探讨糖尿病患者的骨转换标志物的变化与骨质疏松的关系
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摘要
目的探讨不同血糖控制水平糖尿病患者的骨转换情况与骨质疏松的关系,为控制患者骨折风险提供参考依据。方法将2017年1月至2018年9月于北京大学国际医院内分泌科就诊的患者494例纳入研究,分别测定糖化血红蛋白(glycosylated hemoglobin,HbA1c)与25羟维生素D(25-hydroxyvitamin D,25-VD),I型胶原氨基延长肽(type I collagen amino-lengthening peptide,P1NP),β胶原降解产物(β-crosslaps,β-Cross),骨钙素(osteocalcin,OC)。按糖化血红蛋白水平将糖尿病患者分为A组(HbA1c<7.0%)、B组(7.0%≤HbA1c<9.0%)、C组(HbA1c≥9.0%),同期非糖尿病体检人群45例作为对照组。对不同分组的测定结果进行统计分析。结果糖化血红蛋白与25羟维生素D、I型胶原氨基延长肽、β胶原降解产物、骨钙素均存在负相关关系(P<0.05),相关系数分别为-0.11、-0.10、-0.10、-0.19.对照组4项骨代谢标志物均高于A、B、C 3个糖尿病患者组(P<0.05),糖尿病患者A组的骨钙素水平高于B组和C组(P<0.05)。结论糖尿病患者血糖控制情况影响骨转换标志物水平。骨钙素在骨转换标志物中是更为敏感的实验室检测指标,可能在糖尿病患者骨质疏松的诊断和治疗监测中更值得关注。
Objective To investigate the relationship between bone turnover and osteoporosis in diabetic patients with different blood glucose control levels, and to provide reference for controlling fracture risk. Methods A total of 494 patients in the Department of Endocrinology of our hospital from January 2017 to September 2018 were enrolled in the study. Glycosylated hemoglobin A1 c(HbA1 c), 25-hydroxyvitamin D(25-VD), type I collagen amino-lengthening peptide(P1 NP), β-crosslaps(β-Cross), and osteocalcin(OC) were measured. According to the level of glycosylated hemoglobin, the diabetic patients were divided into group A(HbA1 c < 7.0%), group B(7.0%
Objective To investigate the relationship between bone turnover and osteoporosis in diabetic patients with different blood glucose control levels, and to provide reference for controlling fracture risk. Methods A total of 494 patients in the Department of Endocrinology of our hospital from January 2017 to September 2018 were enrolled in the study. Glycosylated hemoglobin A1 c(HbA1 c), 25-hydroxyvitamin D(25-VD), type I collagen amino-lengthening peptide(P1 NP), β-crosslaps(β-Cross), and osteocalcin(OC) were measured. According to the level of glycosylated hemoglobin, the diabetic patients were divided into group A(HbA1 c < 7.0%), group B(7.0%
引文
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[3] Sha A, Yin MT,Stein E, et al. Bone structure and turnover n type 2 diabetes mellitus[J]. Osteoporos Int, 2012,23(2):635-641.
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[9] Sanches CP, Vianna AGD, Barreto FC. The impact of type 2 diabetes on bone metabolism[J].Diabetol Metab Syndr, 2017(9):85.
[10] Strollo R, Rizzo P, Spoletini M, et al. HLA-dependent autoantibodies against post-translationally modified collagen type II in type 1 diabetes mellitus[J].Diabetologia, 2013,6(3):563-572.
[11] Ma XY, Chen FQ, Hong H, et al. The relationship between serum osteocalcin concentration and glucose and lipid metabolism in patients with type 2 diabetes mellitus-the role of osteocalcin in energy metabolism[J]. Ann Nutr Metab, 2015,66(2-3):110-116.
[12] Kostoglou-Athanassiou I, Athanassiou P, Gkountouvas A, et al. Vitamin D and glycemic control in diabetes mellitus type 2[J].Ther Adv Endocrinol Metab, 2013(4):122-128.
[13] Munasinghe LL, Mastroeni MF, Mastroeni SSBS, et al. The Association of serum 25-hydroxyvitamin D concentrations and elevated glycated hemoglobin values: a longitudinal study of non-diabetic participants of a preventive health program[J].Nutrients, 2017,9(7):640.
[14] Yoshikawa Y,Kode A,Xu L,et al.Genetic Evidence Points to an Osteocalcin-independent Influence of Osteoblasts on Energy Metabolism[J].J Bone Miner Res, 2011,26(9):2012-2025.
[2] Janghorbani M, Van Dam RM, Willett WC, et al.Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture[J].Am J Epidemiol,2007,166:495-505.
[3] Sha A, Yin MT,Stein E, et al. Bone structure and turnover n type 2 diabetes mellitus[J]. Osteoporos Int, 2012,23(2):635-641.
[4] Siddapur PR, Patil AB, Borde VS. Comparison of bone mineral density, t-scores and serum zine between diabetic and non diabetic postmenopausal women with osteoporosis[J]. J Lab Physicians, 2015,7(1): 43-48.
[5] Farr JN, Khosla S. Determinants of bone strength and quality in diabetes mellitus in humans[J]. Bone, 2016,82:28-34.
[6] 王玉楠,许琳,吴瑶强,等.2型糖尿病患者合并骨量减少及骨质疏松症相关影响因素分析[J]. 中国骨质疏松杂志,2017,23(8):1045-1048.
[7] 刘忠厚. 骨内科学[M].北京: 化学工业出版社,2015: 273-280.
[8] Starup-Linde J,Eriksen SA,Lykkeboe S,et al.Biochemical markers of bone turnover in diabetes patients: a meta-analysis, and a methodological study on the effects of glucose on bone markers[J]. Osteoporos Int, 2014,25(6):1697-708.
[9] Sanches CP, Vianna AGD, Barreto FC. The impact of type 2 diabetes on bone metabolism[J].Diabetol Metab Syndr, 2017(9):85.
[10] Strollo R, Rizzo P, Spoletini M, et al. HLA-dependent autoantibodies against post-translationally modified collagen type II in type 1 diabetes mellitus[J].Diabetologia, 2013,6(3):563-572.
[11] Ma XY, Chen FQ, Hong H, et al. The relationship between serum osteocalcin concentration and glucose and lipid metabolism in patients with type 2 diabetes mellitus-the role of osteocalcin in energy metabolism[J]. Ann Nutr Metab, 2015,66(2-3):110-116.
[12] Kostoglou-Athanassiou I, Athanassiou P, Gkountouvas A, et al. Vitamin D and glycemic control in diabetes mellitus type 2[J].Ther Adv Endocrinol Metab, 2013(4):122-128.
[13] Munasinghe LL, Mastroeni MF, Mastroeni SSBS, et al. The Association of serum 25-hydroxyvitamin D concentrations and elevated glycated hemoglobin values: a longitudinal study of non-diabetic participants of a preventive health program[J].Nutrients, 2017,9(7):640.
[14] Yoshikawa Y,Kode A,Xu L,et al.Genetic Evidence Points to an Osteocalcin-independent Influence of Osteoblasts on Energy Metabolism[J].J Bone Miner Res, 2011,26(9):2012-2025.