中老年男性2型糖尿病合并骨质疏松患者骨转换标志物的变化

Change of biochemical bone turnover markers in the middle-aged and elderly men with type 2 diabetes mellitus and osteoporosis

目的探讨中老年男性2型糖尿病合并骨质疏松患者骨转换标志物的变化及其相关因素。方法选取80例中老年男性患者,根据1998年世界卫生组织(WHO)骨质疏松诊断标准和1999年WHO糖尿病诊断标准,分为骨质疏松(OP)组40例,糖尿病性骨质疏松(DOP)组40例。分别测定受试者的骨转换标志物、血钙、磷、甲状旁腺激素、25羟维生素D(25OHD)及糖代谢等相关指标。采用SPSS 22.0统计软件进行分析。依据数据类型,分别进行t检验、Pearson线性相关分析及多元逐步回归分析。结果两组相比,L1-4[(0. 960±0. 281) vs (0. 970±0. 126) g/cm^2,P=0. 22]、股骨颈[(0. 895±0. 162) vs(0. 895±0. 119) g/cm^2,P=0. 99)]和全髋部[(0. 784±0. 143) vs (0. 748±0. 112) g/cm^2,P=0. 85)]骨密度均无明显差异。与OP组相比,DOP组骨钙素(OC)[(16. 69±8. 91) vs (22. 71±13. 12) ng/ml,P=0. 019]、P1NP [(43. 04±20. 29) vs(53. 64±24. 08) ng/ml,P=0. 037]、25OHD[(12. 80±5. 5) vs (16. 58±8. 00) ng/ml,P=0. 044)]降低,CTX[(0. 64±0. 22) vs(0. 49±0. 30) ng/ml,P=0. 013]升高,差异均有统计学意义。相关分析显示,OC、P1NP均与Hb A1c、病程呈负相关,CTX与Hb A1c、病程呈正相关,与全髋部骨密度呈负相关(P<0. 05)。回归分析显示,Hb A1c是OC、P1NP的独立相关因素,CTX除受Hb A1c的影响外,还受全髋部骨密度的影响。结论 2型糖尿病患者骨形成降低,骨吸收增加,且随着血糖的恶化、病程的进展逐步加重。2型糖尿病合并骨质疏松患者维生素D缺乏更严重。

Objective To investigate bone turnover markers and associated factors in the middle-aged and elderly men with type 2 diabetes mellitus(T2DM)and osteoporosis.Methods According to the 1998 WHO diagnostic criteria for osteoporosis and the 1990 WHO diagnostic criteria for diabetes,80 middle-aged and elderly men were divided into osteoporosis group(OP,n=40)and diabetic osteoporosis group(DOP,n=40).All the patients received tests for bone turnover markers,serum calcium(Ca),serum phosphor(P),parathyroid hormone(PTH),25-OH vitamin D(25OHD)and other biomarkers of glucose metabolism.Statistical analysis was done using SPSS statistics 22.0.Depending on data type,Student′s t test,Pearson linear correlation or multivariate regression was performed.Results There were no obvious differences between the OP and DOP groups in BMD of L 1-4[(0.960±0.281)vs(0.970±0.126)g/cm 2,P=0.22],femoral neck[(0.895±0.162)vs(0.895±0.119)g/cm 2,P=0.99]and total hip[(0.784±0.143)vs(0.748±0.112)g/cm 2,P=0.85].Compared with OP group,DOP group had lower osteocalcin(OC)[(16.69±8.91)vs(22.71±13.12)ng/ml,P=0.019],P1NP[(43.04±20.29)vs(53.64±24.08)ng/ml,P=0.037]and 25OHD[(12.80±5.54)vs(16.58±8.00)ng/ml,P=0.044],but higher CTX[(0.64±0.22)vs(0.49±0.30)ng/ml,P=0.013],the differences being statistically significant.Correlation analysis found that OC and P1NP were negatively correlated with HbA1c and the duration of diabetes,and that CTX was positively correlated with HbA1c and the duration of diabetes but negatively correlated with BMD of total hip(P<0.05).Regression analysis showed that HbA1c was an independent risk factor for OC and P1NP,and that CTX was affected by HbA1c and BMD of total hip.Conclusion Patients with T2DM have decreased bone formation and increased bone absorption which was gradually exacerbated with the deterioration of blood glucose and progression of diabetes.Vitamin D deficiency is worse in patients with diabetic osteoporosis.