中国骨质疏松杂志

IGF-1、IGFBP-3、TNF-α对绝经后2型糖尿病骨质疏松疗效评价的意义

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

DOI：10.3969/j.issn.1006-7108.2023.12.010

中文关键词: 绝经后骨质疏松 2型糖尿病胰岛素样生长因子-1 胰岛素样生长因子结合蛋白-3 肿瘤坏死因子-α

英文关键词:postmenopausal osteoporosis type 2 diabetes mellitus insulin-like growth factor-1 insulin-like growth factor binding protein-3 tumor necrosis factor-α

基金项目:

作者	单位
虎静1 雷涛2∗	1.宁夏回族自治区人民医院内分泌科，宁夏银川 750001 2.上海中医药大学附属普陀医院内分泌科，上海 200333

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中文摘要:

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。

英文摘要:

Objective To observe the expression characteristics of IGF-1, IGF-BP-3, and TNF-α in 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-α on 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-α were 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-α decreased 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-α decreased, 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 between β-CTX and TNF-α, and a negative correlation between β-CTX and IGFBP-3 BP-3, with statistical significance (P<0.05). Conclusion IGF-1, IGFBP-3, and TNF-α are 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 index β-CTX decreases. At the same time, BMD increases effectively, and IGF-1 and IGFBP-3 increase, and TNF-α decreases. By detection of IGF-1, IGFBP-3, and TNF-α combined with the improvement of bone metabolism index, the therapeutic effect of osteoporosis can be effectively evaluated.

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