绝经后女性2型糖尿病患者骨转换生化指标的研究

Evaluation of biochemical bone turnover markers in postmenopausal patients with type 2 diabetes mellitus

目的探讨绝经后2型糖尿病(type2diabetes mellitus,T2DM)、T2DM合并骨质疏松(osteo-porosis,OP)及OP患者的糖代谢、骨代谢、骨密度(bone mineral density,BMD)变化及其相关性。方法 776位绝经后汉族女性被分为4组:T2DM组(218例),OP组(223例),T2DM+OP组(186例),健康对照组(149名)。分别测定受试者的骨代谢、糖代谢指标及血钙、血磷等相关指标,用双能X线仪测定不同部位BMD,并进行统计分析及相关性研究。结果 T2DM组腰椎BMD明显高于对照组,T2DM+OP组和OP组腰椎及股骨颈BMD低于对照组。T2DM组血清25羟基维生素D3、骨碱性磷酸酶(bone alkaline phosphate,BALP)、抗酒石酸酸性磷酸酶(tartrate-resistant acid phosphatase,TrACP)明显低于正常对照组(均P<0.01)。T2DM+OP组与对照组比较,血清骨钙素(osteocalcin,OT)、BALP、TrACP明显升高(P<0.01),而血清25羟基维生素D3则显著降低(P<0.01)。相关性分析显示,T2DM患者BMD与患者HbA1C、FPG、血清TrACP呈显著负相关,与血清OT、BALP、25羟基维生素D3、BMI呈显著正相关。结论 T2DM患者骨代谢呈低转换状态,因长期血糖控制不佳,T2DM组OP的危险性增加。血清BALP、OT、TrACP和25OHD可考虑作为T2DM合并OP的早期诊断生化指标。

Objective To evaluate the glucose metabolism,bone metabolism,bone mineral density and its relevance in postmenopausal patients with type 2 diabetes mellitus（T2DM） or osteoporosis（OP） in comparison with healthy controls.Methods A total of 776 postmenopausal women were divided into four groups：T2DM group,OP group,T2DM＋OP group and healthy control group.Biomarkers concentrations of bone metabolism（BALP,25（OH）VD3,OT,TrACP） and other selected biomarkers as glycosylated hemoglobin A1C（HbA1C）,fasting plasma glucose（FPG）,serum calcium（Ca）,serum phosphor（P） were measured.Bone mineral density（BMD）were measured by dual-energy X-ray absorptiometry（DXA）.In addition the correlation between BMD and main factors were evaluated in diabetic subjects.Results Lumbar spine BMD was significantly higher in T2DM group,lumbar spine and femoral neck BMD were lower in T2DM＋OP group and OP group than the control group.Serum 25 hydroxy vitamin D3,BALP,TrACP were significantly lower in T2DM group than those in the control group（P〈0.01）.Serum osteocalcin,BALP,TrACP significantly increased in T2DM＋OP group compared with the control group（P〈0.01）,while serum 25 hydroxy vitamin D3 was significantly lower（P〈0.01）.Correlation analysis revealed that there was a positive relationship between BMD and OT,BALP,25 hydroxy vitamin D3,BMI,and a negative relationship between BMD and HbA1C、FPG、TrACP.Conclusion Serum BALP,OT,TRACP and 25（OH）VD may be considered as biochemical markers in early stage of T2DM patients with OP.Poor long term glycemic control increased OP risk in patients with T2DM.