中国骨质疏松杂志

与正常人群比较2型糖尿病患者骨转换标志物特点及分析

A study of biochemical bone turnover markers in type 2 diabetes mellitus

DOI：10.3969/j.issn.1006.7108.2018.09.008

英文关键词:type 2 diabetes mellitus biochemical bone turnover markers osteoporosis

基金项目:北京市优秀人才培养资助青年骨干个人项目（2017000021469G260）

作者	单位
李伟1 孔卓2 王志新1 王红1 邓微1*	1.北京积水潭医院内分泌科，北京 100035；2.北京积水潭医院检验科，北京 100035

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中文摘要:

目的研究2型糖尿病患者骨转换标志物的变化情况。方法选取2型糖尿病患者（822例）为T2DM组；健康人群（821例）为对照组。比较两组间的骨转换标志物【血钙，血磷（P），血磷碱性磷酸酶（ALP），总Ⅰ型前胶原氨基端延长肽（tP1NP）,Ⅰ型胶原羧基端肽β特殊序列（β-CTX），骨钙素（OC），25羟维生素D（25OHD），甲状旁腺素（PTH）】；并分析T2DM组上述指标与糖化血红蛋（HbA1c)，空腹血糖（FPG）、糖尿病病程、年龄等指标的关系。同时根据《维生素 D 与成年人骨骼健康应用指南 ( 2014年标准版) 》将T2DM组患者按25OHD的水平分为维生素D（VitD）充足（≥20ng /ml）、VitD不足（12～20 ng /mL）和VitD缺乏（＜12 ng /mL）3个亚组，比较分析T2DM患者不同维生素 D水平的3个亚组各参数的差别。结果 T2DM组的β-CTX、OC、25OHD水平均低于对照组（P＜0.05），PTH水平高于对照组（P＜0.05）。T2DM组中OC的主要影响因素有tP1NP、β-CTX、PTH、HbA1c（标准β=0.533、0.256、0.163、-0.127，P＜0.05）；β-CTX的主要影响因素有OC、tP1NP、HbA1c、年龄（标准β=0.415、0.215、-0.149、-0.077，P＜0.05），25OHD的主要影响因素有Ca、HbA1c、PTH、P（标准β=0.250、-0.149、-0.155、-0.130，P＜0.05）。2型糖尿病患者VitD充足组、VitD不足组的FPG、HbA1c水平均低于VitD缺乏组（P＜0.05），血钙水平均高于VitD缺乏组（P＜0.05）。VitD充足组、VitD不足组的PTH水平均低于VitD缺乏组（P＜0.05）；三组间tP1NP、β-CTX、OC无明显差异（P＞0.05）。结论 2型糖尿病患者较正常人群β-CTX、OC、25OHD减低，PTH升高；其改变独立于25OHD的变化；受到血糖代谢的影响。

英文摘要:

Objective To investigate the biochemical bone turnover markers in patients with type 2 diabetes mellitus (T2DM). Methods A total of 822 subjects with T2DM were enrolled in this study as the study group (T2DM group), and 821 healthy subjects were selected as the control group. The levels of bone turnover markers between the two groups were compared, including serum calcium (Ca), serum phosphorus (P), alkaline phosphatase (ALP), total procollagen type Ⅰ amino-terminal propeptide (tP1NP), β isomer of the C-terminal telopeptide of type I collagen (β-CTX), osteocalcin (OC), 25 hydroxy vitamin D (25OHD), and parathyroid hormone (PTH). In T2DM group, the relationship between the bone turnover markers and levels of glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), diabetic duration, and age were analyzed. According to the levels of 25OHD, T2DM patients were divided into 3 subgroups, sufficient vitamin D (VitD) group (≥20 ng/mL), insufficient VitD group (≥ 12ng/mL but <20ng/mL), and deficient VitD group (<12ng/ml). The levels of bone turnover markers among 3 subgroups were compared. Results Compared with control group, T2DM group had lower levels of β-CTX, OC, 25OHD, and higher levels of PTH (all P < 0.05). In T2DM group, the multiple linear regression analysis showed that OC was correlated with tP1NP, β-CTX, PTH, and HbA1c (standard β =0.533, 0.256, 0.163, and -0.127, respectively; all P < 0.05), β-CTX was correlated with OC, tP1NP, HbA1c and age (standard β =0.415, 0.215, -0.149, and -0.077, respectively; P < 0.05), and 25OHD was correlated with Ca, HbA1c, PTH, and P (standard β = 0.250, -0.149, -0.155, and -0.130, respectively; P < 0.05). The analysis in subgroups showed that compared with deficient VitD subgroup, sufficient VitD subgroup and insufficient VitD subgroup had lower levels of FBG, HbA1c, and PTH, and higher levels of calcium (all P < 0.05). There were no significant differences in the levels of tP1NP, β-CTX, and OC among 3 subgroups. Conclusion Compared with normal people, patients with T2DM have lower levels of β-CTX, OC, and 25OHD, and higher levels of PTH. The change is independent of levels of 25OHD and is affected by blood glucose metabolism.

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