晚期糖基化终末产物、氧化低密度脂蛋白与老年糖尿病合并骨质疏松症的关系

Relationships of advanced glycation end products and oxidized low-density lipoprotein in elderly diabetic patients with osteoporosis

目的探讨晚期糖基化终末产物（AGE）、氧化低密度脂蛋白（ox-LDL）与老年糖尿病（T2DM）合并骨质疏松症（OP）的关系。方法选取≥60岁的T2DM患者304例,按是否发生OP分为单纯T2DM组（201例）和T2DM合并OP组（103例）,以68名健康体检者作为正常对照组。检测所有对象腰椎（L1~L4）、脊柱（除腰椎外）、左侧股骨颈（Neck）、左侧股骨大转子（Troch）及Ward＇s三角区的骨密度,同时检测AGE、ox-LDL、糖化血红蛋白（Hb A1c）、钙（Ca）、磷（P）、肌酐（Cr）、尿素、空腹血糖（FPG）、餐后2 h血糖（2 h PG）、尿酸（UA）/Cr比值及碱性磷酸酶（ALP）,记录性别、年龄、降糖药物使用情况以及有无吸烟史、高血压史,计算体重指数（BMI）。采用多因素Logistic回归分析评估与T2DM合并OP密切相关的危险因素。采用Spearman相关分析评估AGE、ox-LDL与T2DM合并OP患者不同部位骨密度的关系。采用受试者工作特征（ROC）曲线评价ox-LDL、AGE诊断T2DM合并OP的敏感性、特异性。结果单纯T2DM组、T2DM合并OP组Hb A1c、Cr、UA/Cr比值、FPG、ALP、AGE、ox-LDL及高血压比例均高于正常对照组（P〈0.05）;T2DM合并OP组UA/Cr比值、AGE、ox-LDL值高于单纯T2DM组（P〈0.05）;其余指标各组间差异均无统计学意义（P〉0.05）。T2DM合并OP组腰椎（L1~L4）、脊柱、Neck、Troch及Wald＇s三角区的骨密度均低于单纯T2DM组（P〈0.05）;T2DM合并OP组及单纯T2DM组腰椎（L1~L4）、脊柱的骨密度均低于正常对照组（P〈0.05）。Logistic回归分析显示高血压史、UA/Cr比值、Hb A1c、AGE及ox-LDL是T2DM合并OP的危险因素。Spearman相关分析显示AGE、ox-LDL与Neck、Troch及Wald＇s三角区的骨密度明显相关（P〈0.05）,而与腰椎（L1~L4）、脊柱的骨密度无相关性（P〉0.05）。ROC曲线显示ox-LDL、AGE联合检测诊断T2DM合并OP的敏感性、特异性及ROC曲线下面积均高于ox-LDL、AGE单项检测（P〈0.05）。结论 AGE、ox-LDL与T2DM合并OP的发病有一定相关性,其联合检测有助于提高临床诊断效能。

Objective To investigate the relationships of advanced glycation end products（AGE） and oxidized low-density lipoprotein（ox-LDL） in elderly diabetic patients with osteoporosis（OP）.Methods A total of 304 patients with type 2 diabetes mellitus（T2DM）were enrolled,and their ages were≥60 years. According to the occurrence of OP,they were classified into simple T2DM group（201 cases） and T2DM with OP group（103 cases）. A total of 68 healthy subjects were enrolled as healthy control group. The bone mineral densities of lumbar spine（L1-L4）,spine（exceptlumbar spine）,left femoral neck（Neck）,left femoral large rotor（Troch） and Ward＇s triangle area were determined. AGE,ox-LDL,glycated hemoglobin A1c（HbA1c）,calcium（Ca）, phosphorus（P）,creatinine（Cr）,urea,fasting plasma glucose（FPG）,2 h postprandial plasma glucose （2 hPG）,uric acid（UA）/ Cr and alkaline phosphatase（ALP） were determined. The data of sex,age,the use of hypoglycemic drugs,the histories of smoking and hypertension,body mass index（BMI） were recorded. Multivariate Logistic regression analysis was used to evaluate the risk factors for T2DM with OP. Spearman correlation analysis was used to analyze the relationship of bone mineral densities with AGE and ox-LDL in T2DM with OP group. Receiver operating characteristic（ROC） curve was used to evaluate the sensitivities and specificities of ox-LDL and AGE for the diagnosis of T2DM with OP.Results HbA1c,Cr,UA/Cr,FPG,ALP,AGE,ox-LDL and the proportion of hypertension in simple T2DM and T2DM with OP groups were higher than those in healthy control group（P〈0.05）. UA/Cr,AGE and ox-LDL in T2DM with OP group were higher than those in simple T2DM group （P〈0.05）,and there was no statistical significance for the other indices（P〉0.05）. The bone mineral densities of lumbar spine（L1-L4）,spine,Neck,Troch and Ward＇s triangle area in T2DM with OP group were lower than those in simple T2DM group（P〈0.05）,and the bone mineral densities of lumbar spine（L1-L4）and spine in T2DM with OP group and simple T2DM group were lower than those in healthy control group（P〈0.05）. Logistic regression analysis showed that the history of hypertension,UA/Cr,HbA1c,AGE and ox-LDL were risk factors for T2DM with OP. Spearman correlation analysis showed that AGE and ox-LDL had correlations with the bone mineral densities of Neck,Troch and Wald＇s triangle area（P〈0.05）and no correlation with those of lumbar spine（L1-L4） and spine（P〉0.05）. ROC curve showed that the sensitivity,specificity and area under ROC curve of the combined determination of ox-LDL and AGE were higher than those of ox-LDL and AGE single determinations（P〈0.05）. Conclusions AGE and ox-LDL have correlations with the incidence of T2DM with OP,and the combined determination of AGE and ox-LDL can improve efficacy for the diagnosis of T2DM with OP.