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| 绝经后2型糖尿病患者RANKL蛋白表达水平与骨密度关系研究 |
| Relationship between RANKL protein expression and bone mineral density in postmenopausal patients with type 2 diabetes mellitus |
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| DOI：10.3969/j.issn.1006-7108.2025.11.006 |
| 中文关键词: RANKL蛋白 2型糖尿病 骨质疏松症 骨密度 |
| 英文关键词:RANKL protein type 2 diabetes osteoporosis bone mineral density |
| 基金项目:石河子大学2022年度兵团指导性科技计划（2022ZD044）；石河子大学国际科技合作推进计划（GJHZ202206）；石河子大学成果转化与技术推广计划（CGZH202402）；兵团科技局重点领域科技攻关计划（2021AB031） |
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| 中文摘要: |
| 目的 探讨新疆绝经后2型糖尿病（type 2 diabetes mellitus,T2DM）女性核因子NF-κB受体活化因子配体（RANKL）表达水平与骨量异常的相关性。方法 纳入新疆石河子地区195例绝经后患者为样本人群，根据血糖和骨密度评分结果分为A、B、C、D组。A组：糖耐量正常（normal glucose tolerance, NGT）伴骨量正常组（56例）；B组：T2DM伴骨量正常组（40例）；C组：NGT伴骨量异常组（62例）；D组：T2DM伴骨量异常组（37例）。收集并整理一般基线资料并测定各组生化指标；采用双能X线（DEXA）测定股骨颈骨密度（femoral neck bone mineral density，FN BMD）及腰椎1~4节骨密度（lumbar spinal1-4 bone mineral density，LS1-4 BMD）；RANKL蛋白用酶联免疫吸附测定法（ELISA法）测定；各项指标测定及整理完成后，用SPSS 27.0版本软件分析结果。结果 （1）基线资料比较：与A组比，C组绝经年限较高，体重较低（P<0.05）；与其余三组相比，D组年龄及绝经年限较高，体重较低（P<0.05）；（2）组间生化指标的比较：与A组相比，B组、D组的FPG及HbAlc较高，C组、D组的L1~4、FN BMD较低。与B组相比，C组的HDL-C较低，D组的血P较低，且差异均显著（P<0.05）；（3）组间RANKL蛋白表达水平的比较：与A组相比，C组、D组的RANKL 蛋白表达水平较高（P<0.05），且D组高于C组（P<0.05）；（4）RANKL蛋白表达水平的相关性分析：RANKL蛋白表达水平与空腹血糖（FPG）、碱性磷酸酶（ALP）、年龄和绝经年限呈正相关（P<0.05）；与高密度脂蛋白（HDL-C）、血P、L1~4 BMD和FN BMD呈负相关（P<0.05）；（5）BMD的相关性分析：L1~4 BMD与体质量指数（body mas index, BMI）、血P呈正相关，与RANKL蛋白表达水平、年龄和绝经年限呈负相关；FN BMD与HDL-C、血P呈正相关，与RANKL蛋白表达水平、年龄、ALP和绝经年限呈负相关，差异均有统计学意义（P<0.05）；（6）绘制ROC曲线显示，RANKL蛋白预测绝经后T2DM患者骨量异常发生的曲线下面积（AUC）为0.822（95% CI：0.760～0.877，P<0.01），当约登指数达到最大值0.511时，其对应的RANKL最佳预测浓度为86.17 pg/mL，相对应的特异性和敏感度分别为82.1 %和69.0 %；（7）多元回归分析显示，年龄和RANKL蛋白水平升高是引起L1~4 BMD下降的危险因素，RANKL蛋白水平升高是引起FN BMD下降的危险因素。结论 （1）RANKL蛋白表达升高是绝经后T2DM女性骨密度降低的危险因素，且可能影响糖、脂代谢；（2）RANKL蛋白在绝经后T2DM患者的骨量异常预测中有较高价值，具有一定的特异度和灵敏度。 |
| 英文摘要: |
| Objective To investigate the correlation between the expression level of receptor activator of nuclear factor-κB ligand (RANKL) and abnormal bone mass in postmenopausal women with type 2 diabetes mellitus (T2DM) in Xinjiang. Methods A total of 195 postmenopausal patients in Shihezi area in Xinjiang were included as the sample population. They were divided into group A, B, C, and D based on blood glucose and bone mineral density (BMD) scores. Group A included 56 cases with normal glucose tolerance (NGT) and normal BMD. Group B included 40 cases with T2DM and normal BMD. Group C included 62 cases with NGT and abnormal BMD. Group D included 37 cases with T2DM and abnormal BMD. General baseline data were collected and biochemical indicators were measured. Dual-energy X-ray absorptiometry (DEXA) was used to measure femoral neck BMD (FN BMD) and lumbar spinal 1-4 BMD (LS1-4 BMD). RANKL protein was determined with enzyme-linked immunosorbent assay (ELISA). After the measurement and organization of all indicators, the results were analyzed using SPSS 27.0 version software. Results (1) Comparison of baseline data: Compared to group A, group C had a longer menopausal duration and lower body weight (P<0.05). Compared to the other three groups, group D had a higher age and menopausal duration, and lower body weight (P<0.05). (2) Comparison of biochemical indicators among groups: Compared to group A, group B and group D had higher fasting plasma glucose (FPG) and HbAlc, while group C and group D had lower L1-4 and FN BMD. Compared to group B, group C had lower HDL-C and group D had lower blood P, and the differences were significant (P<0.05). (3) Comparison of RANKL protein expression levels among groups: Compared to group A, group C and group D had higher RANKL protein expression levels (P<0.05), and group D was higher than group C (P<0.05). (4) Correlation analysis of RANKL protein expression levels: RANKL protein expression levels were positively correlated with fasting blood glucose (FPG), alkaline phosphatase (ALP), age and menopausal duration (P<0.05), but negatively correlated with high-density lipoprotein (HDL-C), blood P, and L1-4 BMD and FN BMD (P<0.05). (5) Correlation analysis of BMD: L1-4 BMD was positively correlated with body mass index (BMI) and blood P, but negatively correlated with RANKL protein expression levels, age, and menopausal duration. FN BMD was positively correlated with HDL-C, blood P, but negatively correlated with RANKL protein expression levels, age, ALP, and menopausal duration, and the differences were statistically significant (P<0.05). (6) ROC curve drawing showed that the area under the curve (AUC) of RANKL protein for predicting bone abnormalities in postmenopausal T2DM patients was 0.822 (95% CI: 0.760 - 0.877, P<0.01). When the Youden index reached the maximum value of 0.511, the corresponding optimal RANKL concentration was 86.17 pg/mL, and the corresponding specificity and sensitivity were 82.1% and 69.0%, respectively. (7) Multivariate regression analysis showed that age and elevated RANKL protein levels were risk factors for the decrease of L1-4 BMD, and elevated RANKL protein levels were risk factors for the decrease of FN BMD. Conclusions (1) The elevated expression of RANKL protein is a risk factor for BMD reduction in postmenopausal T2DM women, and it may affect glucose and lipid metabolism. (2) The RANKL protein has a high value in predicting bone abnormalities in postmenopausal patients with type 2 diabetes mellitus, and it has certain specificity and sensitivity. |
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