脂蛋白a对2型糖尿病患者骨密度及骨代谢的影响

Effect of lipoprotein(a)on bone mineral density and bone metabolism in patients with type 2 diabetes mellitus

(1)目的研究脂蛋白a对2型糖尿病(T2DM)患者骨密度的影响,为预防T2DM合并骨质疏松症提供有效可靠的依据。(2)方法选取我院185例T2DM患者,男92例,女93例,测定脂蛋白a(Lp(a))、低密度脂蛋白(LDL-C)、钙、磷、糖化血红蛋白(HbA1c)、碱性磷酸酶(ALP)及股骨颈骨密度(FNBMD)、腰三骨密度(L3BMD)。按照脂蛋白a水平分为A、B、C、D4组,其中A组的Lp(a)值为1～100mg/L,B组的Lp(a)值为101～200mg/L,C组的Lp(a)值为201～300mg/L,D组的Lp(a)值>300mg/L。(3)结果随着脂蛋白a水平的升高,女性所占比例逐渐增大(P <0.05)。与A组比较,C、D两组FNBMD明显下降(P <0.05),D组L3BMD明显下降(P <0.05);与B组比较,D组FNBMD、L3BMD明显下降(P <0.05);与C组比较,D组L3BMD明显降低(P <0.05)。4组间钙磷乘积无统计学意义(P>0.05),与A组比较,B、C、D 3组ALP、钙明显下降(P <0.05),C、D 2组磷水平明显下降(P <0.05);与B组比较,C、D 2组磷显著下降(P <0.05)。脂蛋白a水平与FNBMD、L3BMD、ALP、钙呈负相关(r值分别为-0.342、-0.208、-0.207、-0.247,P值均<0.01),与磷水平呈正相关(r=0.192,P <0.01),较男性相比,与女性呈正相关(rs=0.236,P <0.01)。(4)结论脂蛋白a>200mg/L对2型糖尿病患者尤其女性患者骨密度及骨代谢有负面影响。

Objective To study the effect of lipoprotein(a)on bone mineral density in patients with type 2 diabetes(T2DM)and to provide an effective and reliable basis for the prevention of T2DM combined with osteoporosis.Methods 185 T2DM patients were selected from my hospital,92 males and 93 females.The lipoprotein(a)(Lp(a)),low density lipoprotein(LDL-C),mineral density,ALP,calcium,phosphorus,calcium and phosphorus produccalcium,phosphorus,glycosylated hemoglobin(HbA1c),alkaline phosphatase(ALP),the femoral neck bone mineral density(FNBMD)and the waist three bone mineral density(L3BMD)were measured.According to the level of lipoprotein(a),it is divided into A,B,C and D four groups.The Lp(a)value of the A group is 1~100mg/L,the Lp(a)value of group B is 101~200mg/L,the Lp(a)value of C group is 201~300mg/L,and the Lp(a)value of the D group is>300mg/L.Results As the level of lipoprotein(a)increased,the proportion of women increased gradually(P<0.05).Compared with group A,C and D two groups of FNBMD decreased significantly(P<0.05),L3BMD in group Dsignificantly decreased(P<0.05);Compared with group B,FNBMD and L3BMD decreased significantly in group D(P<0.05).Compared with group C,L3BMD in group D was significantly lower(P<0.05).There was no significant difference.In calcium and phosphorus product between the four groups(P>0.05).Compared with the A group,the ALP and calcium levels in B,C and D 3 groups decreased significantly(P<0.05),and C and D 2 groups decreased significantly(P<0.05).Compared with group B,phosphorus in 2 groups of C and D decreased significantly(P<0.05).The level of lipoprotein(a)was negatively correlated with FNBMD,L3BMD,ALP and calcium(r value was-0.342,-0.208,-0.207,-0.247,respectively P<0.01),and was positively correlated with phosphorus levels(r=0.192,P<0.01),compared with the male,and had a positive correlation with women(r s=0.236,P<0.01).Conclusion Lipoprotein(a)greater than 200mg/L has a negative effect on bone mineral density and bone metabolism in patients with type 2 diabetes mellitus,especially women.