脂蛋白a对2型糖尿病男性骨密度的影响

The effect of lipoprotein-α on bone mineral density in men with type-2 diabetes

目的探讨正常范围内的脂蛋白a对男性2型糖尿病患者骨密度的影响,为防治2型糖尿病患者的骨质疏松提供一定依据。方法选取66例血清脂蛋白a正常(0～300 mg/L)的男性2型糖尿病患者(糖尿病病程5年以内),测定血脂系列、骨代谢等指标;采用双能X线吸收骨密度仪(DXA)测定腰椎(L1-L4)、股骨(Neck、Troch、Inter、Total、Wards)骨密度。按照脂蛋白a水平,将研究对象分为年龄、BMI相匹配的低脂蛋白a组(0～130 mg/L)和高脂蛋白a组(131～300 mg/L),分析骨密度及骨代谢的差异。结果 1、高脂蛋白a组的股骨(Troch)及腰椎(L1、L2、L3、L4、Total Lumbar)骨密度明显高于低脂蛋白a组(Troch:P=0.020;L1:P=0.022;L2:P=0.035;L3:P=0.030;L4:P=0.007;TotalLumbar:P=0.016),高脂蛋白a组Neck、Inter及Ward’s骨密度高于低脂蛋白a组,但差异不具有统计学意义(P=0.068、P=0.249、P=0.107)。2、高脂蛋白a组的骨转换指标(Ⅰ型胶原、骨钙素)较低脂蛋白a组降低,但差异不具有统计学意义(P=0.682、P=0.322)。3、股骨颈(Neck)、腰椎(L3、L4、Total Lumbar)骨密度与血浆脂蛋白a水平正相关(Neck:r=0.270,P=0.028;L3:r=0.250,P=0.043;L4:r=0.302,P=0.015;Total Lumbar:r=0.262,P=0.033)。结论在2型糖尿病男性中,脂蛋白a可能通过调节骨转换而影响全身的骨代谢及骨密度。

Objective To investigate the effect of normal range lipoprotein-ct on bone mineral density in men with type-2 diabetes. Methods Sixty-six men with type 2 diabetes, whose disease course were less than 5 years and serum lipoprotein-α level were in normal range （0 -300mg/L） , were selected. Lipid series and bone metabolic parameters were tested. Bone mineral density （BMD） of the lumbar spine （L1-L4） and femur （neck, Troeh, inter, total, Wards） was measured using dual energy X-ray absorptiometry （DXA）. In accordance with the lipoprotein - α levels, subjects were divided into age and BMI-matched low-LPα group （0 - 130 mg/L） and high LPα group （131 - 300 mg/L）. The difference in BMD and bone metabolism was analyzed. Results 1 ） BMD of the femur （Troch） and the lumbar （L1, L2, L3, L4, Total Lumbar） in high lipoprotein-α group was significantly higher than that in low lipoprotein-α group （Troch： P =0.020; LI： P=0.022; L2： P=0.035; L3：P=0.030; L4： P=0.007; Totallumbar：P=0.016）. 2） Bone turnover markers （type I collagen and osteocalcin） in high lipoprotein-α group were lower than those in low lipoprotein-α group, but the difference was not statistically significant （ P = 0. 682, P = 0. 322）. 3 ） BMD of the femoral neck （Neck） and lumbar spine （L3, IA, Total lumbar） was positively correlated with plasma lipoprotein-α levels （ Neck ： r = 0. 270, P = 0. 028 ; L3 ： r = 0. 250, P = 0. 043 ; L4 ： r = 0. 302, P = 0.015; Total lumbar： r =0.262, P =0.033）. Conclusion In men with type 2 diabetes, lipoprotein-α may affect bone metabolism and BMD by regulating the process of bone turnover.