男性T2DM患者胰岛素抵抗与骨量关系初探
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摘要
目的研究男性T2DM患者胰岛素抵抗与骨量间的相关性,为糖尿病合并骨质疏松症的病因学研究提供新思路。方法选取2016年3月至9月在成都中医药大学附属医院内分泌科住院男性T2DM患者260例,收集临床一般资料、生化核医学指标、第1至第4腰椎椎体和左侧股骨颈的骨密度及体重标准化骨矿含量等资料进行组间比较,以HOMA-IR四分位分为4组,分别以50岁及病程4年为界进行分层,对HOMA-IR和cBMC、aBMD进行双变量相关性分析。结果①各组的体重、BMI、SBP、TG均随HOMA-IR上升呈递增趋势,而HDL-c随之逐渐下降,组间差异有统计学意义;②各组的血清磷、碱性磷酸酶、白蛋白、钙、CYS-C、TC和LDL-c及eGFR等结果 ,均差异无明显统计学意义(P>0.05);③HOMA-IR与FN的aBMD呈正相关(r=0.17,P<0.01),进行年龄分层后,在≤50y组中差异仍有统计学意义(r=0.226,P=0.021),根据病程分层,亦只在FN的≤4y组中差异有统计学意义(r=0.208,P=0.016),余皆无明显相关性(P>0.05);④HOMA-IR与>50y组L_2的cBMC(r=-0.189)、两个年龄组L_3、L_4的cBMC(r=-0.251,-0.228,-0.202,-0.165)皆呈负相关(P<0.05);根据病程分层,只与L_1-L_4的>4y组的cBMC负相关(r=-0.204,-0.242,-0.296,-0.241,P<0.05),其余差异皆无统计学意义。结论男性T2DM患者中,HOMA-IR与FN的骨密度正相关,与腰椎骨强度负相关,单从aBMD评估骨折风险是不够的,cBMC是一个可以考虑采用的指标。
Objective To observe the relationship between insulin resistance and bone mass in male patients with T2 DM, and to provide new idea for the etiology of diabetes mellitus combined with osteoporosis. Methods A total of 260 male T2 DM patients were selected from the Department of Endocrinology, Teaching Hospital of Chengdu University of TCM, between March and September 2016. General clinical data, biochemical and nuclear medicine data, bone mineral density of the lumbar vertebrae(L1-4) and the left femoral neck, and corrected bone mineral content by weight were collected and compared. The patients were divided into 4 groups according to HOMA-IR, and further stratified by 50 years of age and 4-year time course of the disease. HOMA-IR, cBMC, and aBMD were analyzed with bivariate correlation analysis. Results ①The weight, BMI, SBP, and TG increased with the increase of HOMA-IR, while HDL-c decreased successively, and the differences among the groups were statistically significant. ②There was no significant difference in serum phosphorus, alkaline phosphatase, albumin, calcium, CYS-C, TC, LDL-c, and eGFR among the groups(P>0.05). ③aBMD of the femoral neck was positive correlated with HOMA-IR(r=0.17, P<0.01). After age stratification, there was still significant difference in ≤50 y group(r=0.226, P=0.021) and in ≤4 y group(r=0.208, P=0.016) after stratified with course of disease, but no correlation in other groups. ④HOMA-IR was negatively correlated with cBMC of L2 in > 50 y group(r=-0.189) and cBMC of the L3 and L4 in the two age groups(r=-0.251,-0.228,-0.202,-0.165, P< 0.05). After stratified with course of disease, HOMA-IR was only negatively correlated with cBMC of L1-L4 in the > 4 y group(r=-0.204,-0.242,-0.296,-0.241, P < 0.05). Conclusion HOMA-IR is positively correlated with BMD of the femoral neck, but negatively correlated with bone strength of the lumbar spine. aBMD alone is not enough to assess fracture risk in male T2 DM patients. cBMC is a parameter that can be applied.
Objective To observe the relationship between insulin resistance and bone mass in male patients with T2 DM, and to provide new idea for the etiology of diabetes mellitus combined with osteoporosis. Methods A total of 260 male T2 DM patients were selected from the Department of Endocrinology, Teaching Hospital of Chengdu University of TCM, between March and September 2016. General clinical data, biochemical and nuclear medicine data, bone mineral density of the lumbar vertebrae(L1-4) and the left femoral neck, and corrected bone mineral content by weight were collected and compared. The patients were divided into 4 groups according to HOMA-IR, and further stratified by 50 years of age and 4-year time course of the disease. HOMA-IR, cBMC, and aBMD were analyzed with bivariate correlation analysis. Results ①The weight, BMI, SBP, and TG increased with the increase of HOMA-IR, while HDL-c decreased successively, and the differences among the groups were statistically significant. ②There was no significant difference in serum phosphorus, alkaline phosphatase, albumin, calcium, CYS-C, TC, LDL-c, and eGFR among the groups(P>0.05). ③aBMD of the femoral neck was positive correlated with HOMA-IR(r=0.17, P<0.01). After age stratification, there was still significant difference in ≤50 y group(r=0.226, P=0.021) and in ≤4 y group(r=0.208, P=0.016) after stratified with course of disease, but no correlation in other groups. ④HOMA-IR was negatively correlated with cBMC of L2 in > 50 y group(r=-0.189) and cBMC of the L3 and L4 in the two age groups(r=-0.251,-0.228,-0.202,-0.165, P< 0.05). After stratified with course of disease, HOMA-IR was only negatively correlated with cBMC of L1-L4 in the > 4 y group(r=-0.204,-0.242,-0.296,-0.241, P < 0.05). Conclusion HOMA-IR is positively correlated with BMD of the femoral neck, but negatively correlated with bone strength of the lumbar spine. aBMD alone is not enough to assess fracture risk in male T2 DM patients. cBMC is a parameter that can be applied.
引文
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[11] 阮祥燕.体重及骨峰值对骨质疏松诊断的影响[J].当代医学,2000,6(9):47-51.
[12] 邱贵兴.骨质疏松误诊与漏诊原因分析[J].当代医学,2000,6(10):44-49.
[13] NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. Osteoporosis prevention, diagnosis, and therapy[S]. JAMA,2001,285(6):785-795.
[14] 孟瑶,雷涛.骨的微结构与骨强度关系的研究进展[J].中国骨质疏松杂志,2011,17(9):831-834.
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[16] 王文志,杨定焯,全婷,等.体重对青年人骨矿含量和骨密度的影响[J].现代预防医学,2009,36(18):3590-3591,3594.
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[19] Kaplan NM.The deadly quartet and the insulin resistance syndrome: an historical overview[J]. Hypertens Res,1996,19(Suppl 1):S9-11.
[20] 孙爱萍,袁春玲,代雪梅.胰岛素抵抗危险因素的探讨[J].临床荟萃,2004,19(12):669-671.
[21] 钱卫冲,王海燕,王震震,等.体脂分布类型和胰岛素抵抗对心血管病危险因素聚集性的影响[J].中华心血管病杂志,2000,28(4):304-307.
[22] Das UN. Is obesity an inflammatory condition[J]? Nutrition,2001,7(11-12):953-966.
[23] 王静,杜宇国.持久性有机污染物致胰岛素抵抗及其潜在病理机制[J].生态毒理学报,2013,8(6):817-823.
[24] 杨姗姗,胡秀芬,温宇.脂毒性-炎症反应与胰岛素抵抗的关系研究进展[J].生理科学进展,2011,42(2):112-117.
[25] Srikanthan P, Crandall CJ, Miller-Martinez D, et al. Insulin resistance and bone strength: findings from the study of midlife in the United States[J]. J Bone Miner Res,2014,29(4):796-803.
[26] 高飞,李伟,葛志敏,等.绝经后女性相关代谢指标与腰椎骨密度的关系探讨[J].中国药物与临床,2014,14(12):1616-1619.
[27] Toru Yamaguchi. Bone fragility in type 2 diabetes mellitus[J]. World J Orthop,2010,1(1):3-9.
[28] Napoli N, Chandran M, Pierroz DD, et al. Mechanisms of diabetes mellitus-induced bone fragility[J]. Nat Rev Endocrinol,2017,13(4):208-219.
[2] Pan H, Wu N, Yang T, et al. Association between bone mineral density and type 1 diabetes mellitus: a meta-analysis of cross-sectional studies[J]. Diabetes Metab Res Rev,2014,30(7):531-542.
[3] Adil C, Ayd1n T, Tasp1nar Ö, et al. Bone mineral density evaluation of patients with type 2 diabetes mellitus[J]. J Phys Ther Sci,2015,27(1):179-182.
[4] Abdulameer SA, Sulaiman SA, Hassali MA, et al. Osteoporosis and type 2 diabetes mellitus: what do we know, and what we can do[J]? Patient Prefer Adherence,2012,6:435-448.
[5] Girard J. Insulin resistance: role in type 2 diabetes[J]. Diabete Metab,1994,20(3Pt2):330-336.
[6] 刘铭瑶,王文飞,于艺雪,等.成纤维细胞生长因子(FGF)-21 改善胰岛素抵抗肝细胞对葡萄糖的吸收和肝糖原的合成[J].生物化学与生物物理进展,2009,36(10):1327-1333.
[7] Abrahamsen B, Rohold A, Henriksen JE, et al. Correlations between insulin sensitivity and BMD in non-diabetic men[J]. Diabet Med,2000,17(2):124-129.
[8] Arikan S, Tuzcu A, Bahceci M, et al. Insulin resistance in type 2 diabetes mellitus may be related to bone mineral density[J]. J Clin Densitom,2012,15(2):186-190.
[9] 郭雅卿,巩建萍,赵丹宁,等.男性2型糖尿病患者骨密度与胰岛素抵抗的关系[J].山东医药,2010,50(49):85-86.
[10] 贺春燕,毕会民.绝经后2型糖尿病患者骨密度与胰岛素抵抗和体质成分的关系[J].武汉大学学报(医学版),2010,31(6):826-828.
[11] 阮祥燕.体重及骨峰值对骨质疏松诊断的影响[J].当代医学,2000,6(9):47-51.
[12] 邱贵兴.骨质疏松误诊与漏诊原因分析[J].当代医学,2000,6(10):44-49.
[13] NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. Osteoporosis prevention, diagnosis, and therapy[S]. JAMA,2001,285(6):785-795.
[14] 孟瑶,雷涛.骨的微结构与骨强度关系的研究进展[J].中国骨质疏松杂志,2011,17(9):831-834.
[15] 王文志,杨定焯.体重标准化骨矿含量及应用前景[J].中国骨质疏松杂志,2010,16(1):74-77.
[16] 王文志,杨定焯,全婷,等.体重对青年人骨矿含量和骨密度的影响[J].现代预防医学,2009,36(18):3590-3591,3594.
[17] 陆再英,钟南山.内科学[M].第7版.北京:人民卫生出版社,2011:778.
[18] Kaplan NM. The deadly quartet. Upper-body obesity, glucose intolerance, hypertriglyceridemia, and hypertension[J]. Arch Intern Med,1989,149(7):1514-1520.
[19] Kaplan NM.The deadly quartet and the insulin resistance syndrome: an historical overview[J]. Hypertens Res,1996,19(Suppl 1):S9-11.
[20] 孙爱萍,袁春玲,代雪梅.胰岛素抵抗危险因素的探讨[J].临床荟萃,2004,19(12):669-671.
[21] 钱卫冲,王海燕,王震震,等.体脂分布类型和胰岛素抵抗对心血管病危险因素聚集性的影响[J].中华心血管病杂志,2000,28(4):304-307.
[22] Das UN. Is obesity an inflammatory condition[J]? Nutrition,2001,7(11-12):953-966.
[23] 王静,杜宇国.持久性有机污染物致胰岛素抵抗及其潜在病理机制[J].生态毒理学报,2013,8(6):817-823.
[24] 杨姗姗,胡秀芬,温宇.脂毒性-炎症反应与胰岛素抵抗的关系研究进展[J].生理科学进展,2011,42(2):112-117.
[25] Srikanthan P, Crandall CJ, Miller-Martinez D, et al. Insulin resistance and bone strength: findings from the study of midlife in the United States[J]. J Bone Miner Res,2014,29(4):796-803.
[26] 高飞,李伟,葛志敏,等.绝经后女性相关代谢指标与腰椎骨密度的关系探讨[J].中国药物与临床,2014,14(12):1616-1619.
[27] Toru Yamaguchi. Bone fragility in type 2 diabetes mellitus[J]. World J Orthop,2010,1(1):3-9.
[28] Napoli N, Chandran M, Pierroz DD, et al. Mechanisms of diabetes mellitus-induced bone fragility[J]. Nat Rev Endocrinol,2017,13(4):208-219.