老年2型糖尿病患者25(OH)D_(3)、Hcy、SUA水平变化及其与骨代谢、骨密度及骨质疏松的相关性

Changes of 25(OH)D_(3),Hcy,and SUA levels in elderly patients with type 2 diabetes and their correlation with bone metabolism,bone mineral density,and osteoporosis

目的探讨老年2型糖尿病患者25羟基维生素D_(3)[25(OH)D_(3)]、同型半胱氨酸(Hcy)、尿酸(SUA)水平变化及其与骨代谢、骨密度及骨质疏松的相关性。方法回顾性分析2019年1月至2020年7月上海交通大学医学院附属同仁医院收治的100例老年2型糖尿病患者的临床资料,根据骨质疏松诊断标准分组,其中T值≤-2.5为骨质疏松组26例,-2.5<T值<-1.0为骨量减少组45例,T值≥1.0为骨量正常组29例。比较三组患者的血清25(OH)D_(3)、Hcy、SUA、β-胶原特殊序列(β-CTX)、甲状旁腺素(PTH)、骨钙素(OC)水平及腰椎L_(1~4)骨密度、股骨颈骨密度、全髋骨密度、均值骨密度,并采用Pearson相关系数分析血清25(OH)D_(3)、Hcy、SUA水平与骨代谢、骨密度的相关性。结果骨质疏松组患者的血清25(OH)D_(3)水平为(9.10±1.53)μg/L,明显低于骨量减少组的(14.85±1.65)μg/L和骨量正常组的(21.20±2.21)μg/L,骨量减少组患者的25(OH)D_(3)水平明显低于骨量正常组,差异均具有统计学意义(P<0.05);骨质疏松组患者的血清Hcy、SUA水平分别为(18.23±2.18)μmol/L、(365.23±31.42)μmol/L,明显高于骨量减少组的(11.52±1.67)μmol/L、(291.05±23.18)μmol/L和骨量正常组的(7.02±1.38)μmol/L、(232.82±27.04)μmol/L,骨量减少组患者的Hcy、SUA水平明显高于骨量正常组,差异均具有统计学意义(P<0.05);骨质疏松组患者的β-CTX、PTH水平分别为(0.78±0.15)ng/mL、(11.38±2.05)pmol/L,明显高于骨量减少组的(0.57±0.09)ng/mL、(6.62±1.63)pmol/L和骨量正常组的(0.40±0.06)ng/mL、(3.85±0.87)pmol/L,骨量减少组患者β-CTX、PTH水平明显高于骨量正常组,差异均有统计学意义(P<0.05);骨质疏松组患者的血清OC水平及腰椎L_(1~4)骨密度、股骨颈骨密度、全髋骨密度、均值骨密度均明显低于骨量减少组、骨量正常组,且骨量减少组患者的上述各项指标明显低于骨量正常组,差异均有统计学意义(P<0.05);经Pearson相关性分析结果显示,血清25(OH)D_(3)与β-CTX、PTH均呈负相关(P<0.05),与OC、均值骨密度呈正相关(P<0.05),血清Hcy、SUA与β-CTX、PTH均呈正相关(P<0.05),与OC、均值骨密度呈负相关(P<0.05)。结论老年2型糖尿病患者25(OH)D_(3)、Hcy、SUA水平变化与骨代谢、骨密度具有明显相关性,且与骨质疏松的发生密切相关。

Objective To investigate the changes of 25 hydroxyvitamin D_(3)[25(OH)D_(3)],homocysteine(Hcy),serum uric acid(SUA)levels in elderly patients with type 2 diabetes mellitus and their correlation with bone metabolism,bone mineral density,and osteoporosis.Methods The clinical data of 100 elderly patients with type 2 diabetes mellitus admitted to Tongren Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2019 to July 2020 were retrospectively analyzed.According to the diagnostic criteria of osteoporosis,T value≤-2.5 was regarded as osteoporosis group in 26 cases,-2.5<T value<-1.0 was regarded as bone mass loss group in 45 cases,and T value≥1.0 was regarded as normal bone mass group in 29 cases.The serum 25(OH)D_(3),Hcy,SUA,β-collagen special sequence(β-CTX),parathyroid hormone(PTH),osteocalcin(OC),lumbar 1-4 bone mineral density,femoral neck bone mineral density,hip bone mineral density,mean bone mineral density the three groups were compared.Pearson correlation coefficient was used to analyze the correlation between serum 25(OH)D_(3),Hcy,SUA levels and bone metabolism and bone mineral density.Results The 25(OH)D_(3) level in osteoporosis group was(9.10±1.53)μg/L,which was significantly lower than(14.85±1.65)μg/L in bone mass loss group and(21.20±2.21)μg/L in normal bone mass group;the level in bone mass loss group was significantly lower than that in normal bone mass group;the differences were statistically significant(P<0.05).The Hcy and SUA levels in osteoporosis group were(18.23±2.18)μmol/L and(365.23±31.42)μmol/L,which were significantly higher than(11.52±1.67)μmol/L and(291.05±23.18)μmol/L in bone mass loss group and(7.02±1.38)μmol/L and(232.82±27.04)μmol/L in normal bone mass group;the levels in bone mass loss group were significantly higher than those in the normal bone mass group;the differences were statistically significant(P<0.05).The β-CTX and PTH levels in osteoporosis group were(0.78±0.15)ng/mL and(11.38±2.05)pmol/L,which were significantly higher than(0.57±0.09)ng/mL and(6.62±1.63)pmol/L in bone mass loss group and(0.40±0.06)ng/mL and(3.85±0.87)pmol/L in normal bone mass group;the β-CTX and PTH levels in bone mass loss group were significantly higher than those in normal bone mass group;the differences were statistically significant(P<0.05).The serum OC levels,lumbar L1-4 bone mineral density,femoral neck bone mineral density,hip bone mineral density,and mean bone mineral density in osteoporosis group were significantly higher than those in bone mass loss group and normal bone mass group;the levels in bone mass loss group were significantly lower than those in normal bone mass group;the differences were statistically significant(P<0.05).Pearson correlation analysis showed that serum 25(OH)D_(3) were negatively correlated with β-CTX and PTH(P<0.05)and positively correlated with OC and mean BMD(P<0.05),while serum Hcy,SUA were positively correlated with β-CTX and PTH(P<0.05)and negatively correlated with OC and mean BMD(P<0.05).Conclusion The changes of 25(OH)D_(3),Hcy,and SUA levels in elderly patients with type 2 diabetes mellitus are significantly correlated with bone metabolism and bone mineral density,and are closely related to the occurrence of osteoporosis.