2型糖尿病合并骨质疏松患者DEXA骨密度测量结果与血清细胞因子、胰岛素抵抗的关系

Relationship between DEXA bone mineral density measurement results and serum cytokines as well as insulin resistance in patients with type 2 diabetes mellitus and osteoporosis

目的:研究2型糖尿病合并骨质疏松患者DEXA骨密度测量结果与血清细胞因子、胰岛素抵抗的关系。方法:选择2013年5月~2015年7月期间在四川省自贡市第三人民医院初诊的2型糖尿病患者并根据股骨颈骨密度DEXA测量结果分为骨量正常组、骨量减少组、骨质疏松组,测量3组患者各个部位的骨密度,采集血清并测定骨代谢指标、细胞因子以及胰岛素的含量。结果:骨量减少组、骨质疏松组患者股骨粗隆、Ward's区以及第2~4腰椎的骨密度测量值显著低于骨量正常组,骨质疏松组患者股骨粗隆、Ward's区以及第2~4腰椎的骨密度测量值显著低于骨量减少组;骨量减少组、骨质疏松组患者血清中N-MID、PINP、BGP的含量均显著低于骨量正常组,β-CTX、TRACP5b、Ins、Chemerin、TNF-α、IL-1β、MCP-1的含量均显著高于骨量正常组;骨质疏松组患者血清中N-MID、PINP、BGP的含量均显著低于骨量减少组,β-CTX、TRACP5b、Ins、Chemerin、TNF-α、IL-1β、MCP-1的含量均显著高于骨量减少组;血清中Ins、Chemerin、TNF-α、IL-1β、MCP-1的含量与N-MID、PINP、BGP的含量呈负相关关系,与血清中β-CTX、TRACP5b的含量呈正相关关系。结论:2型糖尿病合并骨质疏松患者体内过多合成的炎性因子以及代偿性的高胰岛素血症会促进骨吸收、抑制骨形成,进而造成全身多个部位骨量减少。

Objective：To study the relationship between DEXA bone mineral density measurement results and serum cytokines as well as insulin resistance in patients with type 2 diabetes mellitus and osteoporosis.Methods：Patients newly diagnosed with type 2 diabetes were selected and divided into normal bone mass group,osteopenia group and osteoporosis group according to the DEXA femoral neck bone mineral density measurement results,the bone mineral density of all parts in of three groups of patients were measured,and serum was collected to determine the levels of bone metabolism indexes,cytokines and insulin.Results：Femoral trochanter,Ward＇s area as well as the 2-4th lumbar vertebra bone mineral density values of osteopenia group and osteoporosis group were significantly lower than those of normal bone mass group,and the femoral trochanter,Ward＇s area as well as the 2-4th lumbar vertebra bone mineral density values of osteoporosis group were significantly lower than those of osteopenia group;serum N-MID,PINP and BGP levels of osteopenia group and osteoporosis group were significantly lower than those of normal bone mass group whileβ-CTX,TRACP5 b,Ins,Chemerin,TNF-α,IL-1β and MCP-1 levels were significantly higher than those of normal bone mass group;serum N-MID,PINP and BGP levels of osteoporosis group were significantly lower than those of osteopenia group whileβ-CTX,TRACP5 b,Ins,Chemerin,TNF-α,IL-1β and MCP-1 levels were significantly higher than those of osteopenia group;serum Ins,Chemerin,TNF-α,IL-1β and MCP-1 levels were negatively correlated with N-MID,PIN and BGP levels,and positively correlated with serumβ-CTX and TRACP5 blevels.Conclusions：Excessively synthesized inflammatory factors and compensatory hyperinsulinemia in patients with type 2 diabetes mellitus and osteoporosis can promote bone resorption and inhibit bone formation,thus resulting in the osteopenia in multiple areas of the body.