中国学校卫生

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

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

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

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

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)

组别

自变量

BMC

CTX

总人群

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)

0.18(0.11~0.28)^#

1.85(1.28~2.67)^#

0.77(0.55~1.07)

1.05(0.76~1.45)

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

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)

0.06(0.02~0.21)^#

2.01(1.18~3.44)^#

0.82(0.53~1.27)

1.04(0.67~1.60)

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

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)

0.22(0.13~0.37)^#

1.72(1.04~2.84)^#

0.67(0.40~1.14)

1.05(0.65~1.70)

0.02(0.01~0.07)^#

2.00(1.17~3.41)^#

0.29(0.14~0.57)^#

1.16(0.69~1.95)

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)

组别

自变量

BMC

CTX

总人群

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)

0.18(0.11~0.28)^#

1.85(1.28~2.67)^#

0.77(0.55~1.07)

1.05(0.76~1.45)

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

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)

0.06(0.02~0.21)^#

2.01(1.18~3.44)^#

0.82(0.53~1.27)

1.04(0.67~1.60)

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

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)

0.22(0.13~0.37)^#

1.72(1.04~2.84)^#

0.67(0.40~1.14)

1.05(0.65~1.70)

0.02(0.01~0.07)^#

2.00(1.17~3.41)^#

0.29(0.14~0.57)^#

1.16(0.69~1.95)

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

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刘建熹 , 史龙凯 , 陈琳琳 , 许应丽 , 丁文清 ^*

中国学校卫生 | 疾病控制 2025,46(10): 1498-1502

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中国学校卫生 |疾病控制 2025 , 46 (10) : 1498 -1502

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

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刘建熹, 史龙凯, 陈琳琳, 许应丽, 丁文清^*

作者信息

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

通讯作者:

丁文清，E-mail：dwqdz@163.com

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

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

Jianxi LIU, Longkai SHI, Linlin CHEN, Yingli XU, Wenqing DING^*

Affiliations

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

出版时间: 2025-10-25 doi: 10.16835/j.cnki.1000-9817.2025299

文章导航

摘要

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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。

关键词

胰岛素抵抗 / 骨矿物质含量 / 回归分析 / 青少年

Abstract

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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.

Key words

Insulin resistance / Bone mineral content / Regression analysis / Adolescent

引用本文

刘建熹, 史龙凯, 陈琳琳, 许应丽, 丁文清. 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. 中国学校卫生, 2025 , 46 (10) : 1498 -1502 . DOI: 10.16835/j.cnki.1000-9817.2025299

Jianxi LIU, Longkai SHI, Linlin CHEN, Yingli XU, Wenqing DING. Association of metabolic score for insulin resistance with bone mineral content and bone metabolic markers among adolescents[J]. Chinese Journal of School Health, 2025 , 46 (10) : 1498 -1502 . DOI: 10.16835/j.cnki.1000-9817.2025299

正文

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骨质疏松症(osteoporosis, OP)是一种骨量减少、微结构恶化和脆性骨折的疾病^[1]。评价骨骼健康的指标有骨矿物质含量(bone mineral content, BMC)和骨代谢标志物等。成年期超过95%的BMC在青春期时形成^[2-3]，已有报道称青少年末期获得的关键BMC会影响成年后OP的发生^[4]。

胰岛素抵抗(insulin resistance, IR)被认为与青少年的骨骼健康以及成年后发生骨质疏松的潜在机制密切相关^[5-6]。尽管高胰岛素-葡萄糖钳夹技术被认为是评估胰岛素的金标准，但由于其检测成本高且程序复杂而限制了大规模流行病学应用; 稳态模型评估指数依赖于空腹胰岛素的实验室检测，限制了其在日常临床实践中的普及。因此，基于非胰岛素的标志物如三酰甘油-葡萄糖指数(triglyceride and glucose index, TyG)和三酰甘油与高密度脂蛋白胆固醇比值(triglyceride/high-density lipoprotein cholesterol, TG/HDL-C)，均已被证实可作为IR的替代标志物^[7-8]，但通常使用的TyG指数与一般人群的全因死亡率和心血管死亡率之间的关联存在争议，限制了其应用^[9]。胰岛素抵抗代谢评分(metabolic score for insulin resistance, METS-IR)是Bello-Chavolla等^[10]开发出评估IR的替代标志物，目前在成人中已被发现与OP密切相关^[11-13]。本研究选取银川市12~18岁青少年作为研究对象，分析METS-IR对骨骼健康的影响及其对BMC低下的预测效果，为防治青少年骨骼健康问题及预防成年期骨质疏松提供科学依据。

1　对象与方法

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1.1　对象

以银川市12~18岁青少年为目标人群，民族、性别不限，采用方便抽样与分层整群随机抽样相结合的方法于2017—2019及2023年分别进行现况调查。首先在银川市城区采用方便抽样方法确定3所初中和3所高中，再按照年级分层，采用随机数字表法从每个年级抽取班级，以班级为单位进行整群抽样，共抽取45个班级(3所初中共抽取13个班级，3所高中共抽取32个班级)、2 021名学生进行调查(2017年327名，2018年716名，2019年240名，2023年738名)。根据纳入标准、排除标准和数据缺失者排除607名，最终纳入1 414名学生作为研究对象。其中男生817名，女生597名; 年龄12~18岁。

纳入标准：(1)银川市本地居民; (2)身体健康、发育健全。排除标准：(1)本人、父母或法定监护人不愿签署知情同意书; (2)患有心、肾、肝、骨关节及血液系统等有关疾病; (3)近期或长期服用影响骨代谢的药物。研究已获得宁夏医科大学伦理委员会的审查及批准(批号：2021-G053)。

1.2　方法

1.2.1　问卷调查

主要包括研究对象的基本情况(如姓名、性别、出生日期、年龄、民族)、生活行为方式(如是否吸烟、饮酒、睡眠情况、体力活动)等。

1.2.2　体格检查

采用ZH7082型身高坐高计和RGT-140型杠杆式体重秤进行身高和体重的测量^[14]，均连续测量2次，结果取均值，数据分别精确至0.1 cm和0.1 kg，并根据身高、体重数据计算体质量指数(body mass index, BMI)=体重(kg)/[身高(m)]²。

1.2.3　实验室检测

使用全自动生化分析仪(型号：日立7060C)检测血清空腹血糖(fasting plasma glucose, FPG)、总胆固醇、三酰甘油(triglyceride, TG)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol, HDL-C)和低密度脂蛋白胆固醇(low-density lipoprotein cholesterol, LDL-C)。采用酶联免疫吸附法检测血清骨钙素(osteocalcin, OC)、Ⅰ型胶原交联C末端肽(C-terminal peptide, CTX)水平和钙(Ca)。

1.2.4　BMC测定

采用韩国Biospace公司In-Body 370人体成分分析仪生物电阻抗分析法对腰围及BMC进行测定。

1.2.5　诊断标准及定义

BMC经性别-年龄别标准化的Z≤-1 s为BMC低下; >-1 s为BMC正常^[15]。OC、CTX、Ca≤P₂₅为低下，>P₂₅为正常，METS-IR根据P₂₅、P₅₀、P₇₅分为四分类变量，即≤P₂₅为Q1、>P₂₅~P₅₀为Q2、>P₅₀~P₇₅为Q3、>P₇₅为Q4。METS-IR=ln[2×FPG(mg/dL)+TG(mg/dL)]×BMI(kg/m²)/ln[HDL-C(mg/dL)]; TyG=ln[TG(mg/dL)×FPG(mg/dL)/2]^[10]。

1.3　质量控制

调查前对所有调查人员统一进行培训和考核，保证所收集资料方法和调查标准的一致性; 每日调查结束后由调查员核对调查问卷; 每日测量前由专业人员对测量仪器进行校准，并按照标准测量方法进行体格测量及血液生化检测; 数据采取双录入方法并进行一致性检验。

1.4　统计学分析

数据录入采用EpiData 3.1软件完成，统计分析使用SPSS 26.0和R 4.3.0软件完成。正态分布计量资料以(x ±s)表示，两组间比较采用t检验。采用二元Logistic回归评估METS-IR四分位数分组情况下与BMC、OC、CTX和Ca水平的影响，METS-IR与BMC、OC、CTX和Ca水平间的剂量-反应关系通过限制性立方样条进行探索; 受试者工作特征(receiver operating characteristic, ROC)曲线分析不同IR指标对BMC低下的预测效果。以P < 0.05为有统计学意义。

2　结果

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2.1　青少年METS-TR和骨指标基本情况

调查的青少年METS-IR、BMC、OC、CTX和Ca水平分别为30.63±7.58，(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; 男、女生上述指标的差异均有统计学意义(P值均 < 0.05)。见表1。

2.2　青少年不同METS-IR水平与骨指标的Logistic回归分析

以青少年BMC、OC、CTX和Ca是否低下为因变量(否=0，是=1)、METS-IR为自变量(Q1=0，Q2=1，Q3=2，Q4=3)进行Logistic回归分析，结果显示，调整性别、年龄和体力活动水平后，METS-IR中Q4组发生BMC低下和CTX低下的风险低于Q1组(OR值分别为0.03，0.45)，性别分层后表现出相似的结果(P值均 < 0.05);METS-IR中Q4组发生OC低下的风险高于Q1组(OR=1.85)，性别分层后，男、女生METS-IR与骨指标关联的结果与总体相似(P值均 < 0.05);METS-IR与Ca的关联均无统计学意义(P值均>0.05)。见表2。

2.3　青少年METS-IR与骨指标低下的剂量反应关系

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、低Ca存在线性剂量-反应关系(P_总趋势值均 < 0.01，P_非线性值分别为0.72，0.84)。按性别分层后，除在男、女生中发现METS-IR与低OC之间存在线性剂量-反应关系(P_总趋势值均 < 0.01，P_非线性值分别为0.05，0.17)，女生METS-IR与BMC低下存在线性剂量-反应关系(P_总趋势 < 0.01，P_非线性=0.39)以外，其余均与总人群保持相似的结果。见图1。

2.4　青少年IR替代标志物对BMC低下的预测效果

ROC曲线结果显示，METS-IR(AUC=0.85，95%CI=0.82~0.88)对BMC低下的预测价值高于TyG(AUC=0.75，95%CI=0.72~0.79)和TG/HDL-C(AUC=0.77，95%CI=0.74~0.80)对BMC低下的预测价值(P值均 < 0.01)，METS-IR敏感度为85%，特异度73%，约登指数为0.58。见图2。

3　讨论

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本研究发现，在调整性别、年龄、体力活动水平后，随着METS-IR水平升高，BMC低下风险显著降低，且两者之间存在非线性关联，与美国非糖尿病成人METS-IR和股骨总骨密度(bone mineral density, BMD)、脊柱BMD关联的结果一致^[13]。这一结果可能与胰岛素的双重作用相关：一方面，胰岛素通过胰岛素受体激活一系列下游信号通路，增加成骨细胞活性，从而增强BMC^[16-17]; 另一方面，肥胖可能通过机械负荷效应刺激骨骼生长，进而提高BMC^[18]。性别分层分析显示，男女生均呈现METS-IR越高，BMC低下风险越低的趋势，但女生中METS-IR与BMC低下存在线性剂量反应关系，而男生呈非线性关系，性别差异可能与青春期女生雌激素的分泌、骨骼生长速度和模式的差异有关^[19]。

CTX是反应破骨细胞活性的骨吸收标志物。本研究结果显示，METS-IR Q4组发生CTX低下的风险低于Q1组，且在男女生中均存在此趋势。在一项绝经后女性IR与骨转换的研究中也得出了IR会增加CTX水平的结论^[20]，与本研究结果一致。出现这种情况的原因可能是在IR的情况下，合成代谢信号几乎被消除，促炎因子升高会增加破骨细胞活性，从而增加了CTX水平^[21]; 肥胖与IR密切相关，还有一种原因可能是肥胖个体的脂肪组织会释放一系列激素和细胞因子，包括瘦素和游离脂肪酸。这些物质可以通过直接和间接途径影响骨代谢，抑制成骨细胞活性并促进破骨细胞生成^[6]。线性剂量反应关系提示IR与骨吸收之间可能存在直接关联。OC是反应成骨细胞活性的骨形成标志物。在一项2型糖尿病男性患者的研究中发现TyG指数与OC呈负相关^[22]，与本研究发现的METS-IR与OC呈负相关的结论一致。Bilotta等^[23]的研究表明，IR可以抑制骨钙素基因的表达，降低启动子活性，并通过反馈机制对胰岛素分泌产生负面影响。另外，炎症因子可抑制成骨细胞分化并降低OC水平^[24]。剂量反应关系显示，总人群中METS-IR与低OC呈非线性关系，与TyG和OC之间的非线性关系结论一致。而性别分层后表现出线性关联，推测可能与青春期性激素水平和骨代谢对胰岛素敏感性有关。本研究未发现METS-IR与Ca存在显著关联，可能与钙代谢受多因素调控(如维生素D、甲状旁腺激素)有关，IR对其影响较小。

目前关于IR与BMC之间关系的结论仍存在争议，矛盾的结果可能源于研究人群或评估IR的方法不同。IR影响骨代谢的可能机制：IR导致高胰岛素血症，胰岛素可促进成骨细胞增殖，抑制破骨细胞活性，并补偿骨骼肌、脂肪组织和肝脏对其的抵抗，从而增加BMC^[6]。此外，IR可能通过炎症反应和雌激素水平影响骨代谢，肿瘤坏死因子α和白介素-6等促炎细胞因子增加，可能抑制成骨细胞并提高破骨细胞活性来诱导骨质流失^[25]。

本研究显示METS-IR对BMC低下的预测价值最高。该指标基于实验室检测(血脂、血糖)和BMI，不依赖于胰岛素检测，是一个直观可靠的IR预测指标^[10]，TyG和TG/HDL-C在评估代谢状态方面效应不如METS-IR，因为它们忽略了BMI和其他脂质类型对骨代谢的影响。所以METS-IR被当作是评估中国人IR的可靠指标^[26-27]。

本研究存在一定局限性：首先，研究对象为银川市12~18岁青少年，结果外推需谨慎; 其次，未考虑青春期分期对骨骼可能产生的影响; 此外，BMC通过生物电阻抗法测量，可能影响BMC评估的准确性，未来需采用双能X线吸收法验证; 最后，作为横断面研究，无法确定METS-IR与BMC、OC和CTX之间的因果联系，未来需进行大规模的前瞻性队列研究加以验证。

基金

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国家自然科学基金项目(82160614)

参考文献

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文献

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参考文献引证文献

排序方式：

LANE J M, RUSSELL L, KHAN S N. Osteoporosis[J]. Clin Orthop Relat Res, 2000, 372: 139-150.

MCCORMACK S E, COUSMINER D L, CHESI A, et al. Association between linear growth and bone accrual in a diverse cohort of children and adolescents[J]. JAMA Pediatr, 2017, 171(9): e171769.

BACHRACH L K. Hormonal contraception and bone health in adolescents[J]. Front Endocrinol, 2020(11): 603.

PROIA P, AMATO A, DRID P, et al. The impact of diet and physical activity on bone health in children and adolescents[J]. Front Endocrinol, 2021(12): 704647.

KARIMI F, RANJBAR OMRANI G, DABBAGHMANESH M H. Insulin resistance and bone health in adolescents[J]. Arch Osteoporos, 2021, 16(1): 66.

CONTE C, EPSTEIN S, NAPOLI N. Insulin resistance and bone: a biological partnership[J]. Acta Diabetol, 2018, 55(4): 305-314.

ZHANG Z, ZHAO L, LU Y, et al. Association between non-insulin-based insulin resistance indices and cardiovascular events in patients undergoing percutaneous coronary intervention: a retrospective study[J]. Cardiovasc Diabetol, 2023, 22(1): 161.

BORAI A, LIVINGSTONE C, KADDAM I, et al. Selection of the appropriate method for the assessment of insulin resistance[J]. BMC Med Res Methodol, 2011, 11: 158.

DUAN M, ZHAO X, LI S, et al. Metabolic score for insulin resistance (METS-IR) predicts all-cause and cardiovascular mortality in the general population: evidence from NHANES 2001-2018[J]. Cardiovasc Diabetol, 2024, 23(1): 243.

BELLO-CHAVOLLA O Y, ALMEDA-VALDES P, GOMEZ-VELASCO D, et al. METS-IR, a novel score to evaluate insulin sensitivity, is predictive of visceral adiposity and incident type 2 diabetes[J]. Eur J Endocrinol, 2018, 178(5): 533-544.

LIU Y, YANG Y, LI Y, et al. Nonlinear associations between METS-IR and all-cause as well as cardiovascular mortality in adults with osteoporosis and osteopenia: evidence from NHANES 2007-2023[J]. Sci Rep, 2025, 15(1): 12657.

LI M, GAO L, LIU Y, et al. Relationship between insulin resistance surrogates and bone mineral density in postmenopausal women[J]. Climacteric, 2025, 28(2): 154-161.

PU B, GU P, YUE D, et al. The METS-IR is independently related to bone mineral density, FRAX score, and bone fracture among U.S. non-diabetic adults: a cross-sectional study based on NHANES[J]. BMC Musculoskelet Disord, 2023, 24(1): 730.

周金玉, 白玲, 佟玲玲, 等. 银川市青少年体脂肪分布与骨矿物质含量的关系[J]. 中国学校卫生, 2022, 43(9): 1376-1379.

ZHOU J Y, BAI L, TONG L L, et al. Relationship between body fat distribution and bone mineral content of adolescents in Yinchuan[J]. Chin J Sch Health, 2022, 43(9): 1376-1379. (in Chinese)

FEWTRELL M S. Bone densitometry in children assessed by dual X ray absorptiometry: uses and pitfalls[J]. Arch Dis Child, 2003, 88(9): 795-798.

FULZELE K, RIDDLE R C, DIGIROLAMO D J, et al. Insulin receptor signaling in osteoblasts regulates postnatal bone acquisition and body composition[J]. Cell, 2010, 142(2): 309-319.

PRAMOJANEE S N, PHIMPHILAI M, CHATTIPAKORN N, et al. Possible roles of insulin signaling in osteoblasts[J]. Endocr Res, 2014, 39(4): 144-151.

张丽, 卜淑敏. 肥胖对骨骼的双重影响和机制以及在骨疾病中的作用[J]. 中国骨质疏松杂志, 2022, 28(4): 585-589.

ZHANG L, PU S M. The dual effects and mechanisms of obesity on bone and its roles in bone diseases[J]. Chin J Osteoporos, 2022, 28(4): 585-589. (in Chinese)

TIAN W, TENG F, GAO J, et al. Estrogen and insulin synergistically promote endometrial cancer progression via crosstalk between their receptor signaling pathways[J]. Cancer Biol Med, 2019, 16(1): 55-70.

KALIMERI M, LEEK F, WANG N X, et al. Association of insulin resistance with bone strength and bone turnover in menopausal Chinese-Singaporean women without diabetes[J]. Int J Environ Res Public Health, 2018, 15(5): 889.

KHANMOHAMMADI S, KUCHAY M S. Effects of metabolic dysfunction-associated steatotic liver disease on bone density and fragility fractures: associations and mechanisms[J]. J Obes Metab Syndr, 2024, 33(2): 108-120.

HUANG H, WANG A, CONG L, et al. Osteocalcin is associated with triglyceride glucose index rather than HOMA-IR in men with type 2 diabetes[J]. Front Endocrinol, 2022, 13: 1067903.

BILOTTA F L, ARCIDIACONO B, MESSINEO S, et al. Insulin and osteocalcin: further evidence for a mutual cross-talk[J]. Endocrine, 2018, 59(3): 622-632.

OSTA B, BENEDETTI G, MIOSSEC P. Classical and paradoxical effects of TNF-α on bone homeostasis[J]. Front Immunol, 2014, 5: 48.

MA C, TONKS K T, CENTER J R, et al. Complex interplay among adiposity, insulin resistance and bone health[J]. Clin Obes, 2018, 8(2): 131-139.

LIU X Z, FAN J, PAN S J. METS-IR, a novel simple insulin resistance indexes, is associated with hypertension in normal-weight Chinese adults[J]. J Clin Hypertens, 2019, 21(8): 1075-1081.

ZHANG M, LIU D, QIN P, et al. Association of metabolic score for insulin resistance and its 6-year change with incident type 2 diabetes mellitus[J]. J Diabetes, 2021, 13(9): 725-734.

2025年第46卷第10期

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doi: 10.16835/j.cnki.1000-9817.2025299

接收时间：2025-06-23
首发时间：2026-11-06
出版时间：2025-10-25

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收稿日期：2025-06-23
修回日期：2025-08-08

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国家自然科学基金项目(82160614)

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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

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丁文清，E-mail：dwqdz@163.com

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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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