中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2012年
8期
657-661
,共5页
范光磊%薄静莉%陈杰敏%徐龙宝%李德%张洁
範光磊%薄靜莉%陳傑敏%徐龍寶%李德%張潔
범광뢰%박정리%진걸민%서룡보%리덕%장길
糖尿病,2型%骨质疏松%胶原Ⅰ型%骨密度
糖尿病,2型%骨質疏鬆%膠原Ⅰ型%骨密度
당뇨병,2형%골질소송%효원Ⅰ형%골밀도
Diabetes mellitus,type 2%Osteoporosis%Collagen type Ⅰ%Bone density
目的 探讨老年2型糖尿病患者骨质疏松及与骨转换生化标志物的相关关系.方法 应用双能X线骨密度仪分别测定102例老年2型糖尿病(T2DM)患者和42例健康老年人腰椎和股骨骨密度,将糖尿病患者分成骨质疏松组与非骨质疏松组,检测血清中骨转换生化标志物总Ⅰ型前胶原氨基端延长肽(TPⅠNP)、Ⅰ型胶原羧基端肽β特殊序列(β-CTx)、甲状旁腺素(PTH)及血清钙(Ca)、血清磷(P)、碱性磷酸酶(ALP)、空腹血糖(FBG)、糖化血红蛋白(HbAlc)、肌酐、血尿素、尿微量白蛋白/肌酐(UA/Cr)、25羟维生素D3[25-(OH)VD3]等相关生化指标,并测量其体质指数,分析引起T2DM患者骨质疏松的相关危险因素.结果 骨质疏松组腰椎及股骨骨密度均值均显著低于对照组(t=9.006、6.347、7.387、5.321,均P＜0.01).骨质疏松组TP Ⅰ NP、β-CTx、PTH、ALP、FBG、HbAlc、肌酐及UA/Cr较对照组升高(t=2.212、4.431、2.215、3.544、0.433、1.629、0.365、5.436,P ＜0.01或P＜0.05),25-(OH)VD3低于对照组(t=2.700,P＜0.01).相关分析显示,TP I NP和骨质疏松患者左侧股骨大转子Troch、Ward’s三角的骨密度呈负相关(r=-0.413、-0.375,P＜0.01);β-CTx和骨质疏松患者左侧股骨大转子Troch的骨密度呈负相关(r=-0.301,P＜0.05).对T2DM骨质疏松患者体质指数超重组TP Ⅰ NP、β-CTx和肥胖组TP Ⅰ NP、β-CTx均高于正常体质量组(F=50.59、51.28,F=96.20、95.71,均P＜0.01);口服二甲双胍(MH)患者TP Ⅰ NP、β-CTx显著高于口服噻唑烷二酮类(TZDs)和磺脲类(SU)患者(F=32.33、33.35,F=31.07、39.18,均P＜0.01);血糖控制不佳组TP Ⅰ NP、β-CTx均高于血糖控制良好组(F=11.32、13.69,均P＜0.01);有并发症发生的患者的TP Ⅰ NP、β-CTx均高于没有并发症发生的患者(F=52.75、70.34,均P＜0.01).结论 老年T2DM患者存在不同程度骨密度下降;联合应用TP Ⅰ NP、β-CTx检测有助于T2DM患者骨质疏松的早期诊断.
目的 探討老年2型糖尿病患者骨質疏鬆及與骨轉換生化標誌物的相關關繫.方法 應用雙能X線骨密度儀分彆測定102例老年2型糖尿病(T2DM)患者和42例健康老年人腰椎和股骨骨密度,將糖尿病患者分成骨質疏鬆組與非骨質疏鬆組,檢測血清中骨轉換生化標誌物總Ⅰ型前膠原氨基耑延長肽(TPⅠNP)、Ⅰ型膠原羧基耑肽β特殊序列(β-CTx)、甲狀徬腺素(PTH)及血清鈣(Ca)、血清燐(P)、堿性燐痠酶(ALP)、空腹血糖(FBG)、糖化血紅蛋白(HbAlc)、肌酐、血尿素、尿微量白蛋白/肌酐(UA/Cr)、25羥維生素D3[25-(OH)VD3]等相關生化指標,併測量其體質指數,分析引起T2DM患者骨質疏鬆的相關危險因素.結果 骨質疏鬆組腰椎及股骨骨密度均值均顯著低于對照組(t=9.006、6.347、7.387、5.321,均P＜0.01).骨質疏鬆組TP Ⅰ NP、β-CTx、PTH、ALP、FBG、HbAlc、肌酐及UA/Cr較對照組升高(t=2.212、4.431、2.215、3.544、0.433、1.629、0.365、5.436,P ＜0.01或P＜0.05),25-(OH)VD3低于對照組(t=2.700,P＜0.01).相關分析顯示,TP I NP和骨質疏鬆患者左側股骨大轉子Troch、Ward’s三角的骨密度呈負相關(r=-0.413、-0.375,P＜0.01);β-CTx和骨質疏鬆患者左側股骨大轉子Troch的骨密度呈負相關(r=-0.301,P＜0.05).對T2DM骨質疏鬆患者體質指數超重組TP Ⅰ NP、β-CTx和肥胖組TP Ⅰ NP、β-CTx均高于正常體質量組(F=50.59、51.28,F=96.20、95.71,均P＜0.01);口服二甲雙胍(MH)患者TP Ⅰ NP、β-CTx顯著高于口服噻唑烷二酮類(TZDs)和磺脲類(SU)患者(F=32.33、33.35,F=31.07、39.18,均P＜0.01);血糖控製不佳組TP Ⅰ NP、β-CTx均高于血糖控製良好組(F=11.32、13.69,均P＜0.01);有併髮癥髮生的患者的TP Ⅰ NP、β-CTx均高于沒有併髮癥髮生的患者(F=52.75、70.34,均P＜0.01).結論 老年T2DM患者存在不同程度骨密度下降;聯閤應用TP Ⅰ NP、β-CTx檢測有助于T2DM患者骨質疏鬆的早期診斷.
목적 탐토노년2형당뇨병환자골질소송급여골전환생화표지물적상관관계.방법 응용쌍능X선골밀도의분별측정102례노년2형당뇨병(T2DM)환자화42례건강노년인요추화고골골밀도,장당뇨병환자분성골질소송조여비골질소송조,검측혈청중골전환생화표지물총Ⅰ형전효원안기단연장태(TPⅠNP)、Ⅰ형효원최기단태β특수서렬(β-CTx)、갑상방선소(PTH)급혈청개(Ca)、혈청린(P)、감성린산매(ALP)、공복혈당(FBG)、당화혈홍단백(HbAlc)、기항、혈뇨소、뇨미량백단백/기항(UA/Cr)、25간유생소D3[25-(OH)VD3]등상관생화지표,병측량기체질지수,분석인기T2DM환자골질소송적상관위험인소.결과 골질소송조요추급고골골밀도균치균현저저우대조조(t=9.006、6.347、7.387、5.321,균P＜0.01).골질소송조TP Ⅰ NP、β-CTx、PTH、ALP、FBG、HbAlc、기항급UA/Cr교대조조승고(t=2.212、4.431、2.215、3.544、0.433、1.629、0.365、5.436,P ＜0.01혹P＜0.05),25-(OH)VD3저우대조조(t=2.700,P＜0.01).상관분석현시,TP I NP화골질소송환자좌측고골대전자Troch、Ward’s삼각적골밀도정부상관(r=-0.413、-0.375,P＜0.01);β-CTx화골질소송환자좌측고골대전자Troch적골밀도정부상관(r=-0.301,P＜0.05).대T2DM골질소송환자체질지수초중조TP Ⅰ NP、β-CTx화비반조TP Ⅰ NP、β-CTx균고우정상체질량조(F=50.59、51.28,F=96.20、95.71,균P＜0.01);구복이갑쌍고(MH)환자TP Ⅰ NP、β-CTx현저고우구복새서완이동류(TZDs)화광뇨류(SU)환자(F=32.33、33.35,F=31.07、39.18,균P＜0.01);혈당공제불가조TP Ⅰ NP、β-CTx균고우혈당공제량호조(F=11.32、13.69,균P＜0.01);유병발증발생적환자적TP Ⅰ NP、β-CTx균고우몰유병발증발생적환자(F=52.75、70.34,균P＜0.01).결론 노년T2DM환자존재불동정도골밀도하강;연합응용TP Ⅰ NP、β-CTx검측유조우T2DM환자골질소송적조기진단.
Objective To investigate the relationship of the changes of bone density and biochemical marker of bone turnover with osteoporosis in the elderly with type 2 diabetes mellitus(T2DM). Methods A total of 102 elderly patients with type 2 diabetes and 42 healthy subjects (normal controls) were included in this study.The bone mineral density (BMD) of lumbar vertebrae and femur were measured by dual-energy X-ray absorptiometry (DXA).The T2 DM subjects were divided into two groups:osteoporosis group (56 cases) and non-osteoporosis group (46 cases).The levels of total procollagen type Ⅰ amino-terminal propeptide (TP Ⅰ NP),β-isomerized carboxyterminal propeptide (β-CTx),parathyroid hormone (PTH),serum calcium (Ca2+),serum phosphorus (P),alkaline phosphatase (ALP),fasting blood glucose(FBG),glycosylated hemoglobin (HbAlc) and body mass index (BMI) were detected. The correlations between BMD of the osteoporosis group and other related factors were analyzed. Results The BMD values of lumbar vertebrae and femur neck,troch,ward's triangle in the osteoporosis group were decreased as compared with control(t=9.006,6.347,7.387,5.321,P＜ 0.01) and the serum TP Ⅰ NP,β-CTx,PTH,ALP,FBG,HbAlc,Creatinine and albumin/Cr in the osteoporosis group were significantly higher than controls(t=2.212,4.431,2.215,3.544,0.433,1.629,0.365,5.436,P＜0.01 or P＜0.05),the 25-(OH)VD3 in the osteoporosis group was lower than in controls(t=2.700,P＜0.01).Correlation analysis showed TP Ⅰ NP was negatively correlated with the BMD of femoral Troch and Ward's triangle (r=-0.413,-0.375,P＜0.01),and β CTx was negatively correlated with the BMD of femoral Troch (r=-0.301,P＜0.05).The TP Ⅰ NP,β-CTx in the overweight group and obesity group were higher than in normal group(F=50.59,51.28; F =96.20,95.71,all P＜0.01);the melbine group had higher TP Ⅰ NP,β-CTx than the thiazolidinedione and sulfonylurea group(F=32.33,33.35,F=31.07,39.18,P＜0.01);the TP Ⅰ NP,β-CTx in the better blood glucose control group were lower than in the bad control group(F=11.32,13.69,P＜0.01);the TP Ⅰ NP,β-CTx in the group with complication were increased as compared with no complication group(F=52.75,70.34,P＜0.01).Conclusions The spine BMD in elderly T2DM patients is decreased to some degree.The combined application of TP Ⅰ NP and β-CTx is helpful for the early diagnosis of osteoporosis in patients with type 2 diabetes.
