老年2型糖尿病合并骨质疏松症患者的血清IL-34、APN表达水平与骨代谢标志物的关系

The Relationship Between Serum IL-34 and APN Expression Levels and Bone Metabolism Markers in Elderly Patients with Type 2 Diabetes Mellitus and Osteoporosis

目的探究老年2型糖尿病(T2DM)合并骨质疏松(OP)患者的血清白细胞介素-34(IL-34)、脂联素(APN)表达水平与骨代谢标志物的关系。方法回顾性分析于2018年1月至2019年12月沈阳市第四人民医院收治的150例初诊老年T2DM患者临床资料,在随访的过程中,11例失访,实际纳入139例,根据骨密度(BMD)测定结果分为:骨质疏松者纳入A组(n=49),骨量减少者纳入B组(n=46),无骨质疏松和骨量减少者纳入C组(n=44),另取同期在本院进行体检的健康成年人50例作为正常对照组。记录所有受试者一般资料,采用酶联免疫吸附法(ELISA)检检测血清中IL-34、APN水平,采用全自动电化学发光仪检测所有受试者血清Ⅰ型前胶原N端前肽(PINP)、Ⅰ型胶原C端肽(CTX)、骨钙素(BGP)等骨代谢标志物水平,同时通过Pearson检验分析,研究老年T2DM合并OP患者血清IL-34、APN水平与骨代谢标志物的相关性。结果A、B、C组FPG、HbAlc、2 h PG、FINS、HOMA-IR、TG、TC等方面与对照组比较差异有统计学意义(P<0.05);A组IL-34、APN、CTX水平均明显高于B、C组及对照组(P<0.05),而PINP、BGP水平则明显低于B、C组及对照组(P<0.05);B组IL-34、APN、CTX水平均明显高于C组及对照组(P<0.05),而PINP、BGP水平则明显低于C组及对照组(P<0.05);C组IL-34、APN、CTX水平均明显高于对照组(P<0.05),而PINP、BGP水平则明显低于对照组(P<0.05);Pearson相关分析结果显示,IL-34、APN与CTX均呈直线正相关(P<0.05),而与PINP、BGP均呈直线负相关(P<0.05);同时IL-34、APN两两相互呈直线正相关(P<0.05)。结论血清IL-34、APN可以反映老年T2DM患者早期骨代谢情况,预测OP的发生风险,其可能共同参与了T2DM、OP的发生发展。

Objective To explore the relationship between the expression levels of serum interleukin-34(IL-34)and adiponectin(APN)and bone metabolism markers in elderly patients with type 2 diabetes(T2DM)and osteoporosis(OP).Methods Aretrospective analysis was conducted with clinical data of 150 newly diagnosed elderly T2DM patients admitted to Department of Endocrinology,the Fourth People’s Hospital of Shenyang from January,2018 to December,2019.During the follow-up process,11 cases were lost,and 139 cases were actually included.According to bone density(BMD),The subjects were divided into groups as following:osteoporosis was included in group A(n=49),osteopenia was included in group B(n=46),and osteoporosis and osteopenia were included in group C(n=44),while fifty healthy adults who underwent physical examination in our hospital during the same period were selected as the normal control group.We collected the general information of all subjects,and used enzyme-linked immunosorbent assay(ELISA)to detect the levels of IL-34 and APN in patients’serum,and used automatic electrochemical luminescence instrument to detect the serum type I procollagen N-terminal pro-peptide of all subjects(PINP),also type I collagen C-terminal peptide(CTX),osteocalcin(BGP)and other bone metabolic marker levels.Pearson analysis was conducted to study the correlation of serum IL-34 and APN levels of elderly patients with type 2 diabetes and osteoporosis and bone metabolism markers.Results Groups A,B and C had significant differences in FPG,HbAlc,2h PG,FINS,HOMA-IR,TG and TC levels compared with the control group(P<0.05).The levels of IL-34,APN and CTX in Group A were significantly higher than those in Group B,C,and the control group(P<0.05),while the levels of PINP and BGP were significantly lower than those in groups B,C and the control group(P<0.05).The levels of IL-34,APN,CTX in group B were significantly higher than group C and the control group(P<0.05),while PINP and BGP levels were significantly lower than group C and the control group(P<0.05).CTX level were significantly higher than the control group(P<0.05),while PINP and BGP levels was significantly lower than the control group(P<0.05).The correlation analysis results showed that IL-34,APN and CTX were linearly positively correlated(P<0.05),but were linearly negatively correlated with PINP and BGP(P<0.05),meanwhile,IL-34 and APN were mutually correlated with straight line positive correlation(P<0.05).Conclusion Serum IL-34 and APN can reflect the early bone metabolism of elderly T2DM patients and predict the risk of osteoporosis,which may jointly participate in the development of T2DM and osteoporosis.