老年男性初发2型糖尿病患者鞘氨醇-1-磷酸与骨代谢的相关性

Correlation between serum sphingosine-1-phosphate level and bone metabolism in elderly male patients with newly diagnosed type 2 diabetes mellitus

目的 探讨鞘氨醇-1-磷酸(sphingosine-1-phosphate, S1P)与骨转换标志物、骨密度和骨折发生风险的相关性。方法 纳入59例老年男性初发2型糖病患者作为2型糖尿病(type 2 diabetes mellitus, T2DM)组,49例非糖尿病居民作为非糖尿病(non diabetes mellitus, NDM)组,收集临床资料,采集静脉血,检查骨密度,计算FRAX评分,比较两组一般资料、糖脂代谢和骨代谢生化指标、骨密度、骨折发生风险及S1P水平的差异,分析S1P与骨转换标志物、骨折发生风险和糖代谢指标的相关性。结果 与NDM组比较,T2DM组空腹血糖(fasting plasma glucose, FPG)、糖化血红蛋白(glycosylated hemoglobin Alc, HbAlc)、游离脂肪酸(free fatty acids, FFA)显著升高(P<0.01),总胆固醇(total cholesterol, TC)、甘油三酯(triglycerides, TG)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol, LDL-C)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol, HDL-C)差异无统计学意义(P≥0.05);T2DM组甲状旁腺激素(parathyroid hormone, PTH)显著降低(P<0.01),钙(calcium, Ca)、磷(phosphorus, P)差异无统计学意义(P≥0.05);T2DM组骨钙素(osteocalcin, OC)、骨型碱性磷酸酶(bone alkaline phosphatase, BALP)、β-Ⅰ型胶原C端肽(β cross-linked c-telopeptide, β-CTX)显著降低(P<0.01),Ⅰ型胶原氨基端延长肽(procollagen type 1 n-terminal propetide, PlNP)、抗酒石酸酸性磷酸酶-5b(tartrate-resistant acid phosphatase-5b, TRACP-5b)和不同部位骨密度差异无统计学意义(P≥0.05);T2DM组10年内主要骨质疏松性骨折风险FRAX评分(FRAX 10-year major osteoporotic fracture risk score, FRAXM)和10年内髋部骨折风险FRAX评分(FRAX 10-year hip fracture risk score, FRAXH)显著升高(P<0.01);T2DM组血清S1P显著高于NDM组(P<0.01)。NDM组S1P与TRACP-5b呈正相关(P<0.05);T2DM组S1P与5种传统骨代谢标志物均无相关性(P≥0.05)。两组血清S1P与骨密度、FRAXM和FRAXH均无相关性(P≥0.05)。两组血清S1P与FPG和HbAlc均无相关性(P≥0.05)。结论 老年男性T2DM组血清S1P水平升高,S1P与传统骨转换标志物、骨密度、FRAXM和FRAXH无相关性。NDM组血清S1P与TRACP-5b呈正相关。

Objective To investigate the correlation between serum sphingosine-1-phosphate(S1P) level and bone metabolism in patients with type 2 diabetes mellitus(T2DM). Methods Fifty-nine elderly male patients with newly diagnosed T2DM and 49 non-diabetic subjects(NDM) were included in this study. The serum SIP, bone metabolism biochemical indicators were measured;bone mineral density and FRAX scores were evaluated and compared between the two groups. The correlation of serum S1P level with bone turnover markers, bone mineral density, fracture risk and glucose metabolism indexes were analyzed. Results Compared with those in NDM group, the fasting plasma glucose(FPG), glycosylated hemoglobin Alc(HbAlc), free fatty acids(FFA) were significantly higher in T2DM group(P<0.01);there was no significant difference in total cholesterol(TC), triglycerides(TG), low density lipoprotein cholesterol(LDL-C) and high density lipoprotein cholesterol(HDL-C) between two groups(P≥0.05). In T2DM group, parathyroid hormone(PTH) decreased significantly(P<0.01), and there was no significant difference in calcium(Ca) and phosphorus(P)(P≥0.05). In T2DM group, osteocalcin(OC), bone alkaline phosphatase(BALP), β cross-linked c-telopeptide(β-CTX) decreased significantly(P<0.01), and there was no significant difference in procollagen type 1 N-terminal peptide(P1NP), tartrate resistant acid phosphatase-5b(TRACP-5b) and bone mineral density in all sites(P≥0.05). In T2DM group, the FRAX 10-year major osteoporotic fracture risk score(FRAXM) and the FRAX 10-year hip fracture risk score(FRAXH) were significantly increased(P<0.01);serum S1P in T2DM group was significantly higher than that in NDM group(P<0.01). In NDM group serum S1P was positively correlated with TRACP-5b(P<0.05);and there was no correlation between S1P and 5 traditional bone turnover markers in T2DM group(P≥0.05). There was no correlation of serum S1P with bone mineral density, FRAXM, FRAXH, FPG and HbAlc in the two groups(P≥0.05). Conclusion The serum level of S1P in elderly male T2DM group is increased, and there is no correlation of S1P with bone turnover markers, bone mineral density, FRAXM and FRAXH. There is a positive correlation between serum S1P andTRACP-5b in NDM group.