕士在读，研究方向：慢性疾病照护与健康管理

通讯作者:

王妤；E-mail：
Relationship between dietary oxidative balance score and risk of osteoporosis in patients with chronic kidney disease
Yu-ting HUANG1, Yu WANG2 , Ya-qin LI1, Rui-yao HE1
Affiliations
  • College of Nursing, Jinan University, Guangzhou, Guangdong 510632, China
出版时间: 2024-04-25 doi: 10.20043/j.cnki.MPM.202401293
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摘要
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目的

基于美国国家健康和营养调查数据（NHANES）探讨膳食氧化平衡评分（DOBS）与慢性肾脏病（CKD）患者骨质疏松症患病风险的关系。

方法

本研究人群选自NHANES 2007—2008、2009—2010、2013—2014、2017—2018共4个调查周期中40岁及以上CKD患者，采用加权logistic回归评估DOBS与CKD患者骨质疏松症患病风险的关联，采用平滑曲线拟合阐明二者之间的剂量-反应关系，并根据年龄和性别进行亚组分析。

结果

共纳入2281例参与者，完全调整模型（模型3）发现，较高的DOBS可显著降低CKD患者骨质疏松症患病风险，与Q1相比，DOBS的最高四分位数组（Q4）的OR值为0.400（95% CI：0.211~0.758）。平滑曲线拟合发现，DOBS与骨质疏松症的患病率呈负向线性剂量-反应关系。亚组分析发现，DOBS与骨质疏松症的负向关联分别在女性和≥65岁CKD患者中更显著。

结论

DOBS与CKD患者骨质疏松症患病风险关系呈线性负向相关，并表现出性别与年龄差异，但仍需进一步研究证实。

慢性肾脏病  /  骨质疏松症  /  膳食氧化平衡评分  /  NHANES
Objective

To explored the relationship between the Dietary Oxidative Balance Score (DOBS) and the risk of developing osteoporosis in patients with chronic kidney disease (CKD) based on data from the National Health and Nutrition Examination Survey (NHANES).

Methods

The study population was selected from CKD patients aged 40 years and above in a total of four survey cycles of NHANES 2007—2008, 2009—2010, 2013—2014, and 2017—2018, and the association between DOBS and the risk of developing osteoporosis in CKD patients was assessed using weighted logistic regression, with smoothed curve fitting demonstrating the dose-response relationship between the two and subgroup analyses based on age and gender.

Results

A total of 2 281 participants were included in this study, and the fully adjusted model (Model 3) found that higher DOBS significantly reduced the risk of osteoporosis in CKD patients, with an OR of 0.400 (95% CI: 0.211-0.758) in the highest quartile group of DOBS (Q4) compared with Q1. Smoothed curve fitting revealed a negative linear dose-response relationship between DOBS and the prevalence of osteoporosis. Subgroup analysis revealed that the negative association between DOBS and osteoporosis was more significant in female and ≥65-year-old CKD patients, respectively.

Conclusion

In this study, we found that the relationship between DOBS and the risk of osteoporosis in CKD patients was linearly negatively correlated and showed gender and age differences, but further studies are needed to confirm this.

Chronic kidney disease  /  Osteoporosis  /  Dietary oxidative balance score  /  NHANES
黄宇婷, 王妤, 李雅琴, 何瑞瑶. 膳食氧化平衡评分与慢性肾脏病患者骨质疏松症患病风险的关系. 现代预防医学, 2024 , 51 (8) : 1420 -1424 . DOI: 10.20043/j.cnki.MPM.202401293
Yu-ting HUANG, Yu WANG, Ya-qin LI, Rui-yao HE. Relationship between dietary oxidative balance score and risk of osteoporosis in patients with chronic kidney disease[J]. Modern Preventive Medicine, 2024 , 51 (8) : 1420 -1424 . DOI: 10.20043/j.cnki.MPM.202401293
正文
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慢性肾脏病（chronic kidney disease，CKD）是由各种原因引起的肾脏结构和功能异常性疾病，与骨质疏松症是高度共患疾病[1]。最新的一项系统评价显示CKD患者的骨质疏松症患病率高达24.5%[2]。骨质疏松症与CKD患者的骨折、跌倒和死亡风险密切相关[3, 4]，相关指南要求应积极关注CKD患者矿物质和骨代谢情况[5]。既往有关饮食对CKD患者矿物质和骨代谢影响的研究主要集中在低磷饮食[6, 7]。近年来相关研究报道了氧化应激对机体骨代谢的重要作用[8]。膳食氧化平衡评分（dietary oxidative balance score，DOBS）是评估膳食中抗氧化及促氧化物质摄入的综合指标，可反映个体从膳食中获得的抵御氧化应激的能力[9, 10]。既往有研究显示DOBS与绝经后妇女骨质疏松症患病风险有关，但尚不清楚DOBS与CKD患者骨质疏松症患病风险的关系[10]。本研究将基于美国国家健康和营养调查数据（National Health and Nutrition Examination，NHANES）探讨DOBS与CKD患者骨质疏松症患病风险的关系，为预防CKD患者骨质疏松症的饮食指导提供依据。
1 对象与方法
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1.1 研究对象
NHANES是一项由美国疾控中心发起的全国性横断面调查，收集参与者的人口统计学、生活方式以及健康和饮食状况信息，该调查中的所有研究方案均获得国家健康统计中心研究伦理审查委员会的批准，并在调查前获取了所有参与者的知情同意（伦理审查批号：NHANES Protocaol #98-12，Continuation of Protocaol #2011-17，Protocol #2018-01）。本研究的研究人群来自NHANES 2007—2008、2009—2010、2013—2014和2017—2018共4个调查周期，纳入标准为（1）年龄≥40岁；（2）诊断为CKD（估计肾小球滤过率<60 ml/min/1.73 m2或者尿白蛋白/肌酐比值≥30 mg/g[11]），排除标准为（1）缺少股骨颈骨密度数据的参与者；（2）缺少DOBS数据的参与者；（3）极端能量摄入的参与者（女性<500kcal/d或>5 000 kcal/d、男性<500 kcal/d或>8 000 kcal/d[12]）。本研究最终纳入2 281名参与者，详见图1。
1.2 膳食氧化平衡评分的计算方法
本研究使用的膳食数据来自参与者的两次24小时回忆访谈，参考既往的研究[10]，首先计算个体每种膳食营养成分摄入平均值，再根据三分位值将不同性别的膳食营养成分摄入平均值分为高、中、低三组，并赋值。其中14种抗氧化剂（膳食纤维、胡萝卜素、核黄素、烟酸、维生素B6、维生素B12、总叶酸、维生素C、维生素E、钙、镁、锌、铜和硒）高、中、低摄入组分别赋值2、1、0分；2种促氧化剂（总脂肪和铁）高、中、低摄入组分别赋值0、1、2分。通过计算个体膳食抗氧化剂和促氧化剂摄入总分得到DOBS。DOBS评分越高表示个体暴露于更多的抗氧化剂、更少的促氧化剂，个体抵御氧化应激的能力较强[13]。
1.3 结局指标
本研究结局指标是有无骨质疏松症。根据世界卫生组织[14]的推荐，将股骨颈骨密度T值为-2.5及以下定义为骨质疏松症。纳入的所有参与者均接受双能X射线吸收测定法以确定股骨颈骨密度，以NHANES III中20~29岁非西班牙裔白人的平均股骨颈骨密度作为参考值计算T值[15]，该参考值已广泛应用于基于NHANES数据的各种研究[16, 17]。
1.4 统计分析
本研究应用EmpowerStats 2.0与STATA 16.0进行统计分析，并遵循NHANES权重选择标准，在所有分析中均使用抽样权重变量WTDR2D除以调查周期数4来获得无偏差的全民估计。采用加权均值±标准差对连续变量进行描述，采用频数（加权百分比）对分类变量进行描述。使用加权t检验、加权卡方检验分别比较骨质疏松症组和非骨质疏松症组在连续变量及分类变量上的差异。采用加权logistic回归模型探讨DOBS与CKD患者骨质疏松症患病风险之间的关系，采用平滑曲线拟合阐明DOBS与骨质疏松症患病风险之间的剂量-反应关系。本研究按照年龄（≥65岁、<65岁）和性别（男性、女性）对CKD患者进行分层，以探究DOBS与CKD患者骨质疏松症患病风险的关联在不同年龄和性别上是否存在差异。所有统计分析的检验水准α=0.05。
2 结果
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2.1 研究对象一般情况分析
共纳入2 281名参与者，其中骨质疏松症患者222名，占比9.73%。与非骨质疏松症患者相比，骨质疏松症患者年龄更大、体质量指数更低、磷及碱性磷酸酶水平更高、尿酸及血红蛋白水平更低，女性、有家族史、心血管疾病、关节炎及癌症发生比例在骨质疏松症患者中的比例较高。此外，骨质疏松症患者的DOBS较低，差异均具有统计学意义（P<0.05）。研究对象的一般情况分析具体见表1。
2.2 DOBS与CKD患者骨质疏松症患病风险的logistic分析
本研究按四分位数将DOBS划分为Q1、Q2、Q3、Q4四组，按有无骨质疏松症将研究对象分为两组，并分别赋值为“1”与“0”。采用加权logistic回归模型探讨DOBS与CKD患者骨质疏松症之间的关系，分别构建了3个模型。以DOBS的Q1组为参考，发现Q4组与CKD患者骨质疏松症患病风险降低相关，即较高水平的DOBS是CKD患者骨质疏松症患病风险的保护因素，并在各模型中保持相对稳定。趋势分析结果发现，CKD患者骨质疏松症患病风险随着DOBS的分位数增加而逐步增加（P趋势<0.001）。DOBS与CKD患者骨质疏松症患病风险的加权logistic模型具体见表2。
2.3 DOBS与CKD患者骨质疏松症患病风险的剂量-反应关系
为进一步探讨DOBS与CKD患者骨质疏松症患病风险的关系，本研究调整了所有协变量后进行曲线拟合，结果发现二者存在负向线性剂量-反应关系。DOBS与CKD患者骨质疏松症患病风险平滑曲线拟合结果具体见图2，其中黑色实线表示其预估值，黑色虚线表示其95% CI。
2.4 DOBS与CKD患者骨质疏松症患病风险关联的亚组分析
为了探讨DOBS与CKD患者骨质疏松症患病风险关联在不同性别、年龄上的差异，本研究根据CKD患者性别进行分层后发现仅在女性CKD患者中发现较高的DOBS与骨质疏松症患病风险存在显著负向相关，与DOBS最低组（Q1）相比，DOBS最高组（Q4）的OR为0.391（95% CI：0.176~0.869），具体见表3。根据年龄进行分层后发现仅在≥65岁CKD患者中发现较高的DOBS与骨质疏松症患病风险存在显著负向相关，与Q1相比，DOBS中Q4的OR为0.332（95% CI：0.164~0.669），具体见表4。
3 讨论
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本研究结果发现较高水平的DOBS与CKD患者骨质疏松症患病风险降低密切相关，且二者呈负向线性剂量反应关系。Wang等[10]对绝经后妇女的研究结果也发现DOBS与骨质疏松症密切相关。但伊朗学者Zahra等[18]对绝经后妇女的研究结果发现氧化平衡评分与骨质疏松症患病风险无关，这可能与该研究采用的氧化平衡评分包含非膳食因素即生活方式氧化平衡评分有关。体质指数作为构成生活方式氧化平衡评分的因素，相关研究显示肥胖的个体往往表现出更好的骨骼健康水平[19]，这与生活方式氧化平衡评分的计算方式相悖，可能是导致研究结果不一致的潜在原因。氧化应激被定义为氧化剂（活性氧和活性氮）与抗氧化剂之间的不平衡，而相关研究显示在CKD早期即可观察到活性氧和活性氮产生及抗氧化剂消耗的增加[20]。氧化应激可以通过各种机制对骨质量产生负面影响，包括抑制成骨细胞分化和增殖的Wnt/β-catenin通路的信号传导、激活主要炎症转录因子核因子kappaB信号通路，以抑制成骨细胞生成和活性、激活破骨细胞生成以及促进成骨细胞凋亡[21, 22]。DOBS与CKD患者骨质疏松症患病风险密切相关可能与机体抵御氧化应激的能力有关，膳食作为外源性抗氧化剂摄入的重要途径，较高的DOBS可增强机体抵御氧化应激的能力[13]，且抗氧化剂有益于CKD患者肾功能的改善[23]。因此，CKD患者可通过增加富含抗氧化剂食物的联合摄入以降低氧化应激水平预防骨质疏松症。
本研究以性别为分层的结果显示，女性CKD患者DOBS最高组（Q4）与DOBS最低组（Q1）相比，患骨质疏松症的风险降低，但是在男性CKD患者中并没有发生这种关联。这与Wang等[10]对于56岁以上的绝经后妇女的研究结果类似。女性雌激素水平往往于35岁开始逐步下降，而内源性雌激素水平的降低可引起抗氧化酶如超氧化物歧化酶、谷胱甘肽过氧化物酶表达水平降低，进而导致机体活性氧异常增加[22]。此外，相关研究显示雌激素A环上的游离酚羟基可以通过脱氢以阻断自由基链反应，从而减少自由基的生成，具有抗氧化特性，但雌激素的减少减弱了这种反应[24]。因此，雌激素的下降或缺乏会显著降低机体对氧化应激的防御能力，对骨骼健康产生负面影响，这可能是导致女性CKD患者对抗氧化剂及促氧化剂暴露更为敏感的潜在原因。本研究以年龄分层的结果显示，在≥65岁的CKD患者中，DOBS与骨质疏松症存在显著负向关联，而在<65岁的CKD患者中两者的关联不显著，该研究结果与Zhou等[25]针对美国老年人群的研究一致。既往研究报道[22]机体衰老相关的线粒体功能障碍、DNA损伤和促炎细胞因子产生的增加都可能导致活性氧产生增加，这可能是导致老年CKD患者对抗氧化剂及促氧化剂暴露更为敏感的潜在原因。
综上，本研究发现DOBS与CKD患者骨质疏松症患病风险呈负向线性剂量反应关系，且分别在女性和≥65岁CKD患者中关联较强。这一结果为未来使用膳食抗氧化剂预防和治疗CKD患者的骨质疏松症的研究提供了思路。但本研究是基于NHANES数据库的横断面研究，无法推断出DOBS与CKD患者骨质疏松症患病风险之间的因果关系，只能解释二者之间的相关性。同时，本研究的膳食数据来源于参与者的回忆，可能存在回忆偏倚。此外，研究只调整了部分混杂因素，不能排除一些其他潜在因素。未来需要进一步开展大样本的前瞻性研究进一步探讨DOBS和CKD患者骨质疏松症患病风险的关系和机制。
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2024年第51卷第8期
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doi: 10.20043/j.cnki.MPM.202401293
  • 接收时间：2024-01-17
  • 首发时间：2026-03-16
  • 出版时间：2024-04-25
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  • 收稿日期：2024-01-17
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    1.暨南大学护理学院,广东 广州 510632
    2.暨南大学附属第一医院校门诊

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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