单核细胞/高密度脂蛋白胆固醇比值与2型糖尿病合并骨质疏松的相关性

Relationship between MHR and T2DM complicated with osteoporosis

目的探讨单核细胞/高密度脂蛋白胆固醇比值(MHR)与2型糖尿病(T2DM)合并骨质疏松的相关性。方法选取2019年9月至2021年11月于华中科技大学同济医学院附属武汉市中西医结合医院脊柱外科住院的患者158例,按骨密度及血糖测量结果将其分为骨密度正常组(40例)、骨质疏松组(62例)、T2DM合并骨质疏松组(56例)。比较3组患者一般资料、白细胞、单核细胞、淋巴细胞、中性粒细胞、C反应蛋白(CRP)、红细胞沉降率、血清总蛋白(TP)、电解质、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)、肌酐、尿酸、25羟基维生素D[25(OH)D]、骨密度、骨转换标志物等指标,计算MHR值。结果T2DM合并骨质疏松组的单核细胞、血糖、MHR较骨密度正常组、骨质疏松组明显升高,年龄、CRP、碱性磷酸酶(ALP)、中性粒细胞、甲状旁腺素(PTH)较骨密度正常组明显升高;T2DM合并骨质疏松组的25(OH)D较骨密度正常组、骨质疏松组明显下降,淋巴细胞、BMI、骨钙素较骨密度正常组明显下降,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,MHR、ALP升高及25(OH)D、BMI、骨钙素降低是T2DM合并骨质疏松的独立危险因素(P<0.05,P<0.01)。ROC曲线显示,对T2DM合并骨质疏松的诊断,MHR的ROC曲线下面积(AUC)为0.771(95%CI:0.670~0.871),最佳截断值为0.347,灵敏度和特异度分别是0.893、0.625,其AUC仅次于25(OH)D。结论外周血MHR对T2DM合并骨质疏松的诊断有较高参考意义。

Objective To explore the correlation between monocyte to high-density lipoprotein cholesterol ratio(MHR)and type 2 diabetes mellitus(T2DM)complicated with osteoporosis.Methods A total of 158 patients hospitalized in Spinal Surgery Department of Wuhan Hospital of Integrated Traditional Chinese and Western Medicine from September 2019 to November 2021 were selected and were divided into normal bone mineral density(BMD)group(group A,n=40),osteoporosis group(group B,n=62)and osteoporosis combined with T2DM group(group C,n=56)according to BMD measurement and blood glucose level.The following indicators were observed and compared among three groups,including general information,white blood cells,monocytes,lymphocytes,neutrophils,CRP,erythrocyte sedimentation rate,TP,electrolytes,TC,TG,LDL-C,HDL-C,creatinine,uric acid and 25 hydroxyvitamin D[25(OH)D)]levels,BMD and markers of bone turnover.MHR values of the patients were calculated.Results In group C,monocytes,blood sugar and MHR were higher than those in group A and B,while age,CRP,alkaline phosphatase(ALP),neutrophils and PTH were higher than those in group A(P<0.05).In group C,25(OH)D was lower than that in group A and B,lymphocytes,BMI and osteocalcin were lower than those in group A,and the difference was statistically significant(P<0.05).Multiple logistic regression analysis showed that higher levels of MHR and ALP,lower levels of 25(OH)D,osteocalcin and BMI were the independent risk factors of T2MD complicated with osteoporosis(P<0.05,P<0.01).ROC curve showed that the area under the curve(AUC)of MHR was 0.771(95%CI:0.670-0.871),the cut-off value was 0.347,and the sensitivity and specificity were 0.893 and 0.625,respectively in diagnosing T2MD complicated with osteoporosis.Its AUC is second only to 25(OH)D.Conclusion Peripheral blood MHR has a high reference significance for the diagnosis of T2DM complicated with osteoporosis.