老年2型糖尿病合并肌少症患者血清25羟维生素D与外周血单个核细胞血红素加氧酶1 mRNA的表达水平及意义

Expression and significance of serum 25(OH)D and peripheral blood mononuclear cells HO-1 mRNA in elderly patients with type 2 diabetes mellitus and myasthenia gravis

目的探讨老年T2DM合并肌少症(SP)患者血清25羟维生素D[25(OH)D]与外周血单个核细胞(PBMC)血红素加氧酶1(HO-1)mRNA的表达水平及意义。方法选取2018年11月至2019年4月于我院内分泌科收治的120例门诊及住院老年患者,分为单纯SP组(SP组)、单纯T2DM组(T2DM组)、T2DM合并SP组(T2DM+SP组),每组各40例。另选取40名同期我院老年健康体检者为正常对照组(NC组)。采用双能X线吸收测量法测定四肢骨骼肌质量指数(SMI),RT-PCR测定各组PBMC中HO-1 mRNA的表达水平。Pearson相关分析SMI与其他指标的相关性;Logistic回归分析老年T2DM患者合并SP的影响因素。结果与NC组比较,SP、T2DM组HO-1mRNA表达升高[(24.28±11.9)vs(49.53±12.3)vs(51.45±12.1),P<0.05],25(OH)D降低[(26.27±5.45)vs(16.27±3.53)vs(15.17±2.48),P<0.05];T2DM+SP组HO-1 mRNA较NC组升高[(24.28±11.9)vs(63.59±12.5),P<0.05],25(OH)D降低[(26.27±5.45)vs(8.23±1.57),P<0.05];与T2DM+SP组比较,SP、T2DM组HO-1 mRNA表达降低[(63.59±12.5)vs(49.53±12.3)vs(51.45±12.1),P<0.05],25(OH)D升高[(8.23±1.57)vs(16.27±3.53)vs(15.17±2.48),P<0.05]。Pearson相关分析显示,SMI与HO-1 mRNA表达呈正相关(r=0.546,P=0.012),与25(OH)D呈负相关(r=―0.554,P=0.024)。Logistic回归分析结果显示,HbA1c、TG、HO-1 mRNA及25(OH)D均为老年T2DM患者合并SP的影响因素。结论 25(OH)D水平降低及HO-1 mRNA表达升高可能通过氧化应激反应共同参与老年人群糖脂代谢紊乱和肌量流失。

Objective To explore the serum 25-hydroxy vitamin D[25(OH)D]level and the expression of heme oxygenase-1(HO-1)in peripheral blood mononuclear cell(PBMC)in elderly patients with type 2 diabetes mellitus(T2DM)and oligomyosis(SP).Methods A total of 120 elderly patients from Endocrinology department of our hospital during November 2018 to April 2019 were randomly divided into three groups:SP group(n=40),T2DM group(n=40),and T2DM combined with SP group(n=40).Healthy elderly subjects were collected as controls from the physical examination center of our hospital(n=40).Skeletal lean mass index(SMI)of limbs was measured by dual energy X-ray absorption spectrometry (DXA).Real-time quantitative reverse transcription polymerase chain reaction(RT-PCR)was used to detect the expression of HO-1 mRNA in PBMC in all the subjects.Pearson correlation method was used to analyze the relationship between SMI and other indicators.Logistic regression analysis was used to analyze the influencing factors for elderly patients with T2DM and SP.Results Compared with NC group,the expression of HO-1 mRNA was significantly higher[(49.53±12.3)vs(51.45±12.1)vs(24.28±11.9),P<0.05],while 25(OH)D was significantly lower[(16.27±3.53)vs(15.17±2.48)vs(26.27±5.45),P<0.05]in SP group and T2DM group.Compared with NC group,HO-1 mRNA expression was significantly higher[(63.59±12.5)vs(24.28±11.9),P<0.05],while 25(OH)D was significantly lower[(8.23±1.57)vs(26.27±5.45),P<0.05]in T2DM with SP group.Compared with T2DM+SP group,HO-1 mRNA expression was significantly lower[(49.53±12.3)vs(51.45±12.1)vs(63.59±12.5),P<0.05],while 25(OH)D was significantly higher[(16.27 ± 3.53)vs(15.17 ± 2.48)vs(8.23±1.57),P<0.05]in SP group and T2DM group.Pearson correlation analysis showed that HO-1 mRNA expression was positively correlated with SMI(r=―0.546,P=0.012),and 25(OH)D was negatively correlated with SMI(r=―0.554,P=0.024).Logistic regression analysis showed that HbA1c,TG,HO-1 mRNA and 25(OH)D were all the influencing factors for elderly T2DM with SP.Conclusion The decrease of 25(OH)D level and the increase of HO-1 mRNA expression may participate in the disorder of glucose and lipid metabolism and muscle loss through oxidative stress.