骨量减少或骨质疏松症合并2型糖尿病患者血清视黄醇结合蛋白4水平与骨密度的联系

The association between serum level of retinol binding protein 4 and bone mineral density in osteopenia and osteoporosis patients with type 2 diabetes

目的探讨50岁以上2型糖尿病患者伴有骨量减少或骨质疏松症血清视黄醇结合蛋白4 (retinol binding protein 4,RBP4)、骨密度(bone mineral density,BMD)与其他相关骨代谢指标之间的关系。方法 2016年4月至2017年8月在我院就诊的2型糖尿病患者(n=204例)入选本研究。采用双能X线骨密度仪测量BMD,分为正常骨密度组(110例)、骨量减少组(69例)和骨质疏松组(25例)。同时确定血清RBP4和其他生物标志物。结果与正常骨密度组相比,骨量减少和骨质疏松组患者血清RBP4、体重、钙和体质量指数(bone mass index,BMI)均与BMD呈正相关。相比之下,年龄、糖尿病病程和碱性磷酸酶(alkaline phosphatase,ALP)与所有测试部位的BMD呈负相关。在未调整的分析中,年龄、性别、糖尿病持续时间、ALP与股骨颈、髋部和腰椎BMD呈负相关,而体重、BMI和RBP4与所有部位的BMD呈正相关。在多元回归分析中,根据年龄、体重、BMI和其他骨骼相关因素进行校正,结果显示,在所有部位,血清RBP4与BMD之间呈逐级递增关系。结论与2型糖尿病患者的正常骨密度组相比,调整其他因素后,在骨量减少和骨质疏松症组中患者血清RBP4与所有部位的骨密度均呈正相关。

Objective This study intended to study the association between serum retinol-binding protein 4(RBP4), bone mineral density(BMD), and other bone metabolic related parameters in type 2 diabetic patients older than 50 years, with or without osteopenia or osteoporosis. Methods Patients with type 2 diabetes(n=204) who were diagnosed between April 2016 and August 2017 were enrolled in this study. Bone mineral density(BMD) was recorded by dual-energy X-ray absorptiometer. Patients were divided into normal BMD group(110 cases), osteopenia(69 cases), and osteoporosis group(25 cases). The serum adipokine RBP4 and other biomarkers were determined accordingly. Results Serum RBP4, body weight, calcium, and body mass index(BMI) were positively correlated with BMD at all tested body sites in osteopenia and osteoporosis group. In contrast, age, duration of diabetes, and alkaline phosphatase(ALP) were negatively correlated with BMD at all tested body sites. In non-adjusted analyses, age, gender, duration of diabetes, and ALP were negatively associated with BMD at the femoral neck, total hip, and lumbar spine. Body weight, BMI, and RBP4 were positively associated with BMD at all sites. In multiple regression analyses adjusted for age, weight, BMI, and other bone-related factors, a graded stepwise positive association between serum RBP4 and BMD at all sites was observed. Conclusion Serum RBP4 is positively associated with BMD at all sites after adjustment for other factors in osteopenia and osteoporosis group compared with normal BMD group of type 2 diabetic patients.