2型糖尿病患者血清胱抑素C、尿酸水平与骨密度的相关性分析

Correlation analysis of serum cystatin C, uric acid and bone mineral density in patients with type 2 diabetes mellitus

目的探究2型糖尿病患者血清胱抑素C、尿酸水平与骨密度的相关性,并分析影响糖尿病性骨质疏松的相关因素。方法选取2018年1月~2019年5月于郑州大学第二附属医院内分泌科就诊的228例2型糖尿病患者,根据世界卫生组织(WHO)骨质疏松症诊断标准分为骨量正常组(43例)、低骨量组(87例)、骨质疏松组(77例)、严重骨质疏松组(21例),收集患者的一般资料。对患者的生化指标及骨密度进行相关性分析,并探讨其可能的作用机制。结果四组患者的性别、年龄、病程、舒张压、糖化血红蛋白、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血磷、碱性磷酸酶、血肌酐、血尿酸、血清胱抑素C、25-羟基维生素D及肾小球滤过率估算值、腰椎1-4(L1~4)骨密度、双侧股骨颈骨密度比较,差异有统计学意义(P<0.05);四组患者的体重指数、空腹血糖、糖耐量试验2 h血糖、C肽、血钙、血尿素氮比较,差异无统计学意义(P>0.05)。相关性分析显示,L1~4骨密度与血尿酸、碱性磷酸酶成正相关(r=0.334、0.443,P<0.05),与血磷、糖化血红蛋白、血清胱抑素C成负相关(r=-0.224、-0.371、-0.357,P<0.05);左侧股骨颈骨密度与血尿酸、碱性磷酸酶成正相关(r=0.242、0.607,P<0.05),与血磷、糖化血红蛋白、血清胱抑素C成负相关(r=-0.156、-0.351、-0.442,P<0.05);右侧股骨颈骨密度与血尿酸、碱性磷酸酶成正相关(r=0.229、0.609,P<0.05),与血磷、糖化血红蛋白、血清胱抑素C成负相关(r=-0.134、-0.276、-0.414,P<0.05)。多元线性回归分析显示,糖化血红蛋白、碱性磷酸酶、血清胱抑素C、尿酸是影响2型糖尿病患者骨密度的相关因素(P<0.05)。结论高水平血清胱抑素C可能是2型糖尿病患者患骨质疏松症的危险因素,高水平血尿酸则可能是其保护因素。

Objective To explore the relationship between serum cystatin C,uric acid and bone mineral density in patients with type 2 diabetes mellitus,and to analyze the related factors of diabetic osteoporosis.Methods From January 2018 to May 2019,228 patients with type 2 diabetes treated in the Department of Endocrinology,the Second Affiliated Hospital of Zhengzhou University were selected.According to the World Health Organization(WHO)diagnosis standard of osteoporosis,they were divided into normal bone mass group(43 cases),low bone mass group(87 cases),osteoporosis group(77 cases)and severe osteoporosis group(21 cases).The general data of patients were collected.The correlation between biochemical parameters and bone mineral density was analyzed and the possible mechanism was discussed.Results There were significant differences in sex,age,course of disease,diastolic pressure,glycosylated hemoglobin,total cholesterol,triacylglycerol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,blood phosphorus,alkaline phosphatase,blood creatinine,blood uric acid,serum cystatin C,25 hydroxyvitamin D and estimated glomerular filtration rate, lumbar spine 1-4 (L1~4) bone mineral density, bilateral femoral neck bone mineral density among the four groups (P<0.05). There were no significant differences in body mass index、systolic blood pressure、fasting plasma glucose、2-hour postprandial glucose C-peptide、serum Ca、blood urea nitrogen among the four groups (P>0.05). Correlation analysis showed that bone mineral density of L1~4 positively correlated with serum uric acid, alkaline phosphatase (r=0.334, 0.443;P<0.05), negatively correlated with serum P, glycosylated hemoglobin, cystatin C (r=-0.224, -0.371, -0.357;P<0.05);bone mineral density of the left femoral neck positively correlated with serum uric acid, alkaline phosphatase (r=0.242, 0.607;P<0.05), negatively correlated with serum P, glycosylated hemoglobin, cystatin C (r=-0.156, -0.351, -0.442;P<0.05);bone mineral density of the right femoral neck positively correlated with serum uric acid、alkaline phosphatase (r=0.229, r=0.609;P<0.05), negatively correlated with serum P, glycated hemoglobin, cystatin C (r=-0.134, -0.276, -0.414;P<0.05). Multiple linear regression analysis showed that glycosylated hemoglobin, alkaline phosphatase, serum cystatin C and uric acid were the related factors affecting bone mineral density in patients with type 2 diabetes mellitus (P<0.05). Conclusion High levels of serum cystatin C may be risk factors for osteoporosis in patients with type 2 diabetes, and high blood levels of uric acid may be the protection factors.