减重代谢手术病人代谢危险因素与骨代谢血清标志物关系的研究

Relationship between metabolic risk factors and serum markers of bone metabolism in patients with metabolic and bariatric surgery

目的:探讨代谢危险因素对骨代谢血清标志物的影响及其关系。方法:收集2015年1月至2020年4月于华西医院胃肠外科行减重手术的病人,并抽血检测血糖、三酰甘油(triglycerides, TG)、高密度脂蛋白(high-density lipoprotein, HDL)、骨特异碱性磷酸酶(bone specific alkaline phosphatase,B-ALP)及Ⅰ型胶原羧基末端肽(C-telopeptide of type 1 collagen, CTX)等。根据B-ALP及CTX中位数分为两组(B-ALP≤14.24μg/L,B-ALP>14.24μg/L;CTX≤0.36μg/L,CTX>0.36μg/L)。比较两组临床资料、代谢危险因素,以及这些因素与B-ALP和CTX的相关性。结果:本研究共纳入205例,男81例,女124例。B-ALP≤14.24μg/L组在收缩压、舒张压、TG、HDL及低HDL血症例数方面与BALP>14.24μg/L组比较差异有统计学意义(P<0.05)。CTX≤0.36μg/L组在性别、皮下脂肪面积及空腹血糖方面与CTX>0.36μg/L组比较差异有统计学意义(P<0.05)。B-ALP与年龄及HDL负相关,与收缩压、舒张压及TG正相关。CTX与年龄及空腹血糖负相关。Logistic回归分析显示,HDL高者发生B-ALP指标异常的风险明显增加(OR=2.931,95%CI:1.585~5.421,P=0.001)。皮下脂肪面积大者发生CTX指标异常的风险明显降低(OR=0.381,95%CI:0.194~0.748,P=0.005);HDL高者发生CTX指标异常的风险明显增加(OR=2.067,95%CI:1.118~3.824,P=0.021)。结论:HDL降低、空腹血糖升高、高血压代谢危险因素以及皮下脂肪面积对减重手术病人的骨代谢指标有一定影响。

Objective To investigate the influence of metabolic risk factors on serum markers of bone metabolism and their relationship.Methods The data of patients with metabolic and bariatric surgery including blood glucose,triglyceride(TG),high density lipoprotein(HDL),bone specific alkaline phosphatase(B-ALP)and carboxy terminal peptide of type I collagen(CTX)were collected from department of gastrointestinal surgery in our hospital from January 2015 to April 2020.The patients were divided into two groups according to the median of B-ALP(≤14.24μg/L,>14.24μg/L)and CTX(≤0.36μg/L,>0.36μg/L).The clinical data and metabolic risk factors were compared between two groups and the clinical and metabolic factors correlated with parameters including B-ALP and CTX were analyzed.Results A total of 205 patients were included in this study with 81 males and 124 females There were significant differences in the parameters including systolic blood pressure,diastolic blood pressure,TG,HDL and the cases with lower HDL between B-ALP≤14.24μg/L group and B-ALP>14.24μg/L group(P<0.05).Between CTX≤0.36μg/L group and CTX>0.36μg/L group,there were significant differences in gender,subcutaneous fat area and fasting blood glucose(P<0.05).B-ALP correlated with age and HDL negatively,and with systolic blood pressure,diastolic blood pressure and TG positively.CTX correlated with age and fasting blood glucose negatively.Logistic regression analysis showed that the risk of abnormal B-ALP increased significantly in patients with higher HDL(OR=2.931,95%CI:1.585-5.421,P=0.001).Patients with larger area of subcutaneous fat decreased risk of abnormal CTX significantly(OR=0.381,95%CI:0.194-0.748,P=0.005),while those with higher HDL had higher risk of abnormal CTX significantly(OR=2.067,95%CI:1.118-3.824,P=0.021).Conclusions It was shown that lower HDL,higher fasting hyperglycemia and hypertension have influence on bone metabolism indexes of patients with metabolic and bariatric surgery.