骨转换生化标志物与老年2型糖尿病患者并发骨质疏松的相关性研究

Relationship between the changes of biochemical marker of bone turnover and osteoporosis in elderly patients with type 2 diabetes

目的 探讨老年2型糖尿病患者骨质疏松及与骨转换生化标志物的相关关系。方法应用双能x线骨密度仪分别测定102例老年2型糖尿病（T2DM）患者和42例健康老年人腰椎和股骨骨密度，将糖尿病患者分成骨质疏松组与非骨质疏松组，检测血清中骨转换生化标志物总I型前胶原氨基端延长肽（TPINP）、I型胶原羧基端肽p特殊序列（p—CTx）、甲状旁腺素（PTH）及血清钙（ca）、血清磷（P）、碱性磷酸酶（ALP）、空腹血糖（FBG）、糖化血红蛋白（HbA1c）、肌酐、血尿素、尿微量白蛋白／肌酐（uA／cr）、25羟维生素D3（25-（OH）VD3]等相关生化指标，并测量其体质指数，分析引起T2DM患者骨质疏松的相关危险因素。结果骨质疏松组腰椎及股骨骨密度均值均显著低于对照组（t=9．006、6．347、7．387、5．321，均P〈0．01）。骨质疏松组TPINP、13-CTx、PTH、ALP、FBG、HbA1c、肌酐及UA／Cr较对照组升高（t=2．212、4．431、2．215、3．544、0．433、1．629、0．365、5．436，P〈0．01或P％0．05），25-（OH）VD3低于对照组（t=2．700，P％0．01）。相关分析显示，TPINP和骨质疏松患者左侧股骨大转子Troch、ward’S三角的骨密度呈负相关（r=-0．413、-0．375，P〈0．01）；pCTx和骨质疏松患者左侧股骨大转子Troch的骨密度呈负相关（r=-0.301，P％0．05）。对TzDM骨质疏松患者体质指数超重组TPINP、13-CTx和肥胖组TPINP、β-CTx均高于正常体质量组（F=50．59、51．28，F=96．20、95．71，均P〈0．01）；口服二甲双胍（MH）患者TPINP、pCTx显著高于口服噻唑烷二酮类（TZDs）和磺脲类（su）患者（F=32．33、33．35，F=31．07、39．18，均P〈0．01）；血糖控制不佳组TPINP、B—CTx均高于血糖控制良好组（F=11．32、13．69，均P〈0．01）；有并发症发生的患者的TPINP、B—CTx均高于没有并发症发生的患者（F=52．75、70．34，均P〈0．01）。结论老年TzDM患者存在不同程度骨密度下降；联合应用TPINP、β-CTx检测有助于T.DM患者骨质疏松的早期诊断。

Objective To investigate the relationship of the changes of bone density and biochemical marker of bone turnover with osteoporosis in the elderly with type 2 diabetes mellitus（T2DM）. Methods A total of 102 elderly patients with type 2 diabetes and 42 healthy subjects （normal controls） were included in this study. The bone mineral density （BMD） of lumbar vertebrae and femur were measured by dual-energy X-ray absorptiometry （DXA）. The T2 DM subjects were divided into two groups： osteoporosis group （56 cases） and non-osteoporosis group （46 cases）. The levels of total procollagen type I amino-terminal propeptide （TP INP）, β-isomerized carboxyterminal propeptide （β-CTx）, parathyroid hormone （PTH）, serum calcium （Ca2＋）, serum phosphorus （P）, alkaline phosphatase （ALP）, fasting blood glucose（FBG）, glycosylated hemoglobin （HbAlc） and body mass index （BMI） were detected. The correlations between BMD of the osteoporosis group and other related factors were analyzed. Results The BMD values of lumbar vertebrae and femur neck,troch,ward＇s triangle in the osteoporosis group were decreased as compared with control（t= 9. 006, 6.347, 7.387, 5.321,P〈0.01）and the serum TP I NP, β-CTx, PTH, ALP, FBG, HbAlc, Creatinine and albumin/Cr in the osteoporosis group were significantly higher than controls（t= 2. 212, 4. 431, 2. 215, 3. 544, 0. 433, 1. 629, 0. 365, 5. 436,P%0.01 or P〈0.05） ,the 25-（OH）VDa in the osteoporosis group was lower than in controls（t= 2. 700,P〈0.01）. Correlation analysis showed TP I NP was negatively correlated with the BMD of femoral Troch and Wardrs triangle （r=- 0. 413, -0. 375, P〈0.01）,and β-CTx was negatively correlated with the BMD of femoral Troch （r= -0. 301,P〈0.05）. The TP I NP, β-CTx in the overweight group and obesity group were higher than in normal group（F= 50.59, 51.28; F=96.20, 95.71, all P〈0.01）;the melbine group had higher TPI NP, β-CTx than the thiazolidinedione and sulfonylurea group（F= 32.33, 33.35, F= 31.07, 39.18,P〈0.01）;the TP I NP, β-CTx in the better blood glucose control group were lower than in the bad control group（F= 11.32, 13.69, P〈0.01）;the TP I NP, β-CTx in the group with complication were increased as compared with no complication group（F= 52.75, 70.34, P〈0.01）. Conclusions The spine BMD in elderly T2DM patients is decreased to some degree. The combined application of TP I NP and β-CTx is helpful for the early diagnosis of osteoporosis in patients with type 2 diabetes.