非糖尿病结核病患者和糖尿病并发结核病患者血清骨转换标志物和维生素D水平比较

Comparison of serum bone turnover biomarkers and vitamin D level in tuberculosis patients with or without diabetes

目的探讨非糖尿病结核病和糖尿病并发结核病患者血清骨转换标志物和维生素D水平的关系。方法连续纳入结核病患者178例(男性103例、女性75例),其中非糖尿病结核病患者95例(结核病患者),糖尿病并发结核病患者83例,并纳入查体正常的对照组80例。分别检测血清25羟维生素D (25hydroxyvitamin D,25OHD),以及骨转换标志物Ⅰ型胶原C端肽β降解产物(β-C-terminal telopeptide of typeⅠcollagen,β-CTX)、N-MID骨钙素(N-mid osteocalcin, OCN)和总Ⅰ型前胶原氨基端肽(total N-terminal propeptide of typeⅠprecollagen,t P1NP)的水平,并进行比较。结果结核病患者和糖尿病并发结核病患者的血清25OHD水平与对照组比较,差异均有统计学意义(P<0. 001),糖尿病并发结核患者25OHD最低,糖尿病并发结核病患者与结核病患者间血清25OHD水平差异有统计学意义(P<0. 05)。将维生素D水平按严重缺乏、缺乏、不足和充足划分,糖尿病并发结核病组25OHD严重缺乏和缺乏的比例最高,为81. 9%,结核病组为61. 1%,对照组为41. 3%。结核病患者、糖尿病并发结核病患者和对照组t P1NP和β-CTX骨转换标志物比较,差异有统计学意义(P<0. 001); OCN骨转换标志物差异有统计学意义(P<0. 05)。结论结核病患者和糖尿病并发结核病患者维生素D水平均显著低于对照组,应引起临床医生的注意。结核病患者和糖尿病并发结核病患者的骨吸收标志物β-CTX和骨形成标志物t P1NP、OCN均高于对照组,可能与维生素D水平和代谢障碍有关。

Objective To study serum level of bone turnover biomarks and vitamin D in tuberculosis(TB)patients with diabetes(DM),TB patients without DM in comparison with normal controls to provide more scientific evidences for appropriate TB and DM treatment.Methods We consecutively recruited 178 TB patients,including 103 male and 75 female.Of them,95 TB patients with normal fasting blood glucose(FBG),83 were TB patients with DM,and 80 normal controls.Serum levels of 25OHD,β-C-terminal telopeptide of type Ⅰ collagen(β-CTX),osteocalcin,N-mid osteocalcin(OCN),and total N-terminal propeptide of type Ⅰ precollagen(tP1NP)were measured respectively.Results There was a significant difference in serum 25OHD levels between the normal controls and TB patients without DM,TB patients with DM(P<0.001).Within the patient groups,serum 25OHD levels were also significant different between TB patients with normal FBG and TB patients with DM(P<0.05).According to the international classification of normal insufficiency,deficiency and severe deficiency of vitamin D,the differences on mean 25OHD still existed(P<0.05).The proportion of severe vitamin D deficiency in TB patients with DM,TB patients without DM,and the normal controls were 81.9%,61.1%,and 41.3% respectively.The value of bone turnover biomarkers was significant different among TB patients with normal FBG,TB patients with DM,and normal control(for tP1NP and β-CTX,P<0.001,and for OCN P<0.05).Conclusion Vitamin D level in patients with TB and DM patients with TB were significantly lower than that in normal control and this should be given attention by clinicians.TB patients and diabetes TB patients had higher bone absorption biomarkers(β-CTX)and higher level of bone formation biomarkers(tP1NP,OCN)than normal control.This may attribute to vitamin D deficiency and metabolic disorder in TB and DM-TB patients.