绝经后2型糖尿病患者骨硬化蛋白、PINP、CTX与骨密度相关性研究

The correlation among sclerostin,PINP,CTX,and BMD in postmenopausal patients with type 2 diabetes mellitus

目的比较绝经后2型糖尿病患者骨质疏松组、低骨量组、骨量正常组血清骨硬化蛋白(sclerostin,SO)水平,探讨SO与Ⅰ型前胶原氨基末端(N端)前肽(procollagen typeⅠN-terminal propetide,PINP)、Ⅰ型胶原C端肽(typeⅠcollagen carboxyterminal peptide,CTX)、骨密度(bone mineral density,BMD)的关系。方法比较绝经后2型糖尿病患者骨质疏松症组、低骨量组、骨量正常组3组间年龄、绝经年限、糖尿病病程、体重指数、股骨颈及平均腰椎BMD、空腹血糖、糖化血红蛋白、25-(OH)D3、SO、PINP、CTX各指标的差异,并做SO与上述指标的单因素相关性分析和多元线性回归分析。结果 (1)骨质疏松症组年龄、绝经年限显著高于低骨量组、骨量正常组(P均=0.000),低骨量组明显高于骨量正常组(P=0.009、0.002);(2)绝经后2型糖尿病患者中25-(OH)D3缺乏113例(90.4%);(3)骨质疏松症组SO、PINP水平显著高于低骨量组、骨量正常组(P=0.000),低骨量组SO水平明显高于骨量正常组(P=0.045);(4)SO与PINP、年龄、绝经年限正相关(r=0.978、0.194、0.205),与股骨颈BMD、平均腰椎BMD、体重指数负相关(r=-0.518、-0.349、-0.249),多元线性回归分析显示SO与PINP呈正相关(β=7.015,P=0.000)、与股骨颈BMD呈负相关(β=-11.245,P=0.023)。结论 (1)绝经后2型糖尿病合并骨质疏松者SO水平明显增高,与PINP水平呈显著正相关,与股骨颈BMD呈显著负相关;(2)25(OH)D3在绝经后2型糖尿病患者中普遍缺乏。

Objective To compare the serum sclerostin（SO） level among osteoporosis group,osteopenia group,and control group of postmenopausal patients with type 2 diabetes mellitus,and to discuss the relationship among SO,bone mineral density（BMD）,procollagen type Ⅰ N-terminal propeptide（PINP）,and type Ⅰ collagen carboxy-terminal peptide（CTX）.Methods The differences of age,menopausal duration,duration of diabetes,body mass index（BMI）,BMD of femoral neck,BMD of lumbar vertebra,fasting glucose,glycosylated hemoglobin（HbA1c）,25-hydroxy vitamin D3,serum SO,PINP,and CTX were compared among osteoporosis group,osteopenia group,and control group in postmenopausal patients with type 2 diabetes mellitus.The single factor correlation analysis and multiple linear regression analysis for SO and all above indexes were performed.Results（1） Age and menopausal duration in osteoporosis group were significantly higher than those in osteopenia group and control group（P=0.000）,and they were significantly higher in osteopenia group than in control group（P=0.009,0.002）.（2） Among postmenopausal patients with type 2 diabetes,patients with 25-（OH） D3 deficiency were 113 cases（90.4%）.（3） Serum SO and PINP levels in osteoporosis group were significantly higher than those in osteopenia group and control group（P=0.000）.Serum SO level in osteopenia group was obviously higher than that in control group（P=0.045）.（4） SO was positively correlated with PINP,age,and menopausal duration（r=0.978,0.194,0.205）,but was negatively correlated with BMD of the femoral neck,average BMD of the lumbar vertebra,and BMI（r=0.518,0.349,0.249）.The multiple linear regression analysis revealed that SO was positively correlated with PINP（β=7.015,P=0.000）,but was negatively correlated with BMD of the femoral neck（β=11.245,P=0.023）.Conclusion（1） SO level is high in postmenopausal osteoporosis patients with type 2 diabetes mellitus.Meanwhile,it is significantly and positively correlated with PINP,but significantly and negatively correlated with BMD of the femoral neck.（2） 25-（OH） D3 deficiency is popular in postmenopausal patients with type 2 diabetes mellitus.