25(OH)D_(3)、Omentin-1与老年2型糖尿病患者合并骨质疏松的相关性分析

Analysis of the correlation between 25(OH)D_(3),Omentin-1,and comorbid osteoporosis in elderly patients with type 2 diabetes mellitus

目的探讨25-羟维生素D_(3)[25(OH)D_(3)]、网膜素-1(omentin-1)与老年2型糖尿病(T2DM)患者合并骨质疏松的相关性,以期为临床治疗提供参考。方法选取2019年2月—2020年2月河南省舞阳县人民医院收治的246例T2DM患者为研究对象。根据骨密度(BMD)将患者分为T2DM骨量正常组、T2DM骨量减少组、T2DM骨质疏松组,各82例。另选同期在我院做体检的82例健康者作为对照组。比较4组研究对象低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、总胆固醇(TC)、糖化血红蛋白(Hb A1c)、空腹胰岛素(FBG)、25(OH)D_(3)、Omentin-1、抗酒石酸酸性磷酸酶-5b(TRAP-5b)、骨钙素(OCN)水平等。采用Pearson相关分析T2DM骨质疏松组患者血清25(OH)D_(3)、Omentin-1水平与骨密度(股骨颈、腰椎、股骨粗隆、股骨BMD)的关系。结果T2DM骨量正常组、T2DM骨量减少组、T2DM骨质疏松组研究对象FBG、LDL-C、TRAP-5b水平及Hb A1c、稳态模式胰岛素抵抗指数(HOMA-IR)高于对照组,而HDL-C、OCN水平低于对照组,差异均有统计学意义(P<0.05)。T2DM骨量减少组、T2DM骨质疏松组股骨颈、腰椎、股骨粗隆、股骨BMD低于T2DM骨量正常组,差异有统计学意义(P<0.05);T2DM骨质疏松组股骨颈、腰椎、股骨粗隆、股骨BMD低于T2DM骨量减少组,差异均有统计学意义(P<0.05)。T2DM骨量正常组、T2DM骨量减少组、T2DM骨质疏松组血清25(OH)D_(3)、Omentin-1水平低于对照组,差异有统计学意义(P<0.05)。T2DM骨质疏松组患者血清25(OH)D_(3)、Omentin-1水平均与股骨颈、腰椎、股骨粗隆、股骨BMD呈正相关关系(P<0.05)。结论T2DM患者血清中25(OH)D_(3)、Omentin-1水平随着患者骨量的减少而逐渐下降。临床工作中加强对T2DM患者外周血中25(OH)D_(3)、Omentin-1的检测与监控,有助于及时了解患者骨吸收状态,早期发现T2DM并发骨质疏松,以给予更具针对性的治疗方案。

Objective This paper aims to investigate the correlation between 25-hydroxyvitamin D_(3)[25(OH)D_(3)],omentin-1,and comorbid osteoporosis in elderly patients with type 2 diabetes mellitus(T2DM).Methods From Feb.2019 to Feb.2020,246 patients with T2DM were enrolled at People's Hospital of Wuyang.According to bone mineral density(BMD),the patients were assigned to the T2DM normal bone mass,T2DM osteopenia,and T2DM osteoporosis groups,with 82 cases in each group.Another 82 healthy participants who underwent physical examination in our hospital during the same period were selected as the controls.Low-density lipoprotein cholesterol(LDL-C),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),total cholesterol(TC),glycosylated hemoglobin(HbA1c),fasting insulin(FBG),25(OH)D_(3),Omentin-1,tartrate-resistant acid phosphatase-5b(TRAP-5b),and osteocalcin(OCN)levels were compared among the four groups.Pearson correlation was used to analyze the relationship between serum 25(OH)D_(3),Omentin-1 levels and BMD at the femoral neck,lumbar spine,femoral trochanter,and femur in T2DM patients comorbid with osteoporosis.Results The levels of FBG,LDL-C,TRAP-5b,HbA1c,and homeostasis modelinsulin resistance index(HOMA-IR)in T2DM with normal bone mass,T2DM with osteopenia and T2DM with osteoporosis groups were higher than those in the control group,while the levels of HDL-C,OCN,were lower than those in the control group,with statistical significance(P<0.05).BMD at the femoral neck,lumbar spine,femoral trochanter,and femur was significantly lower in the T2DM with osteopenia and T2DM with osteoporosis groups than that in the T2DM with normal bone mass group(P<0.05);BMD at the femoral neck,lumbar spine,femoral trochanter,and femur was significantly lower in the T2DM with osteoporosis group than in the T2DM with osteopenia group(P<0.05).Serum 25(OH)D_(3)and Omentin-1 water were lower in the T2DM with normal bone mass,T2DM with osteopenia,and T2DM with osteoporosis groups than in the control group,and the differences were statistically significant(P<0.05).Serum 25(OH)D_(3)and Omentin-1 levels were positively correlated with BMD at the femoral neck,lumbar spine,femoral trochanter and femur in T2DM patients comorbid with osteoporosis(P<0.05).Conclusion The serum levels of 25(OH)D_(3)and Omentin-1 in patients with T2DM decreased gradually with decreasing in bone mass.We should strengthen the detection and monitoring of 25(OH)D_(3)and Omentin-1 in the peripheral blood of T2DM patients,which is helpful to understand the bone resorption status of patients timely and early detect T2DM accompanied by osteoporosis,so as to provide a more targeted treatment plan.