血清骨硬化蛋白及戊糖素与2型糖尿病肾病患者并发肌少症的关系

The relationship between serum sclerostin,pentosidine and patients with type 2 diabetic nephropathy complicated with sarcopenia

目的探讨血清骨硬化蛋白(SOST)、戊糖素(PTD)与2型糖尿病肾病(T2DN)患者并发肌少症的关系。方法选取2021年1月—2023年1月山西省长治市人民医院内分泌科收治T2DN患者277例,根据是否并发肌少症分为肌少症组85例和非肌少症组192例。采用酶联免疫吸附法检测血清SOST、PTD水平;Spearman相关性分析T2DN并发肌少症患者血清SOST、PTD水平与肌少症指标[四肢骨骼肌质量指数(ASMI)、握力、步速和5次坐起时间]的相关性;多因素Logistic回归分析T2DN患者并发肌少症的影响因素;受试者工作特征(ROC)曲线分析血清SOST、PTD水平对T2DN患者并发肌少症的诊断价值。结果肌少症组血清SOST、PTD水平高于非肌少症组(t=7.777、7.854,P均<0.001)。血清SOST、PTD水平与T2DN并发肌少症患者ASMI、握力、步速呈负相关(SOST:r s=-0.734、-0.725、-0.762;PTD:r s=-0.720、-0.732、-0.755,P均<0.001),与5次坐起时间呈正相关(r s=0.722、0.729,P均<0.001);多因素Logistic回归分析显示骨密度增加、ASMI增加、握力增加、步速加快为T2DN患者并发肌少症的独立保护因素[OR(95%CI)=0.875(0.779~0.982)、0.716(0.598~0.857)、0.509(0.366~0.707)、0.824(0.780~0.870)],5次坐起时间增加、SOST升高、PTD升高为独立危险因素[OR(95%CI)=1.427(1.159~1.757)、1.056(1.023~1.090)、1.019(1.006~1.031)];血清SOST、PTD及二者联合诊断T2DN患者并发肌少症的曲线下面积(AUC)分别为0.793、0.796、0.897,二者联合的AUC大于血清SOST、PTD水平单独诊断的AUC(Z=4.277、3.825,P均<0.001)。结论血清SOST、PTD水平与T2DN并发肌少症密切相关,二者升高是T2DN患者并发肌少症的独立危险因素,联合检测血清SOST、PTD水平对T2DN患者并发肌少症具有较高的诊断价值。

Objective To investigate the relationship between serum sclerostin(SOST),pentosidine(PTD)and patients with type 2 diabetic nephropathy(T2DN)complicated with sarcopenia.Methods 277 patients with T2DN admitted to the Department of Endocrinology of Changzhi People's Hospital of Shanxi Province,from January 2021 to January 2023 were selected and patients were divided into sarcopenia group(85 cases)and non-sarcopenia group(192 cases)according to whether or not they were complicated with sarcopenia.ELISA was used to detect serum SOST and PTD levels;Spearman's correlation was used to analyze the correlation between serum SOST and PTD levels and the indicators of sarcopenia[appendicular skeletal muscle mass index(ASMI),grip strength,stride speed,and 5 sit-up time]in patients with T2DN complicated with sarcopenia;the factors affecting sarcopenia were analyzed by multifactorial Logistic regression;the diagnostic value of serum SOST and PTD levels for T2DN patients complicated with sarcopenia was analyzed by using receiver operating characteristic(ROC)curves.Results Serum SOST and PTD levels were higher in the sarcopenia group than in the non-sarcopenia group(t=7.777,7.854,all P<0.001).Serum SOST and PTD levels were negatively correlated with ASMI,grip strength,and step speed in patients with T2DN complicated with sarcopenia(SOST:r s=-0.734,-0.725,-0.762;PTD:r s=-0.720,-0.732,-0.755,all P<0.001),and positively correlated with the 5 sitting times(r s=0.722,0.729,all P<0.001);Multifactorial Logistic regression analysis showed that increased bone mineral density,increased ASMI,increased grip strength,and accelerated step speed were independent protective factors for the patients with T2DN complicated with sarcopenia[OR(95%CI)=0.875(0.779-0.982),0.716(0.598-0.857),0.509(0.366-0.707),0.824(0.780-0.870)],and that increased time to 5 sitting times,increased SOST,and increased PTD were independent risk factors[OR(95%CI)=1.427(1.159-1.757),1.056(1.023-1.090),1.019(1.006-1.031)];The area under the curve(AUC)for serum SOST,PTD and the combination of the two for the diagnosis of patients with T2DN complicated with sarcopenia was 0.793,0.796,and 0.897,respectively,and the AUC for the combination of the two was greater than that for the serum SOST and PTD levels alone(Z=4.277,3.825,all P<0.001).Conclusion The serum SOST and PTD levels are closely relate to T2DN complicated with sarcopenia,and elevated levels of both are independent risk factors for patients with T2DN complicated with sarcopenia.The combined detection of serum SOST and PTD levels have high diagnostic value for patients with T2DN complicated with sarcopenia.