绝经后2型糖尿病患者血清25(OH)D、Leptin与骨代谢的相关性

Correlation of serum 25(OH)D, leptin and bone metabolism in postmenopausal women with type 2 diabetes

目的探讨绝经后2型糖尿病(type 2 diabetes mellitus,T2DM)女性患者血清25-羟维生素D(25-hydroxyvitamin D,25(OH)D)、瘦素(leptin,LEP)水平与骨代谢之间的关系。方法选取遵义医学院附属医院内分泌科住院的绝经后T2DM女性患者130例,根据骨密度分为骨量正常组(A组,n=40)、骨量减少组(B组,n=45)和骨质疏松组(C组,n=45),同期选取50名健康绝经后女性作为空白对照组(NC组,n=50)。收集所有受试者临床资料及生化指标,测定血清25(OH)D、LEP、β-胶原降解产物(β-Crosslaps,β-CTX)、I型胶原N-端前肽(N-aminoterminal propeptide of type I collagen,PINP)及骨钙素(bone gla protein,BGP)水平。Spearmen相关分析绝经后T2DM合并骨质疏松症(osteoporosis,OP)患者血清骨代谢指标的相关因素分析;Logistic回归分析绝经后T2DM患者合并OP的影响因素。结果①与NC组比较,A、B、C三组中25(OH)D、PINP、BGP水平均明显降低,而LEP、β-CTX水平明显升高(P<0.05);②与A组比较,B组、C组中25(OH)D、PINP水平均明显降低,而LEP、β-CTX、BGP水平明显升高(P<0.05);③与B组比较,C组中25(OH)D、PINP水平均明显降低,而LEP、β-CTX、BGP水平明显升高(P<0.05);Spearmen相关分析显示,血清25(OH)D与PINP呈正相关,与β-CTX呈负相关,与BGP无明显相关性;血清LEP与PINP呈负相关,与β-CTX、BGP无关;Logistic回归分析显示BMI、HbA1c、25(OH)D、LEP、PINP与β-CTX均是绝经后T2DM患者合并骨质疏松的独立危险因素。结论血清25(OH)D水平的降低及LEP水平的升高,可能共同参与了绝经后T2DM女性患者OP的发生发展。

Objective To investigate the relationship between the levels of serum 25- hydroxyvitamin D (25(OH)D), leptin (LEP) and bone metabolism in postmenopausal women with type 2 diabetes. Methods A total of 130 postmenopausal women with T2DM were selected from Affiliated Hospital of Zunyi Medical College. They were divided into normal bone mass group (group A, n=40), osteopenia group (group B, n=45) and osteoporosis group (C group, n=45) according to bone mineral density. At the same time, 50 healthy postmenopausal women were selected as the blank control group (group NC, n=50). Clinical data and biochemical indexes of all subjects were collected, serum 25(OH)D, LEP, degradation products of collagen beta (beta-Crosslaps, β-CTX), N-terminal propeptide of type I collagen (PINP) and osteocalcin (bone gla protein, BGP) levels were determined. Spearmen correlation analysis was used to analyze related factors of bone metabolism in patients with T2DM and osteoporosis (OP) after menopause. Logistic regression analysis was used to analyze the influencing factors of OP in postmenopausal T2DM patients. Results ① Compared with the NC group, the levels of 25(OH)D and PINP in the A, B and C three groups decreased significantly, while LEP, beta-CTX and BGP levels increased significantly (P<0.05); ②Compared with the A group, the levels of 25(OH)D and PINP in groups B and C decreased significantly, while the levels of LEP, beta-CTX and BGP increased significantly (P<0.05); ③Compared with the B group, the levels of 25(OH)D and PINP in group C decreased obviously, but the levels of LEP, beta-CTX and BGP increased significantly (P<0.05). Spearmen correlation analysis showed that serum 25(OH)D positively correlated with PINP, negatively correlated with beta-CTX, and had no significant correlation with BGP. Serum LEP negatively correlated with PINP, but not related to beta-CTX and BGP. Logistic regression analysis showed that BMI, HbA1c, 25(OH)D, LEP, PINP, and beta-CTX were independent risk factors for osteoporosis in postmenopausal women. Conclusion The decrease of serum levels of 25(OH)D and the increase of LEP levels may lead to osteoporosis in postmenopausal women with T2DM.