非糖尿病绝经后女性胰岛素抵抗与骨代谢的相关性研究

Association between insulin resistance and bone metabolism in non-diabetic postmenopausal women

为探讨胰岛素抵抗与骨代谢之间的相互关系,采用双能X线吸收仪测量了262名非糖尿病绝经后女性腰椎L1-4和股骨颈(Femoral Neck,FN)的骨密度(Bone Mineral Density,BMD),并检测了其外周血骨转换标志物和糖代谢指标以及雌激素水平.结果发现胰岛素和稳态模型评估的胰岛素抵抗(Homeostasis Model Assessment of Insulin Resistance,HOMA-IR)指数与L1-4和FN BMD均呈正相关(P<0.01),但在控制体重指数(Body Mass Index,BMI)与游离雌二醇(Free Estradiol,FE2)水平后相关性均消失(P>0.05);高HOMA-IR组(OR=0.59,P=0.003)和中HOMA-IR组(OR=0.52,P=0.044)的骨质疏松症患病风险显著低于低HOMA-IR组,但校正BMI和FE2后差异消失(OR=0.81,P=0.263和OR=0.68,P=0.268);高HOMA-IR组骨钙素水平显著低于低HOMA-IR组(P=0.001),即使校正BMI和FE2后差异仍有统计学意义(P=0.027).因此,胰岛素抵抗不是非糖尿病绝经后女性骨质疏松症的独立保护或风险因素,而骨钙素可能通过影响外周组织胰岛素敏感性参与糖代谢.

The current study was aimed to investigate the relationship between insulin(INS)resistance and bone metabolism,the bone mineral density(BMD)of lumbar spine L1-4 and femoral neck(FN)in 262 non-diabetic postmenopausal women who were diagnosed by dual-energy X-ray absorptiometry.Bone turnover markers,glucose metabolism and estrogen levels in peripheral blood were measured.The results showed that INS and homeostasis model assessment of insulin resistance(HOMA-IR)index were positively correlated with L1-4 and FN BMD(P<0.01).However,the correlation did not hold after controlling body mass index(BMI)and free estradiol(FE2)levels(P>0.05).OP risk in the high HOMA-IR group(OR=0.59,P=0.003)and middle HOMAIR group(OR=0.52,P=0.044)was significantly lower than that in the low HOMA-IR group.However,the difference was no longer existing after adjusting for BMI and FE2(OR=0.81,P=0.263 and OR=0.68,P=0.268,respectively).The osteocalcin(OCN)level in the high HOMA-IR group was significantly lower than that in the low HOMA-IR group(P=0.001)and the difference was still statistically significant even after adjusting for BMI and FE2(P=0.027).Therefore,INS resistance was not an independent protective or risk factor for OP in non-diabetic postmenopausal women.OCN may be involved in glucose metabolism by influencing peripheral tissue INS sensitivity.