绝经后2型糖尿病妇女骨密度与PTH四项指标的临床分析

Bone mineral density,parathyroid hormone-vitamin D axis and bone turnover markers in postmenopausal women with type 2 diabetes

目的 2型糖尿病患者骨折风险高于健康人群,本研究旨在通过对绝经后2型糖尿病妇女和年龄匹配健康妇女骨密度,骨转换指标和甲状旁腺激素（PTH）-维生素D（VD）轴水平的比较,探讨可能预测2型糖尿病骨折风险的指标。方法随机选取400名绝经后妇女,分为2型糖尿病组（T2D组,n=200）和健康对照组（ND组,n=200）。应用DEXA检测腰椎,股骨近端骨密度,检测血钙,磷,25羟基维生素D[25（OH）VD],PTH,骨钙素（OC）,骨碱性磷酸酶（BAP）和I型胶原C端肽（CTX）,酒石酸酸性磷酸酶（TRAP）。比较两组的骨密度,骨转换指标和PTH-VD轴水平。结果 T2D组体质量指数高于对照组,腰椎,股骨大转子和总臀部骨密度高于对照组（腰椎1-4 0.812±0.151vs.0.751±0.119,P=0.000;股骨大转子0.571±0.108 vs.0.540±0.081,P=0.001;总臀部骨密度0.753±0.139vs.0.713±0.109,P=0.002）。T2D组血清OC及OC/BAP较低（16.87±9.68 vs.22.03±8.57,P=0.000;1.00±0.51 vs.1.23±0.48,P=0.000）。两组血清钙,磷没有明显差异。T2D组25（OH）VD水平明显降低（37.93±15.40 vs.44.95±15.38,P=0.000）,但PTH水平仍低于对照组（40.0±21.33 vs.43.6±18.03,P=0.003）。结论血清OC,OC/BAP和PTH水平可能是评估2型糖尿病患者骨折风险的候选指标。

Objective To investigate the bone mineral density（BMD）,bone turnover markers and parathyroid hormone-vitamin D axis in postmenopausal women with type 2 diabetes mellitus（T2DM）.Methods Two hundred postmenopausal women with T2DM（T2DM group） and 200 age-matched healthy women） ND group） were enrolled in the study.BMDs of the anterior-posterior lumbar spine（L1-L4） and proximal femur were determined by dual energy X-ray absorptiometry（DEXA）.Serum calcium,phosphate,25（OH） vitamin D,parathyroid hormone（PTH）,osteocalcin（OC）,bonespecific alkaline phosphatase（BAP）,C-terminal telopeptide of type Ⅰcollagen（CTX）,tartrateresistant acid phosphatase（TRAP） were measured.The data were analyzed by t test or Wilcoxon tests.Results Patients with T2 DM had significantly higher BMI than controls.BMDs at lumbar spine,the femur troch and total hip in T2 DM group were significantly higher than those in ND group（L1-4 0.812 ±0.151 vs.0.751±0.119,P =0.000;femur troch 0.571 ±0.108 vs.0.540±0.081,P=0.001;total hip0.753 ±0.139 vs.0.713 ±0.109,P =0.002）.Serum OC and OC/BAP ratio were lower in T2 DM group than those in ND group（16.87±9.68 vs.22.03±8.57,P=0.000;1.00±0.51 vs.1.23±0.48,P =0.000,respectively）.25（OH） VD and PTH levels in T2 DM group were also significantly lower than those in ND group（37.93 ±15.40 vs.44.95 ±15.38,P=0.000 and 40.0 ±21.33 vs.43.6 ±18.03,P=0.003,respectively）.There was no significant difference in serum calcium and phosphate between two groups.Conclusion Serum osteocalcin,OC/BAP ratio and PTH level may be possible candidate markers to predict risk of fracture in menopausal women with T2 DM.