2型糖尿病合并骨质疏松的中老年患者血清骨钙素与糖脂代谢及骨密度的关系

Analysis of the relationship between serum osteocalcin and glucose-lipid metabolism as well as bone mineral density in middle-aged and elderly T2DM patients with osteoporosis

目的探讨2型糖尿病(T2DM)合并骨质疏松的中老年患者血清骨钙素与糖脂代谢及骨密度的关系。方法选取2019年6月至2020年12月在上海市第六人民医院住院的179例50岁以上T2DM患者,根据双能X线(DXA)测量的骨密度结果将患者分为3组:①T2DM骨质正常组;②T2DM骨质减少组;③T2DM骨质疏松组。对3组患者间性别、年龄、糖尿病病程、体重指数(BMI)、腰围(WC)、臀围(HC)、内脏脂肪面积(VFA)、皮下脂肪面积(SFA),空腹血糖(FPG)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、骨钙素(OCN)、腰椎、左髋关节骨密度等进行统计学分析。结果3组间糖尿病病程、糖脂代谢指标差异均无统计学意义(P>0.05);与骨质正常组和骨质减少组比较,骨质疏松组年龄和OCN水平均升高,而BMI、WC、HC、VFA、SFA及骨密度均降低(P<0.05)。以OCN作为因变量进行相关性分析:在骨质正常组中,OCN仅与HbA1c呈负相关(r=-0.348,P=0.009);而在骨质异常组(骨质减少+骨质疏松)中,OCN与BMI、WC、HC、VFA、HbA1c、T值(L_(1)~L_(4))均呈负相关(P<0.05);且在骨质异常组中,OCN与VFA、HbA1c、L_(3)有线性回归关系。以OCN≥12.53μg/L为影响因素,分析OCN与骨质疏松的关系,发现血清OCN水平高的糖尿病患者,骨质疏松的患病风险升高(OR=0.363,P=0.003)。结论中老年T2DM合并骨质疏松患者的骨转换率升高,OCN的测定可为糖尿病骨质疏松患者的发病机制提供参考依据。

Objective To explore the relationship between serum osteocalcin and glucose-lipid metabolism as well as Bone Mineral Density in middle-aged and elderly T2DM patients with osteoporosis.Methods A total of 179 patients with T2DM aged over 50 who were admitted to Shanghai Sixth People′s Hospital from June 2019 to December 2020 were enrolled.Those patients were divided into three groups according to the bone mineral density measured by DXA:①T2DM with normal bone density;②T2DM with osteopenia;③T2DM with osteoporosis.We compared gender,age,diabetes course,BMI,WC,HC,VFA,SFA,glucose-lipid metabolic indicators(FPG,HbA1c,TC,TG,HDL-C,LDL-C),OCN(Osteocalcin),lumbar spine and left hip joint bone mineral density among three groups.Results There were no significant difference in diabetes course and glucose-lipid metabolic markers among three groups(P>0.05).Compared with the normal and osteopenia groups,age and OCN were higher in the osteoporosis group,while the anthropometric indexes(BMI,WC,HC,VFA,SFA)were lower(P<0.05).Correlation analysis showed that,in the normal bone group,serum OCN was negatively correlated with HbA1c(r=-0.348,P=0.009),in the abnormal bone group(osteopenia+osteoporosis),OCN was negatively correlated with BMI,WC,HC,VFA,HbA1c,and T-Score(L_(1)-L_(4))(P<0.05),in the abnormal bone group,OCN had a linear regression relationship with VFA,HbA1c,and L_(3).Taking OCN≥12.53μg/L as exposure,serum OCN level in T2DM patients had an increased risk of osteoporosis(OR=0.363,P=0.003).Conclusions Bone turnover rate is increased in middle-aged and elderly T2DM patients with osteoporosis,serum OCN detection provides an important reference for the pathogenesis of diabetic osteoporosis.