心脏代谢共病与骨质疏松的关联及炎症的中介作用

Associations between Cardiometabolic Multimorbidity and Osteoporosis and the Mediating Role of Inflammation

摘要: 背景：心脏代谢共病(Cardiometabolic Multimorbidity, CMM)可引发多种并发症，但其与骨质疏松发病风险的关联尚未明确。本研究旨在探讨CMM与骨质疏松的关联性，并进一步分析炎症在二者关联中是否发挥中介作用。方法：基于美国国家健康和营养检查调查(National Health and Nutrition Examination Survey, NHANES) 2005~2010年，2013~2014年和2017~2020年周期的数据，开展横断面分析。研究共纳入12,595例样本，采用Mann-Whitney U检验或卡方检验比较不同组间的特征差异；通过回归模型分析CMM对骨质疏松的影响，并比较不同亚组中二者的关联强度；运用中介分析探究炎症在CMM与骨质疏松关系中的作用。结果：CMM组与对照组的骨质疏松患病率存在显著差异(p < 0.001)；CMM是骨质疏松的危险因素(OR = 1.987, 95% CI: 1.370~2.881, p < 0.001)。中性粒细胞与淋巴细胞比值(Neutrophil-to-Lymphocyte Ratio, NLR)和全身炎症反应指数(Systemic Inflammation Response Index, SIRI)在CMM影响骨质疏松的过程中发挥部分中介作用，中介效应占比分别为4.8%和5.9%。结论：CMM是骨质疏松的危险因素，炎症在二者关联中起到部分中介作用，提示临床需关注CMM患者的骨质健康状况。

Abstract: Background: Cardiometabolic multimorbidity (CMM) is a well-established risk factor for a broad spectrum of complications. However, its association with osteoporosis remains incompletely understood. This study aimed to investigate the relationship between CMM and osteoporosis and to examine the potential mediating role of inflammation. Methods: This cross-sectional study utilized data from the 2005~2010, 2013~2014, and 2017~2020 cycles of the National Health and Nutrition Examination Survey (NHANES). A total of 12,595 participants were included. Group differences were assessed using the Mann-Whitney U test or Chi-square test. The association between CMM and osteoporosis was evaluated using logistic regression, with subgroup analyses performed to assess its consistency. Mediation analysis was conducted to quantify the contribution of inflammatory indices. Results: The prevalence of osteoporosis was significantly higher in the CMM group than in the non-CMM group (p < 0.001). After full adjustment for covariates, CMM was identified as an independent risk factor for osteoporosis (OR = 1.987, 95% CI: 1.370~2.881, p < 0.001). Mediation analysis revealed that both the neutrophil-to-lymphocyte ratio (NLR) and systemic inflammation response index (SIRI) were significant partial mediators, accounting for 4.8% and 5.9% of the total effect, respectively. Conclusion: CMM is an independent risk factor for osteoporosis, and this association is partially mediated by inflammation. These findings highlight the importance of integrating bone health assessment into the clinical management of patients with CMM.