绝经后女性维生素D和骨钙素水平与代谢综合征的关系

Protective value of vitamin D and osteocalcin in early warning of metabolic syndrome in postmenopausal women with normal bone density

目的探讨维生素D和骨钙素对绝经后骨密度正常的女性发生代谢综合征(Metabolic Syndrome,MS)的预测价值。方法共入组191例绝经1年以上且骨密度正常的女性,依据MS诊断标准将受试者分为研究组(代谢综合征患者99例)和对照组(无代谢综合征受试者92例)。检查受试者血清25-羟基维生素D(25-OHD)、骨钙素(BGP)、C-反应蛋白(CRP)、胰岛素(insulin)、糖化血红蛋白(HbA1c)以及其他血生化、生殖激素等指标。测量或计算受试者腰围、臀围、腰臀比、体质指数(BMI)等指标。分析25-OHD、骨钙素和其他参数之间的相关性,采用Logistic回归分析代谢综合征的骨代谢标志物等危险因素。结果与对照组比较,研究组绝经后骨密度正常的代谢综合征患者血清骨钙素水平(4.23±2.12)ng/mL vs(5.51±3.02)ng/mL,P<0.001)和维生素D均显著下降(16.06±11.22)ng/mL vs(20.35±13.06)ng/mL,P=0.013),二者呈正相关性(r=0.190,P=0.008)。炎症标志物CRP与维生素D(r=-0.320,P=0.032)和骨钙素(r=-0.214,P=0.003)水平呈负相关。骨钙素与HbA1c(r=-0.231,P=0.001)和胰岛素抵抗指数(HOMA-IR)(r=-0.143,P=0.048)之间存在显著的负相关。回归结果显示血清骨钙素(OR=0.788,95%CI:0.683-0.909,P=0.002)、维生素D(OR=0.957,95%CI:0.921-0.986,P=0.003)和炎症标志物CRP(OR=1.121,95%CI:1.021-1.231,P=0.028)是代谢综合征的独立危险因素。结论绝经后骨密度正常的MS患者维生素D与骨钙素水平均较低,且呈显著正相关性,二者对发生MS具有交互作用。对绝经后女性前瞻性地评估骨钙素和维生素D水平可以更好地预测发生MS的风险。

Objective To investigate the relationship between vitamin D and osteocalcin levels in postmenopausal metabolic syndrome patients without osteoporosis. Methods A total of 191 postmenopausal women with normal bone density over 1 year were enrolled, and the subjects were divided into study group(99 patients with metabolic syndrome) and control group(92 subjects without metabolic synthesis) according to MS diagnostic criteria. Serum 25-OHD, osteocalcin(BGP), c-reactive protein(CRP), insulin, glycosylated hemoglobin(HbA1 c), and other blood biochemical and reproductive hormones were examined. Measure or calculate body mass index, waist circumference, hip circumference, waist-to-hip ratio, Body Mass Index(BMI), etc. The correlation between 25-OHD, osteocalcin and other parameters was investigated, and risk factors such as bone metabolism markers of metabolic syndrome were analyzed by Logistic regression. Results Compared with the control group, serum osteocalcin(4.23±2.12) ng/mL vs(5.51±3.02) ng/mL, P<0.001) and vitamin D(16.06±11.22) ng/mL vs(20.35±13.06) ng/mL, P=0.013) were significantly decreased in the study group in patients with metabolic syndrome with normal bone mineral density after menopause, which were positively correlated(r=0.190, P=0.008). There was a significant negative correlation between osteocalcin and HbA1 c(r=-0.231, P=0.001) and insulin resistance index(HOMA-IR)(r=-0.143, P=0.048). Regression results showed serum osteocalcin(OR: 0.788, 95%CI: 0.683-0.909, P=0.002), vitamin D(OR: 0.957, 95% CI:0.921-0.986, P=0.003) and inflammatory marker CRP(OR: 1.121, 95% CI: 1.021-1.231, P=0.028) were independent risk factors for metabolic syndrome. Conclusion The levels of vitamin D and osteocalcin in MS patients with normal bone mineral density after menopause were both low and showed a significant positive correlation, which had an interactive effect on the occurrence of MS. Prospective clinical evaluation of osteocalcin and vitamin D levels in postmenopausal women can better predict the risk of MS.