绝经后女性2型糖尿病患者血清趋化素和骨代谢标志物与骨密度的相关性及其对骨质疏松症的预测价值

Correlation between serum chemerin,bone metabolic markers and bone mineral density in postmenopausal women with type 2 diabetes mellitus and their predictive value for osteoporosis

目的探讨绝经后女性2型糖尿病(T2DM)患者血清趋化素及骨代谢标志物与骨密度的相关性及其对骨质疏松症的预测价值。方法选择2019年9月至2021年6月福建医科大学附属泉州第一医院(泉州医学高等专科学校教学医院)内分泌科收治的321例绝经后女性T2DM患者为研究对象,采用双能X线骨密度仪检测腰椎、股骨颈及全股骨的骨密度T值,按照T值将患者分为骨量正常组(n=114)、骨量减少组(n=117)和骨质疏松症组(n=90)。比较3组患者的年龄、糖尿病病程、体质量指数(BMI)等临床资料;采用双抗体夹心酶联免疫吸附试验法定量检测3组患者血清趋化素水平,葡萄糖氧化酶法检测3组患者空腹血糖(FPG)水平,高压液相色谱法检测3组患者糖化血红蛋白(HbA1c)水平,电化学发光法检测3组患者血清C肽(FCP)、25-羟基维生素D[25(OH)D]、甲状旁腺激素(PTH)、总骨Ⅰ型前胶原N端肽(T-P1NP)、β-胶原特殊序列(β-CTX)水平;采用Pearson和多重线性回归分析腰椎、股骨颈及全股骨的骨密度与年龄、糖尿病病程、体质量指数(BMI)、血清趋化素及骨代谢标志物的相关性。结果3组患者的FPG、FCP、HbA1c、PTH水平比较差异无统计学意义(F=0.414、0.699、0.190、1.651,P>0.05)。骨质疏松症组患者的年龄显著大于骨量减少组和骨量正常组,糖尿病病程显著长于骨量减少组和骨量正常组,T-P1NP、β-CTX、血清趋化素水平显著高于骨量减少组和骨量正常组,BMI、25(OH)D水平显著低于骨量减少组和骨量正常组(P<0.05);骨量减少组患者的年龄大于骨量正常组,糖尿病病程显著长于骨量正常组,T-P1NP、β-CTX、血清趋化素水平显著高于骨量正常组,BMI、25(OH)D水平显著低于骨量正常组(P<0.05)。Pearson回归分析结果显示,腰椎骨密度与BMI、25(OH)D呈正相关(r=0.336、0.184,P<0.05),与年龄、T-P1NP、β-CTX、血清趋化素呈负相关(r=-0.594、-0.294、-0.489、-0.359,P<0.05);股骨颈骨密度与BMI、25(OH)D呈正相关(r=0.313、0.228,P<0.05),与年龄、糖尿病病程、T-P1NP、β-CTX、血清趋化素呈负相关(r=-0.577、-0.178、-0.223、-0.378、-0.336,P<0.05);全股骨骨密度与BMI、25(OH)D呈正相关(r=0.400、0.225,P<0.05),与年龄、糖尿病病程、T-P1NP、β-CTX、血清趋化素呈负相关(r=-0.487、-0.160、-0.235、-0.392、-0.373,P<0.05)。多重线性回归分析显示,年龄、BMI、25(OH)D、T-P1NP、β-CTX是影响腰椎骨密度的因素(β=-0.010、0.013、0.005、-0.001、-0.274,P<0.05);年龄、糖尿病病程、BMI、25(OH)D、β-CTX和血清趋化素是影响股骨颈骨密度的因素(β=-0.008、-0.003、0.012、0.005、-0.152、-0.001,P<0.05);年龄、糖尿病病程、BMI、25(OH)D、β-CTX和血清趋化素是影响全股骨骨密度的因素(β=-0.008、-0.004、0.019、0.006、-0.152、-0.001,P<0.05)。结论绝经后女性T2DM患者的骨密度随着年龄的增长和糖尿病病程的延长呈下降趋势,BMI是绝经后女性T2DM患者骨密度的保护性因素;血清趋化素、25(OH)D、T-P1NP、β-CTX水平与绝经后女性T2DM患者腰椎、股骨颈及全股骨的骨密度存在一定的相关性,可作为绝经后女性T2DM并发骨质疏松症的预测指标。

Objective To investigate the correlation between serum chemokines,bone metabolic markers and bone mineral density in postmenopausal women with type 2 diabetes mellitus(T2DM)and their predictive value for osteoporosis.Methods A total of 321 postmenopausal women with T2DM admitted to Department of Endocrinology,Quanzhou First Hospital Affiliated to Fujian Medical University(Quanzhou Medical College Teaching Hospital)from September 2019 to June 2021 were selected as the research objects.The T value of bone mineral density of lumbar vertebrae,femoral neck and whole femur was measured by dual-energy X-ray bone densitometer,and the patients were divided into the normal bone density group(n=114),osteopenia group(n=117)and osteoporosis group(n=90)according to the T value.The clinical data including age,duration of diabetes and body mass index(BMI)of patients in the three groups were compared.The serum chemerin was quantitatively determined by double antibody sandwich enzyme-linked immunosorbent assay;the fasting blood glucose(FPG)was measured by glucose oxidase method;the level of glycosylated hemoglobin(HbA1c)was detected by high pressure liquid chromatography,and the levels of serum C-peptide(FCP),25-hydroxyvitamin D[25(OH)D],parathyroid hormone(PTH),total bone type Ⅰ procollagen N-terminal peptide(T-P1NP)and β-crosslaps(β-CTX)were measured by electrochemiluminescence.The correlation between the age,duration of diabetes,BMI,serum chemerin,bone metabolic markers and BMD of lumbar vertebrae,femoral neck and whole femur was analyzed by Person correlation analysis and multiple linear regression.Results There was no significant difference in level of FPG,FCP,HbA1c and PTH of patients among the three groups(F=0.414,0.699,0.190,1.651,P>0.05).The age of patients in the osteoporosis group was significantly higher than that in the osteopenia group and normal bone density group(P<0.05);the duration of diabetes of patients in the osteoporosis group was significantly longer than those in the osteopenia group and normal bone density group(P<0.05);the levels of T-P1NP,β-CTX and serum chemerin were significantly higher than those in the osteopenia group and normal bone density group(P<0.05);the BMI and 25(OH)D level were significantly lower than those in the osteopenia group and normal bone density group(P<0.05).The age of patients in the osteopenia group was significantly higher than that in the normal bone density group(P<0.05);the duration of diabetes of patients in the osteopenia group was significantly longer than that in the normal bone density group(P<0.05);the levels of T-P1NP,β-CTX and serum chemerin were significantly higher than those in the normal bone density group(P<0.05);the BMI and 25(OH)D level were significantly lower than those in the normal bone density group(P<0.05).Pearson regression analysis showed that bone mineral density of lumbar was positively correlated with BMI and 25(OH)D(r=0.336,0.184;P<0.05),and it was negatively correlated with age,T-P1NP,β-CTX and serum chemerin(r=-0.594,-0.294,-0.489,-0.359;P<0.05).The bone mineral density of femoral neck was positively correlated with BMI and 25(OH)D(r=0.313,0.228;P<0.05),and it was negatively correlated with age,duration of diabetes,T-P1NP,β-CTX,serum chemerin(r=-0.577,-0.178,-0.223,-0.378,-0.336;P<0.05).The bone mineral density of whole femur was positively correlated with BMI and 25(OH)D(r=0.400,0.225;P<0.05),and it was negatively correlated with age,duration of diabetes,T-P1NP,β-CTX and serum chemerin(r=-0.487,-0.160,-0.235,-0.392,-0.373;P<0.05).Multiple linear regression analysis showed that the age,BMI,25(OH)D,T-P1NP andβ-CTX were the factors affecting lumbar bone mineral density(β=-0.010,0.013,0.005,-0.001,-0.274;P<0.05).The age,duration of diabetes,BMI,25(OH)D,β-CTX and serum chemerin were the factors affecting femoral neck BMD(β=-0.008,-0.003,0.012,0.005,-0.152,-0.001;P<0.05).The age,duration of diabetes,BMI,25(OH)D,β-CTX and serum chemerin were the factors affecting the whole femur bone mineral density(β=-0.008,-0.004,0.019,0.006,-0.152,-0.001;P<0.05).Conclusion The bone mineral density of postmenopausal women with T2DM decreased with age and the duration of diabetes mellitus;BMI was a protective factor of bone mineral density in postmenopausal women with T2DM;the serum chemerin and 25(OH)D,T-P1NP,β-CTX levels have a certain correlation with bone mineral density of lumbar vertebrae,femoral neck and whole femur in postmenopausal women with T2DM,those can be used as a predictor of postmenopausal women with T2DM complicated with osteoporosis.