血清25-羟基维生素D及骨钙素水平与老年2型糖尿病合并迟发性性腺功能减退症的关系

Association of serum 25(OH)D and osteocalcin levels with late-onset hypogonad⁃ism in elderly people with type 2 diabetes mellitus

目的研究血清25-羟基维生素D[25-hydroxyvitaminD,25(OH)D]及骨钙素(Osteocalcin,OC)水平与老年2型糖尿病(Type 2 diabetes mellitus,T2DM)合并迟发性性腺功能减退症(Late-onset hypogonadism,LOH)的关系。方法以2018年5月—2021年5月新疆医科大学第一附属医院内分泌科收治的120例老年T2DM合并LOH患者为观察组,90例单纯T2DM患者为对照组,选取同时期的60例健康体检者为健康组,研究对象均为男性。采用酶联免疫吸附法(ELISA试剂盒)检测3组血清25(OH)D、OC水平,比较3组血清25(OH)D、OC水平差异。收集观察组与对照组患者相关临床资料进行单因素分析,采用多因素Logistic回归分析T2DM合并LOH的相关影响因素,并绘制受试者工作特征曲线(ROC)分析血清25(OH)D、OC水平对T2DM合并LOH的诊断价值。结果3组血清25(OH)D、OC水平总体比较,差异有统计学意义(P<0.05)。与健康组比较,观察组和对照组25(OH)D、OC水平降低,差异有统计学意义(P<0.05);与对照组比较,观察组糖尿病病程延长,血清25(OH)D、OC、促卵泡生成素(Follicle-stimulating hormone,FSH)、黄体生成素(Luteinizing hormone,LH)、睾酮(Testosterone,T)水平降低,差异有统计学意义(P<0.05)。Logistic回归分析显示,血清25(OH)D、OC、FSH、LH、T水平均是影响T2DM合并LOH患者的相关因素(P<0.05)。血清25(OH)D、OC诊断T2DM合并LOH的最佳截断点分别为38.62 nmol/L、3.95 ng/mL,ROC曲线下面积(AUC)分别为0.865、0.886,敏感度分别为84.17%、85.00%,特异度分别为72.22%、70.00%,二者联合检验的AUC为0.912,敏感度与特异度分别为81.67%、78.89%。结论T2DM合并LOH患者血清25(OH)D、OC水平呈现异常表达,二者均是影响T2DM合并LOH的相关因素,对T2DM合并LOH具有良好诊断价值。

Objective To investigate the relationship between serum 25-hydroxyvitamin D[25-dihydroxyvitaminD,25(OH)D]and osteocalcin(OC)levels and late-onset hypogonadism(LOH)in elderly people with type 2 diabetes melli⁃tus(T2DM).Methods One hundred and twenty elderly patients with T2DM combined with LOH admitted to the hospi⁃tal from May 2018 to May 2021 were used as the observation group,90 patients with T2DM alone were used as the con⁃trol group,and 60 healthy physical examiners from the same period were selected as the healthy group using with matching principle.The enzyme-linked immunosorbent assay(ELISA kit)was used to detect serum 25(OH)D and OC levels in the three groups,and the differences in serum 25(OH)D and OC levels between the three groups were com⁃pared.The relevant clinical data of patients in the observation and the control groups were collected for univariate anal⁃ysis,and multi-factor logistic regression were used to analyze the influencing factors related to T2DM combined with LOH,and subject operating characteristic curves(ROC)were drawn to analyze the diagnostic value of serum 25(OH)D and OC levels on T2DM combined with LOH.Results Overall comparison of serum 25(OH)D and OC levels among the three groups showed statistically significant differences(P<0.05).Compared with the healthy group,the levels of 25(OH)D and OC were reduced in the observation and the control groups,and the difference was statistically signifi⁃cant(P<0.05).Compared with the control group,the observation group had a longer duration of diabetes mellitus and lower serum 25(OH)D,OC,follicle-stimulating hormone(FSH),luteinizing hormone(LH),and testosterone(T)levels,and the difference was statistically The differences were statistically significant(P<0.05).Logistic regression analysis showed that serum 25(OH)D,OC,FSH,LH,and T levels were all associated factors affecting the patients with T2DM combined with LOH(P<0.05).The optimal cut-off points for the diagnosis of T2DM combined with LOH by serum 25(OH)D and OC were 38.62 nmol/L and 3.95 ng/mL respectively.And the areas under ROC curve(AUC)were 0.865 and 0.886 and sensitivities were 84.17%and 85.00%,and specificities were 72.22%and 70.00%.The combined test of the two AUC was 0.912,with sensitivity and specificity were 81.67%and 78.89%respectively.Conclusion Patients with T2DM combined with LOH showed the abnormal expression of serum 25(OH)D and OC levels,both of which were risk factors for affecting patients with T2DM combined with LOH,and it had a good diagnostic value for T2DM com⁃bined with LOH.