T2DM伴骨质疏松Cys-C、25(OH)D_(3)、BGP变化及临床意义

Changes and clinical significance of Cys-C,25(OH)D_(3),and BGP in T2DM patients with osteoporosis

目的探究老年2型糖尿病(T2DM)伴骨质疏松患者血清胱抑素C(Cys-C)、25羟维生素D_(3)[25(OH)D_(3)]、骨钙素(BGP)水平变化,并分析其对骨质疏松性骨折的预测价值。方法选取2020年2月至2022年5月本院88例老年T2DM伴骨质疏松患者作为研究组,另选同期88例老年T2DM骨量减少患者作为对照A组,88例老年T2DM骨量正常患者作为对照B组。比较各组血清Cys-C、25(OH)D_(3)、BGP水平、血糖指标、血脂指标、骨矿物质密度(BMD),分析研究组血清各指标水平与血糖指标、血脂指标、BMD的相关性。研究组均行常规对症治疗6个月,依据是否发生骨质疏松性骨折分为发生者、未发生者,比较治疗前后血清各指标水平及变化值,分析其对骨折的预测价值。结果研究组血清Cys-C水平高于对照A组、对照B组,25(OH)D_(3)、BGP水平低于对照A组、对照B组(P<0.05);Cys-C水平与BMD呈负相关,25(OH)D_(3)、BGP水平与BMD呈正相关(P<0.05);发生者治疗前后血清Cys-C水平高于未发生者,25(OH)D_(3)、BGP水平低于未发生者,各指标变化值低于未发生者(P<0.05);血清各指标变化值降低可增加骨质疏松性骨折发生风险(P<0.05);治疗3个月后血清各指标变化值联合预测骨质疏松性骨折的AUC大于治疗1个月后(P<0.05)。结论老年T2DM伴骨质疏松患者血清Cys-C水平升高,25(OH)D_(3)、BGP水平降低,联合检测其水平变化对骨质疏松性骨折具有一定预测价值。

Objective To investigate the changes in serum cystatin C(Cys-C),25 hydroxyvitamin D_(3)[25(OH)D_(3)],and osteocalcin(BGP)levels in elderly patients with type 2 diabetes mellitus(T2DM)and osteoporosis,and to analyze their predictive value for osteoporotic fractures.Methods Eighty-eight elderly patients with T2DM and osteoporosis in our hospital from February 2020 to May 2022 were selected in the study group,88 elderly patients with reduced bone mass and T2DM in the same period were selected in control group A,and 88 elderly patients with normal bone mass and T2DM were selected in control group B.Serum levels of Cys-C,25(OH)D_(3),and BGP,blood glucose indexes,lipid indexes,and bone mineral density(BMD)were compared among the groups.The correlation between serum levels of each index and blood glucose index,lipid index,and BMD in the study group was analyzed.Patients in the study groups were treated with conventional symptomatic therapy for 6 months,and were divided into the group with or without osteoporotic fractures according to whether osteoporotic fractures occurred.The levels and changes of serum indicators were compared before and after 1,3 and 6 months of the treatment.The research group received routine symptomatic treatment for 6 months,and were divided into the group with or without osteoporosis fractures.The levels and changes of various serum indicators were compared before and after the treatment.The predictive value for fractures was analyzed.Results Serum Cys-C levels in the study group were higher than those in control group A and B,while the levels of 25(OH)D_(3)and BGP were lower than those in control group A and B(P<0.05).Cys-C levels were negatively correlated with BMD,and 25(OH)D_(3)and BGP levels were positively correlated with BMD(P<0.05).Serum Cys-C levels in those who occurred were higher than in those who did not occur.25(OH)D_(3)and BGP levels were lower than those who did not occur.The change values of each index were lower than those who did not occur(P<0.05).Decreased values of change in serum indices increased the risk of osteoporotic fracture(P<0.05).The AUC of change in serum indices after 3 months of the treatment was greater than that after 1 month of the treatment for the prediction of osteoporotic fractures(P<0.05).Conclusion In elderly patients with T2DM and osteoporosis,serum Cys-C levels elevate and 25(OH)D_(3)and BGP levels decrease.The combined detection of their level changes has some predictive value for osteoporotic fractures.