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| 甲状旁腺激素和 25 羟维生素 D 对 2 型糖尿病患者并发骨质疏松症的影响及筛查价值 |
| Effects of parathyroid hormone and 25-hydroxy vitamin D for T2DM patients complicated with osteoporosis and their values of screening on disease |
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| DOI： |
| 中文关键词: 糖尿病，2 型 骨质疏松症 甲状旁腺激素 25 羟维生素 D |
| 英文关键词:Diabetes Mellitus,type 2 Osteoporosis Parathyroid hormone 25-hydroxy vitamin D |
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| 中文摘要: |
| 目的 探讨甲状旁腺激素(PTH)及 25 羟维生素 D(25OHD)水平对于 2 型糖尿病(T2DM)并发骨质疏松症(OP)的影响，并分析其对于疾病的筛查价值。方法 选取 2014 年 9 月至 2015 年 11 月收治的 329 例 T2DM 患者，根据双能 X 线骨密度仪(DXA)测定结果，将患者分为骨量正常组(A 组，n =124)、骨量减少组(B 组，n =159)、骨质疏松症组(C 组，n =46)，采用病例对照研究方法，分析不同骨密度组及不同季节就诊患者间 PTH、25OHD 水平的差异;探讨 PTH、25OHD 之间及与骨标志物Ⅰ
型前胶原氨基端延长肽(PⅠNP)、β 胶原特殊序列(β-CTX)间的相关性;采用有序 Logistic 回归分析 PTH、25OHD 对 T2DM 并发 OP 的影响，并观察其对于 OP 的筛查价值。结果 1． 三组之间 PTH 水平比较，C 组明显高于 B 组、B 组明显高于 A 组;25OHD 水平比较，C 组明显低于 B 组、B 组明显低于 A 组。2． 秋季就诊者 25OHD 水平明显高于冬春季;PTH 水平差异无统计学意义。3． 偏相关分析表明:PTH 与 PⅠNP、β-CTX 呈明显正相关;25OHD 与 PTH、PⅠNP、β-CTX 呈明显负相关。4． 有序
Logistic 回归分析 PTH、25OHD 对于 T2DM 并发 OP 的影响显示:PTH:OＲ =6. 265;25OHD:OＲ =0. 369。5． 受试者工作特征曲线(ＲOC 曲线)显示，PTH、25OHD 对于 OP 诊断的截断点分别为:≥46. 58 pg/ml、≤14. 70 ng/ml。结论 PTH 水平增高患者更易患骨量减少及骨质疏松症，是发病的危险因素;而 25OHD 水平增高是发病的保护因素。不同季节 25OHD 水平不同，应特别注意冬春季节 25OHD 的补充。PTH、25OHD 的检测不仅有助于识别 T2DM 并发 OP 的发病风险，还是疾病快速、无创、敏感的筛查指标。 |
| 英文摘要: |
| Objective To explore the effect of parathyroid hormone(PTH) and 25-hydroxy vitamin D(25OHD) for T2DM
patients complicated with osteoporosis and their values of screening on disease． Methods A total of 329 patients with T2DM from
September 2014 to November 2015 were divided into three different groups according to the bone mineral density(BMD) results:
normal BMD group(group A，124 cases)，osteopenia group(group B，159 cases)，osteoporosis group(group C，46 cases)． By
using case-control study，the levels of PTH，25OHD in different BMD groups and different patient visit seasons were compared，and the correlation between PTH and 25OHD and Bone metabolic markers(P1NP and β-CTX) were also analyzed． Furthermore，we
analyzed the relationship of PTH，25OHD and osteopenia，osteoporosis by using Ordinal Logistic regression analysis，and the value
on screening osteoporosis in T2DM patients by using ＲOC curve analysis． Ｒesults 1． The level of PTH in group C were
significantly higher than those in group B，and group B were significantly higher than those in group A． On the contrary，the level
of 25OHD in group C were significantly lower than those in group B，and group B were significantly lower than those in group． 2．
The level of 25OHD in the patients visit in autumn were significantly than those in the patients visit in spring and in winter，and
there were no significantly difference on the level of PTH between the different patients visit seasons． 3． Partial correlation analysis
showed that PTH were significantly positive correlated with P1NP and β-CTX，25OHD were significantly negative correlated with
PTH，P1NP and β-CTX． 4． Ordinal Logistic regression analysis of PTH and 25OHD reveal: PTH: OＲ = 6. 265. 25OHD: OＲ =
0. 369． The level of PTH was positively correlated with the incidence of osteopenia and osteoporosis，which is the risk factor of the
disease． But the level of 25OHD was the opposite，which is the protective factor of the disease． 5． Ｒeceiver operating characteristic
curve(ＲOC curve) indicated: the cut-off value for osteoporosis of these markers: PTH: ≥46. 58 pg/ml; 25OHD: ≤14. 7 ng/ml．
Conclusions Increased PTH level are more likely to associate with osteopenia and osteoporosis as risk factors． However，
increased 25OHD level are protective factor for the disease． The level of 25OHD was not the same in different seasons． PTH，
25OHD screening not only helps to identify high-risk of T2DM complicated with osteoporosis，but also they were rapid，noninvasive
and sensitive screening indicators for the disease． |
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