绝经后2型糖尿病并发骨质疏松患者骨转换标志物的变化及相关因素

摘要

Objective To analyze bone turnover markers in postmenopausal women with type 2 diabetes mellitus ( T2DM) and osteoporosis.Methods Eighty postmenopausal women were divided into postmenopausal osteoporosis group ( OP, n=40) and postmenopausal women with T2DM and osteoporosis group ( DM/OP, n=40) .The human N-MID os-teocalcin (N-MID), tartrate-resistant acid phosphatase (TRAP-5b), C-terminal telopeptides of type 1 collagen (CTX) and relative indicators were compared between two groups.Analyze the related factors of bone turnover markers in DM/OP group.Results There were no obvious differences between two groups in N-MID, CTX levels.In DM/OP group, TRAP-5b level were higher than that in OP group (P=0.020).TRAP-5b has negative correlation with L2-4 BMD (r=-0.746, P=0.044).Regression analysis showed that TRAP-5b was affected by HbA1c.Conclusion Diabetes may affect bone metabolism mainly through increasing the activity of osteoclasts.TRAP-5b may become a specific index for monitoring the changes of bone metabolisms in postmenopausal women with T2DM and osteoporosis.%目的：探讨绝经后2型糖尿病（ type 2 diabetes mellitus， T2DM）并发骨质疏松患者骨转换标志物的变化及相关因素。方法选取绝经后女性80例，根据1998年世界卫生组织（ WHO）骨质疏松诊断标准和1999年WHO糖尿病诊断标准分为绝经后骨质疏松组（ osteoporosis， OP）40例，绝经后T2DM并发骨质疏松组（ DM／OP）40例。比较两组间N端中段骨钙素（ N－MID osteocalcin， N－MID）、抗酒石酸酸性磷酸酶（ tartrate re－sistant acid phosphatase， TRAP－5b）、1型胶原羧基端交联肽（c－terminal telopeptides of type 1 collagen， CTX）及相关资料的差异，并对DM／OP组的骨转换标志物进行相关分析。结果两组间N－MID、 CTX比较，差异无统计学意义（P＞0．05）；DM／OP组TRAP－5b高于OP组（P＝0．020）；相关分析显示TRAP－5b与L2－4骨密度（bone mineral density， BMD）呈负相关（r＝－0．746， P＝0．044）；回归分析显示TRAP－5b水平受糖化血红蛋白（glycosylated hemoglobin， HbA1c）影响。结论糖尿病可能主要通过增加破骨细胞活性影响骨代谢， TRAP－5b可能成为绝经后T2 DM并发骨质疏松患者监测骨代谢变化的特异性指标。