2型糖尿病绝经后女性的骨代谢水平及其与血糖控制、颈动脉内膜中层厚度的关系

Bone metabolism level and its relation with glucose control and carotid intima-media thickness in postmenopausal women with type 2 diabetes mellitus

目的探讨2型糖尿病(T2DM)绝经后女性的骨代谢水平,以及其与血糖控制、颈动脉内膜中层厚度(IMT)的关系。方法纳入37例合并T2DM的绝经后女性(糖尿病组)以及39例健康绝经女性(对照组)。检测并比较两组的ALP、骨钙素、Ⅰ型原胶原N-端前肽(PⅠNP)、β-胶原降解产物(β-CTX)水平。分析糖尿病组糖化血红蛋白(HbA1c)、稳态模型评估胰岛素抵抗(HOMA-IR)指数与上述骨代谢指标的相关性,并比较不同颈动脉IMT增厚患者上述骨代谢指标水平。结果糖尿病组血清骨钙素、PⅠNP、β-CTX水平均低于对照组(均P<0.05)。糖尿病组血清甲状旁腺激素(PTH)、PⅠNP水平与HbA1c呈负相关,而血清PTH、β-CTX水平与HOMA-IR指数呈正相关,IMT增厚者的血清PTH、PⅠNP、骨钙素、β-CTX水平均低于IMT正常者(均P<0.05)。结论T2DM绝经后女性的骨形成及骨吸收指标均较健康绝经女性明显下降,且与胰岛素抵抗及血糖控制情况均有一定的相关性;颈动脉IMT增厚的T2DM绝经后女性骨代谢水平下降加剧,应予以重视。

Objective To investigate bone metabolism level and its relation with glucose control and carotid intima-media thickness(IMT)in postmenopausal women with type 2 diabetes mellitus(T2DM).Methods Thirty-seven postmenopausal women complicated with T2DM and 39 healthy postmenopausal women were enrolled as diabetic group and control group,respectively.The levels of serum ALP,osteocalcin,procollagenⅠN-terminal peptide(PⅠNP),β-collagen degradation product(β-CTX)were determined and compared between the two groups.In the diabetic group,the correlation of hemoglobin A1c(HbA1c)or homeostasis model assessment-insulin resistance(HOMA-IR)index with forementioned bone metabolism indices was analyzed;besides,the levels of forementioned bone metabolism indices were compared between patients with different carotid IMT increments.Results The diabetic group possessed lower levels of serum osteocalcin,PⅠNP andβ-CTX as compared with the control group(all P<0.05).In the diabetic group,serum parathyroid hormone(PTH)or PⅠNP level negatively correlated with HbA1c,whereas serum PTH orβ-CTX level positively correlated with HOMA-IR index,patients with increased IMT exhibited lower serum PTH,PⅠNP,osteocalcin andβ-CTX levels than patients with normal IMT(all P<0.05).Conclusion Bone formation and bone resorption markers are obviously declined in the postmenopausal women with T2DM than in the healthy postmenopausal women,and achieve a certain correlation with insulin resistance and glucose control;postmenopausal women suffering from T2DM with increased carotid IMT manifest severer reduction of bone metabolism level,which deserves an attention.