糖尿病合并骨质疏松患者的血清因子相关危险因素的探讨

Risk Factors Associated with Serum Factors in Patients with Diabetes Complicated with Osteoporosis

目的探讨糖尿病合并骨质疏松患者的相关危险因素。方法选择我院2016年7月至2017年7月收治的2型糖尿病患者60例,根据患者是否发生骨质疏松进行分组,分别为糖尿病合并骨质疏松组(合并组)和单纯糖尿病组。使用流式细胞术检测外周血Th1、Th2、Th17、Treg细胞水平,采用酶偶联紫外分光光度法测定血浆D-乳酸水平,采用全自动生化仪测定血氨水平。利用免疫比浊法检测免疫球蛋白IgA、IgC、IgM、IgE和补体C3、C4水平,比较两组患者治疗后的营养指标水平、钙磷水平和ALP(碱性磷酸酶)。采用Logistic回归分析高危因素。结果 (1)与单纯糖尿病组对比,合并组Th1/Th2明显降低,差异有统计学意义(P<0.05)。两组Treg/Th17差异无统计学差异(P<0.05)。(2)与单纯糖尿病组对比,合并组补体C3明显降低,差异有统计学意义(P<0.05);免疫球蛋白CD3+水平、CD4+水平、CD4+/CD8+降低,差异具有统计学意义(P<0.05);D-乳酸和血氨水平明显升高,差异具有统计学意义(P<0.05)。(3)经治疗后,单纯糖尿病组患者各项营养指标明显优化,TSF、AMC、TP、ALB水平和钙磷水平明显升高,ALP水平明显降低,与合并组对比差异具有统计学意义(P<0.05)。结论 Th1/Th2、C3、钙、磷、D-乳酸是糖尿病患者发生骨质疏松的危险因素。

Objective To study the serum immunology related risk factors in patients with diabetes and osteoporosis. Methods 60 patients with type 2 diabetes admitted in our hospital from July 2016 to July 2017 were enrolled in this study. Patients were divided into two groups according to whether or not patients had osteoporosis,including diabetes combined with osteoporosis group （combined group ）and simple diabetes group. Thl ,Th2, Thl7, and Treg cells were detected by flow cytometry. The level of plasma D-lactic acid was determined by enzyme-coupled UV spectrophotometry. The level of blood ammonia was measured by automatic biochemical analyzer. Immunoglobulin IgA, IgC, IgM, IgE and complement C3, C4 were detected by turbidimetric method. The levels of nutritional indicators, calcium and phosphorus levels and ALP were compared between the two groups after treatment. Logistic regression was used to analyze high risk factors. Results （1）Compared with the simple diabetes group, the value of Thl/Th2 of the combined group was significantly lower（ P 〈 0.05 ）. The value of Treg / Th17 were no significant different between the two groups （ P 〉 0.05 ）. （2）Compared with the simple diabetes group, the C3 of the combined group was significantly lower （ P 〈 0.05 ） ; the levels of CD3 ＋ , CD4＋ , and CD4 ＋/ CD8 ＋ were significantly lower; D- lactic acid and blood ammonia were significantly higher（ P 〈 0.05 ）. （3）After treatment, the indexes of nutrition in patients with simple diabetes mellitus were significantly improved. The levels of TSF, AMC, TP, ALB and calcium and phosphorus were significantly higher than those of the simple diabetes group （ P 〈 0.05 ）. Conclusion The indicators of Thl / Th2, C3, Ca, P and D-lactic acid were the risk factors for developing osteoporosis in diabetic patients.