绝经后2型糖尿病患者血清甲状旁腺素和25羟维生素D及骨代谢标志物与骨密度的相关性

摘要

Objective To assess the correlation between the changes of bone mineral density and serum par-athyroid hormone(PTH),25-hydroxyvitamin D[25(OH)D3],N-terminal-midfragment of osteocalcin (N-MID-OT), total N-terminal propeptide of type I procollagen (T-P1NP)and β-collagen specific sequences (β-CTX)in postm-enopasual women with type 2 diabetes mellitus.Methods 81 postmenopausal women with type 2 diabetes mellitus were recruited and divided into three groups according to the level of bone mineral density,including the control group (n =35),the osteopenia group(n =31)and osteoporosis group(n =15),The height and weight were measured,the level of fasting plasma glucose (FPG),serum lipid,total glycated hemoglobin(HbA1 c),calcium,phosphorus,magne-sium,alkaline phosphatase (ALP),PTH,25 (OH)D3,N-MID-OT,T-P1NP and β-CTX,and the weight mass index (BMI)was calculated.Results There were no significantly differences in FPG,calcium,phosphorus,ALP,serum lipid,PTH levels among the three groups.The levels of Body Mass Index(BMI)and HbA1c in osteoporosis group were lower than those in osteopenia group and control group(P <0.05).The levels of serum 25(OH)D3,N-MID and T-P1NP in groups of osteoporosis and osteopenia were lower than those in control group,while the level of serum β-CTX was on the contrary.The Pearson correlation analysis showed that bone mineral density were significantly positively correlated with the level of BMI ,25(OH)D3,N-MID and T-P1NP ,while the opposite trends were found with the lev-el of age and serum β-CTX .Conclusions The osteoporosis or osteopenia are most likely occur in postmenopasual women with type 2 diabetes mellitus and the changes of bone mineral density is closely correlated with to bone turn-over marker,25(OH)D3,age and the level of blood glucose.%目的探讨绝经后2型糖尿病患者血清甲状旁腺素（PTH）、25羟维生素 D[25（OH）D3]、N －端骨钙素（N-MID-OT）、总1型胶原氨基端延长肽（T-P1NP）及β-胶原特殊序列（β-CTX）的变化及其与骨密度变化的相关性。方法选取绝经后2型糖尿病患者81例，根据骨密度水平分为3组，骨量正常组35例、骨量减少组31例和骨质疏松组15例。测量患者身高、体质量，计算体质量指数（BMI）；测定患者空腹血糖（FPG）、血脂、糖化血红蛋白（HbAl c）、血钙（Ca）、血磷（P）、血碱性磷酸酶（ALP）及 PTH、25（OH）D3、N-MID-OT、总1型胶原氨基端延长肽（T-P1NP）、β-胶原特殊序列（β-CTX）的水平。结果三组患者的年龄、病程、FPG、血 Ca、P、ALP、血脂及 PTH 水平差异无统计学意义（P ＞0．05）；骨质疏松组的 BMI 水平较骨量正常组、骨量减少组低，骨量减少组的 BMI 水平较骨量正常组低（P ＜0．05）；与骨量正常组及骨量减少组比较，骨质疏松组的 HbAl c 水平降低，（P ＜0．05）；与骨量正常组比较，骨量减少组及骨质疏松组的25（OH）D3、N-MID、T-P1NP 水平降低（P ＜0．05），β-CTX 水平升高（P ＜0．05）。Pearson 相关分析提示骨密度与 BMI、25（OH）D3、N-MID、T-P1NP 呈正相关，与年龄及β-CTX 呈负相关。结论绝经后2型糖尿病患者易合并骨量减少或骨质疏松，其骨密度变化与骨代谢标志物、25（OH）D3水平、年龄及血糖控制情况有关。