老年2型糖尿病患者骨代谢标志物与骨密度的相关性分析

doi:10.3969/j.issn.1673-8640.2017.02.004

摘要/Abstract

摘要：

目的探讨2型糖尿病患者（T2DM）骨代谢标志物水平与骨密度的相关性。方法采用双能X线骨密度仪测定200例老年T2DM患者腰椎及髋骨的骨密度,根据骨密度水平将患者分为3组：骨量正常组（75例）、骨量减少组（72例）、骨质疏松症组（53例）。测量所有患者身高、体重并计算体重指数（BMI）;采用电化学发光免疫法测定骨代谢标志物,包括总骨Ⅰ型前胶原N端肽（TPⅠNP）、Ⅰ型胶原羧基末端肽（β-CTX）、骨钙素（BGP）、25-羟基维生素D[25（OH）D];同时测定空腹血糖（FBG）、糖化血红蛋白（HbA_1c）、空腹C肽、甲状旁腺素（PTH）、血清钙、24 h尿蛋白（UP）。结果与骨量正常组比较,骨量减少组和骨质疏松症组BMI及空腹C肽、25（OH）D、BGP、TPⅠNP水平降低（P<0.05）,β-CTX、24 h UP、PTH、HbA_1c水平升高（P<0.05）。3组间年龄、糖尿病病程及FBG、钙水平差异均无统计学意义（P>0.05）。骨密度与BGP、TPⅠNP、25（OH）D呈正相关（r 值分别为0.273、0.269、0.223,P值分别为<0.01、<0.05、<0.01）,与β-CTX呈负相关（r= -0.246,P<0.01）。结论骨代谢标志物与骨密度密切相关。T2DM患者易发生骨量减少,甚至合并骨质疏松症。

关键词: 骨代谢标志物, 25-羟基维生素D, 2型糖尿病, 骨密度

Abstract:

Objective To evaluate the correlation between the markers of bone metabolism and bone mineral density in patients with type 2 diabetes mellitus（T2DM）.Methods The bone mineral densities of lumbar spine and hip bone were measured by dual-energy X-ray absorptiometry in 200 elderly patients with T2DM. According to the bone mineral densities,patients were classified into 3 groups,including normal group（75 cases）,osteopenia group（72 cases） and osteoporosis group（53 cases）. The height,weight and body mass index（BMI） for all patients were recorded. The markers of bone metabolism,including total type Ⅰ collagen N-terminal peptide（TPⅠNP）,type Ⅰ collagen carboxyl-terminal peptide（β-CTX）,bone gamma-carboxyglutamic-acid-containing protein（BGP） and 25-hydroxyvitamin D [25（OH）D],were determined. The levels of fasting blood glucose（FBG）,glycated hemoglobin A_1c（HbA_1c）,fasting C peptide,parathyroid hormone（PTH）,serum calcium,24 h urinary protein（UP） were determined by electro-chemiluminescence.Results Compared with normal group,the levels of BMI,fasting C peptide,25（OH）D,BGP and TPⅠNP were decreased（P<0.05）,while the levels of β-CTX,24 h UP,PTH and HbA_1c were increased in osteopenia and osteoporosis groups（P<0.05）. For age,diabetes mellitus duration,FBG and calcium levels,there was no statistical significance among the 3 groups（P>0.05）. Moreover,bone mineral densities were positively correlated with the levels of BGP,TPⅠNP and 25（OH）D （r=0.273,0.269 and 0.223,P<0.01,0.05 and 0.01）. The level of β-CTX showed a negative correlation with bone mineral densities（r= -0.246,P<0.01）. Conclusions The markers of bone metabolism are related to bone mineral density in patients with T2DM,who easily merge with osteopenia,even osteoporosis.

Key words: Bone metabolism markers, 25-Hydroxyvitamin D, Type 2 diabetes mellitus, Bone mineral density

中图分类号:

R446.1

柯文才, 武强, 顾云霞. 老年2型糖尿病患者骨代谢标志物与骨密度的相关性分析[J]. 检验医学, 2017, 32(2): 86-89.

KE Wencai, WU Qiang, GU Yunxia. Correlation between the markers of bone metabolism and bone mineral density in elderly patients with type 2 diabetes mellitus[J]. Laboratory Medicine, 2017, 32(2): 86-89.

图/表 1

参考文献 15

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组别	例数	年龄（岁）		病程（年）		BMI（kg/m²）		FBG（mmol/L）
骨量正常组	75	64.60±11.29		9.50±4.80		25.51±2.47		7.87±3.30
骨量减少组	72	67.00±9.07		10.30±4.20		24.15±3.30^*		7.82±2.80
骨质疏松症组	53	74.25±6.27		10.50±3.80		23.12±3.17^*		7.97±2.60
组别	Ca（mmol/L）	24 h UP（mg/24 h）		空腹C肽（nmol/L）		PTH（pmol/L）		HbA_1c（%）
骨量正常组	2.25±0.14	28.10±10.20		2.11±0.25		1.60±0.40		8.71±1.41
骨量减少组	2.09±0.12	56.50±9.86^*		1.28±0.27^*		2.40±0.30^*		9.62±2.28^*
骨质疏松症组	1.96±0.18	68.10±11.80^*		0.81±0.26^*		3.30±0.50^*		9.82±2.43^*
组别	25（OH）D（nmol/L）		BGP（ng/mL）		TPⅠNP（ng/mL）		β-CTX（pg/mL）
骨量正常组	54.02±20.27		17.99±4.80		45.11±4.80		143.70±12.30
骨量减少组	44.13±22.26^*		15.44±4.80^*		39.61±4.80^*		391.70±16.40^*
骨质疏松症组	39.57±16.39^*		13.81±4.80^*		34.84±4.80^*		520.40±20.70^*

组别	例数	年龄（岁）		病程（年）		BMI（kg/m²）		FBG（mmol/L）
骨量正常组	75	64.60±11.29		9.50±4.80		25.51±2.47		7.87±3.30
骨量减少组	72	67.00±9.07		10.30±4.20		24.15±3.30^*		7.82±2.80
骨质疏松症组	53	74.25±6.27		10.50±3.80		23.12±3.17^*		7.97±2.60
组别	Ca（mmol/L）	24 h UP（mg/24 h）		空腹C肽（nmol/L）		PTH（pmol/L）		HbA_1c（%）
骨量正常组	2.25±0.14	28.10±10.20		2.11±0.25		1.60±0.40		8.71±1.41
骨量减少组	2.09±0.12	56.50±9.86^*		1.28±0.27^*		2.40±0.30^*		9.62±2.28^*
骨质疏松症组	1.96±0.18	68.10±11.80^*		0.81±0.26^*		3.30±0.50^*		9.82±2.43^*
组别	25（OH）D（nmol/L）		BGP（ng/mL）		TPⅠNP（ng/mL）		β-CTX（pg/mL）
骨量正常组	54.02±20.27		17.99±4.80		45.11±4.80		143.70±12.30
骨量减少组	44.13±22.26^*		15.44±4.80^*		39.61±4.80^*		391.70±16.40^*
骨质疏松症组	39.57±16.39^*		13.81±4.80^*		34.84±4.80^*		520.40±20.70^*