2型糖尿病患者血糖波动与骨代谢指标及骨密度的关系

Correlation between glycemic variability and bone metabolism index and bone mineral density in patients with type 2 diabetes mellitus

目的探讨2型糖尿病(T2DM)患者血糖波动与骨代谢指标及骨密度(BMD)的相关性。方法选取213例2型糖尿病患者,采用雅培扫描式葡萄糖监测(FGM)系统连续7 d监测血糖,计算血糖波动指标即血糖水平标准差(SDBG)、日平均血糖波动幅度(MAGE)及最大血糖波动幅度(LAGE)。同时,采用雅培C1602126型生化分析仪检测总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、白蛋白、钙、磷水平,采用高效液相层析法测定糖化血红蛋白(Hb A1c)。采用电化学发光法测定患者骨代谢指标包括骨钙素(OC)、总I型前胶原氨基端延长肽(T-P1NP)和I型胶原羧基端肽交联(β-CTX)、25-羟基维生素D[25-(OH)D],应用美国GE双能X线骨密度仪行患者第1~4腰椎(L1~4)和股骨颈(FN)正位进行检测,分别获得BMDL1~4和BMDFN,并计算BMD全部T值。以Pearson分析及多元线性回归分析评价SDBG与骨代谢指标的相关性。结果根据SDBG检测结果,213例患者分为血糖波动正常组(A组)93例和血糖波动异常组(B组)120例。两组TC、TG、HDL-C、LDL-C、ALT、AST、白蛋白、钙、磷水平比较差异无统计学意义(P均>0.05)。B组β-CTX、Hb A1C、MAGE、LAGE均高于A组,OC、25(OH)D、BMDFN、BMD全部T值低于A组(P均<0.05);Pearson相关分析患者SDBG与β-CTX及Hb A1C呈正相关(r分别为0.625、0.624,P均<0.05),与OC水平呈负相关(r=-0.287,P<0.05);多元线性回归分析SDBG与OC、β-CTX及Hb A1C存在线性相关。结论2型糖尿病患者骨代谢指标与血糖波动相关,血糖波动可加剧骨吸收,抑制骨形成,导致骨质疏松症的发生。

Objective To investigate the correlation between blood glucose fluctuation and bone metabolism index and bone mineral density(BMD)in patients with type 2 diabetes mellitus(T2 DM).Methods Totally 213 T2 DM patients were selected.Abbott scanning glucose monitoring(FGM)system was used to monitor blood glucose for 7 consecutive days,and we calculated the blood glucose fluctuation indices,namely,standard deviation of blood glucose(SDBG),mean blood glucose fluctuation(MAGE),and large blood glucose fluctuation(LAGE).At the same time,the levels of total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),alanine aminotransferase(AST),aspartate aminotransferase(ALT),albumin,calcium,and phosphorus were detected by Abbott C1602126 biochemical analyzer,and the HbA1 C,was determined by High-performance Liquid Chromatography(HPLC).Osteocalcin(OC),total typeⅠprocollagen amino-terminal prolengthening peptide(T-P1 NP),typeⅠcollagen cross-linked C-telopeptide(β-CTX)and 25-hydroxyvitamin D[25-(OH)D]were determined by electrochemiluminescence.The lumbar vertebra(L1-4)and femoral neck(FN)positions were detected by GE dual-energy X-ray absorptiometry.BMDL1-4 and BMDFN were obtained,respectively,and all T values of BMD were calculated.Pearson analysis and multiple linear regression analysis were used to evaluate the correlation between SDBG and bone metabolism indexes.Results According to the results of SDBG,213 patients were divided into group A(93 cases)with normal blood glucose fluctuations and group B(120 cases)with abnormal blood glucose fluctuations.There were no significant differences in the levels of TC,TG,HDL-C,LDL-C,ALT,AST,albumin,calcium or phosphorus between the two groups(all P>0.05).The levels ofβ-CTX,HbA1 C,MAGE and LAGE in the group B were higher than those in the group A,while the OC,25(OH)D,BMDFN and all T values of BMD in the group B were lower than those in the group A(all P<0.05).Pearson correlation analysis showed that SDBG was positively correlated withβ-CTX and HbA1 C(r=0.625,0.624,both P<0.05),and was negatively correlated with OC level(r=0.287,P<0.05).Multiple linear regression analysis showed that there was a linear correlation between SDBG and OC,β-CTX,and HbA1 C Conclusion In patients with T2 DM,the blood glucose fluctuations are related to bone metabolism indexes,which can aggravate bone resorption and inhibit bone formation,leading to the occurrence of osteoporosis.