IGF-1、IGFBP-3、TNF-α对绝经后2型糖尿病骨质疏松疗效评价

Evaluation of the efficacy of IGF-1,IGF-BP-3 and TNF-αon postmenopausal osteoporosis with type 2 diabetes mellitus

目的观察IGF-1、IGFBP-3、TNF-α在绝经后2型糖尿病(type 2 diabetes,T2DM)骨质疏松症(osteoporosis,OP)患者中的表达特点,以及经抗骨质疏松治疗前后骨密度(bone mineral density,BMD)、骨代谢的变化,探讨IGF-1、IGFBP-3、TNF-α作为OP疗效评判指标的可行性。方法选取2018年5月至2020年6月在上海市中医药大学附属普陀区中心医院就诊的T2DM合并绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)患者共95例,失访7例,最终纳入88例,化验治疗前及治疗1年后的IGF-1、IGFBP-3、TNF-α,并测量BMD。结果(1)IGF-1、IGFBP-3在抗骨质疏松药物治疗后水平均较前升高;而TNF-α则表达减少(P<0.05);(2)治疗后全髋、股骨颈及腰1~4的BMD以及IGF-1、IGFBP-3较治疗前有上升,TNF-α下降,Ward’s三角、大粗隆、股骨干的BMD变化不大;(3)治疗后β-CTX降低(P<0.05),TP1NP、25(OH)D升高(P<0.05),PTH和OC无明显变化;(4)治疗后,将各部位BMD与IGF-1、IGFBP-3、TNF-α等化验数据作相关性分析,提示股骨颈BMD与IGF-1、IGFBP-3存在正相关,腰1~4的BMD与TNF-α存在负相关,差异有统计学意义(P<0.05);(5)25(OH)D及TP1NP均与IGF-1、IGFBP-3存在正相关,与TNF-α负相关;β-CTX与TNF-α存在正相关,与IGFBP-3负相关,差异有统计学意义(P<0.05)。结论IGF-1、IGFBP-3、TNF-α与BMD、骨代谢的变化有一定关系,骨质疏松治疗后患者的骨形成指标TP1NP增加、25(OH)D增加,骨吸收指标β-CTX减少,同步发生变化的还有骨密度的有效提高,以及IGF-1、IGFBP-3的增加和TNF-α的降低。通过对IGF-1、IGFBP-3、TNF-α检测联合骨代谢指标的改善可以有效评估骨质疏松的治疗效果。

Objective To observe the expression characteristics of IGF-1,IGF-BP-3,and TNF-αin postmenopausal patients with type 2 diabetic osteoporosis(PMOP)and the changes of bone mineral density(BMD)before and after anti-osteoporosis treatment,and to explore the therapeutic efficacy of IGF-1,IGF-BP-3,and TNF-αon osteoporosis.Methods From May 2018 to June 2020,95 T2DM patients with PMOP were selected in Putuo Central Hospital affiliated to Shanghai University of Traditional Chinese Medicine.Among those,7 patients were lost,and 88 patients were included finally.BMD,IGF-1,IGF-BP-3,and TNF-αwere measured before and after the treatment for one year.Results(1)The levels of IGF-1 and IGF-BP-3 increased after the treatment with anti-osteoporosis drugs.However,the level of TNF-αdecreased with statistical difference(P<0.05).(2)After the treatment,BMD of the total hip,femoral neck.and L1-4,IGF-1 and IGF-BP-3 increased,TNF-αdecreased,and BMD of the Wards triangle,greater trochanter,and femoral shaft changed little.(3)After the treatment,β-CTX decreased(P<0.05),TP1NP and 25-OH-D increased(P<0.05),while PTH and OC had no obvious changes.(4)After the treatment,the correlation analysis between BMD and IGF-1,IGF-BP-3,TNF-α,and other laboratory data showed that BMD of the femoral neck was positively correlated with IGF-1 and IGF-BP-3,while BMD of L1-4 was negatively correlated with TNF-α,with statistical significance(P<0.05).(5)25-OH-D and TP1NP were positively correlated with IGF-1 and IGFBP-3,and were negatively correlated with TNF-α.There was a positive correlation betweenβ-CTX and TNF-α,and a negative correlation betweenβ-CTX and IGFBP-3 BP-3,with statistical significance(P<0.05).Conclusion IGF-1,IGFBP-3,and TNF-αare related to the changes of BMD and bone metabolism.After osteoporosis treatment,the bone formation index TP1NP increases,25-OH-D increases,but the bone resorption indexβ-CTX decreases.At the same time,BMD increases effectively,and IGF-1 and IGFBP-3 increase,and TNF-αdecreases.By detection of IGF-1,IGFBP-3,and TNF-αcombined with the improvement of bone metabolism index,the therapeutic effect of osteoporosis can be effectively evaluated.