实用检验医师杂志
實用檢驗醫師雜誌
실용검험의사잡지
Chinese Journal of Laboratory Pathologist
2014年
3期
142-146
,共5页
陆怡德%樊宁远%杨帆%彭奕冰
陸怡德%樊寧遠%楊帆%彭奕冰
륙이덕%번저원%양범%팽혁빙
骨转换标志物%骨密度%2型糖尿病%骨质疏松
骨轉換標誌物%骨密度%2型糖尿病%骨質疏鬆
골전환표지물%골밀도%2형당뇨병%골질소송
Bone turnover markers%Bone mineral density%Type 2 diabetes mellitus%Osteoporosis
目的：探讨骨转换标志物在2型糖尿病合并骨质疏松患者中的临床应用价值及与不同部位骨密度的相关关系。方法选择我院64例2型糖尿病成年男性患者为病例组，同期收集20例健康成年男性为对照组，用双能X线吸收测定仪检测受试者正位腰椎（L1-L4）、右侧髋部（股骨颈、大转子、ward＇s三角）的骨密度，并依据WHO骨质疏松症诊断标准将病例组分为骨质疏松组、骨量减少组、骨量正常组。同时检测血清骨钙素（osteocalcin， OC）、总Ⅰ型前胶原氨基端延长肽（procollagen type I N-terminal propeptide， PINP）、Ⅰ型胶原羧基端肽β特殊序列（β-carboxy-terminal collagen crosslinks，β-CTX）、血钙（calcium， Ca）、血磷（phosphorus， P）、甲状旁腺素（parathyroid hormone， PTH）、25羟维生素D3[25-hydroxy vitamin D3，25（OH）D3]、空腹血糖（fasting blood-glucose， FBG）、糖化血红蛋白（hemoglobin A1C， HbA1C）、碱性磷酸酶（alkaline phosphatase， ALP）以及血清肌酐（serum creatinine， SCr）等临床化学指标，对检测结果进行统计学分析。结果各组间年龄、体重指数差异均无统计学意义（P均＞0．05）。骨量减少组及骨质疏松组的脊椎骨密度值、髋部骨密度值均显著低于健康对照组，且差异均有统计学意义（P均＜0．05）；骨量减少组与健康对照组相比，SCr、FBG、HbA1C和β-CTX均升高，差异均有统计学意义（P均＜0．05）；骨质疏松组与健康对照组相比，SCr、ALP、FBG、HbA1C、PINP、β-CTX、PTH结果均升高，且差异具有统计学意义（P均＜0．05）；骨量减少组和骨质疏松组的25（OH）D3均明显降低，与健康对照组相比差异均有统计学意义（P均＜0．05）。相关性分析结果表明，PINP、β-CTX与大转子、股骨全部的骨密度均呈负相关（P均＜0．05）。结论骨转换标志物与骨密度联合检测能更早反映糖尿病患者骨转换情况，帮助临床判断骨丢失速率，更有利于骨质疏松的早期诊断。
目的：探討骨轉換標誌物在2型糖尿病閤併骨質疏鬆患者中的臨床應用價值及與不同部位骨密度的相關關繫。方法選擇我院64例2型糖尿病成年男性患者為病例組，同期收集20例健康成年男性為對照組，用雙能X線吸收測定儀檢測受試者正位腰椎（L1-L4）、右側髖部（股骨頸、大轉子、ward＇s三角）的骨密度，併依據WHO骨質疏鬆癥診斷標準將病例組分為骨質疏鬆組、骨量減少組、骨量正常組。同時檢測血清骨鈣素（osteocalcin， OC）、總Ⅰ型前膠原氨基耑延長肽（procollagen type I N-terminal propeptide， PINP）、Ⅰ型膠原羧基耑肽β特殊序列（β-carboxy-terminal collagen crosslinks，β-CTX）、血鈣（calcium， Ca）、血燐（phosphorus， P）、甲狀徬腺素（parathyroid hormone， PTH）、25羥維生素D3[25-hydroxy vitamin D3，25（OH）D3]、空腹血糖（fasting blood-glucose， FBG）、糖化血紅蛋白（hemoglobin A1C， HbA1C）、堿性燐痠酶（alkaline phosphatase， ALP）以及血清肌酐（serum creatinine， SCr）等臨床化學指標，對檢測結果進行統計學分析。結果各組間年齡、體重指數差異均無統計學意義（P均＞0．05）。骨量減少組及骨質疏鬆組的脊椎骨密度值、髖部骨密度值均顯著低于健康對照組，且差異均有統計學意義（P均＜0．05）；骨量減少組與健康對照組相比，SCr、FBG、HbA1C和β-CTX均升高，差異均有統計學意義（P均＜0．05）；骨質疏鬆組與健康對照組相比，SCr、ALP、FBG、HbA1C、PINP、β-CTX、PTH結果均升高，且差異具有統計學意義（P均＜0．05）；骨量減少組和骨質疏鬆組的25（OH）D3均明顯降低，與健康對照組相比差異均有統計學意義（P均＜0．05）。相關性分析結果錶明，PINP、β-CTX與大轉子、股骨全部的骨密度均呈負相關（P均＜0．05）。結論骨轉換標誌物與骨密度聯閤檢測能更早反映糖尿病患者骨轉換情況，幫助臨床判斷骨丟失速率，更有利于骨質疏鬆的早期診斷。
목적：탐토골전환표지물재2형당뇨병합병골질소송환자중적림상응용개치급여불동부위골밀도적상관관계。방법선택아원64례2형당뇨병성년남성환자위병례조，동기수집20례건강성년남성위대조조，용쌍능X선흡수측정의검측수시자정위요추（L1-L4）、우측관부（고골경、대전자、ward＇s삼각）적골밀도，병의거WHO골질소송증진단표준장병례조분위골질소송조、골량감소조、골량정상조。동시검측혈청골개소（osteocalcin， OC）、총Ⅰ형전효원안기단연장태（procollagen type I N-terminal propeptide， PINP）、Ⅰ형효원최기단태β특수서렬（β-carboxy-terminal collagen crosslinks，β-CTX）、혈개（calcium， Ca）、혈린（phosphorus， P）、갑상방선소（parathyroid hormone， PTH）、25간유생소D3[25-hydroxy vitamin D3，25（OH）D3]、공복혈당（fasting blood-glucose， FBG）、당화혈홍단백（hemoglobin A1C， HbA1C）、감성린산매（alkaline phosphatase， ALP）이급혈청기항（serum creatinine， SCr）등림상화학지표，대검측결과진행통계학분석。결과각조간년령、체중지수차이균무통계학의의（P균＞0．05）。골량감소조급골질소송조적척추골밀도치、관부골밀도치균현저저우건강대조조，차차이균유통계학의의（P균＜0．05）；골량감소조여건강대조조상비，SCr、FBG、HbA1C화β-CTX균승고，차이균유통계학의의（P균＜0．05）；골질소송조여건강대조조상비，SCr、ALP、FBG、HbA1C、PINP、β-CTX、PTH결과균승고，차차이구유통계학의의（P균＜0．05）；골량감소조화골질소송조적25（OH）D3균명현강저，여건강대조조상비차이균유통계학의의（P균＜0．05）。상관성분석결과표명，PINP、β-CTX여대전자、고골전부적골밀도균정부상관（P균＜0．05）。결론골전환표지물여골밀도연합검측능경조반영당뇨병환자골전환정황，방조림상판단골주실속솔，경유리우골질소송적조기진단。
Objective To investigate the clinical value of biochemical marker of bone turnover in type 2 diabetes combined osteoporosis, and to find the relationship between biochemical marker of bone turnover and bone mineral density. Methods 64 cases adult males with type 2 diabetes and 20 cases healthy adult males were collected. The bone mineral density of lumbar vertebrae (L1-L4) and light huckle of all the sub-jects were measured by dual-energy X-ray absorptiometry. The patients were divided into osteoporosis group , osteopenia group and non- osteoporosis group according to the WHO diagnostic criteria of osteoporosis. The levels of osteocalcin (OC), procollagen type I N-terminal propeptide (PINP),β-carboxy-terminal collagen crosslinks(β-CTX), calcium (Ca), phosphorus(P), parathyroid hormone(PTH),25-hydroxy vitamin D3[25 (OH)D3], fasting blood-glucose (FBG), hemoglobin A1C (HbA1C), alkaline phosphatase (ALP) and serum creatinine (SCr) were detected. The results were analyzed statistically. Results There were no statistical sig-nificance in the differences of age and body mass index among all the groups (Pall>0.05). The bone mineral density levels of lumbar vertebrae(L1-L4) and light huckle in osteoporosis group and osteopenia group were all lower than that of control group, and the differences all had statistical significance (Pall<0.05). There were statistical significance in the differences of β-CTX, SCr, HbA1C and FBG levels between osteopenia group and control group (Pall< 0.05). There were statistical significance in the differences of SCr, ALP, FBG, HbA1C, PINP,β-CTX and PTH levels between osteoporosis group and control group(Pall<0.05). The levels of 25(OH)D3 in osteopenia group and osteoporosis group were all lower than that of control group, and the dif-ferences all had statistical significance(Pall<0.05). Correlation analysis results showed that both PINP andβ-CTX were negatively correlated with the bone mineral density of greater trochanter and femur (Pall<0.05). Conclusion Combined bone mineral density and biochemical marker of bone turnover detecting can reflect bone turnover condition of diabetes patients and which is helpful for clinical judgment of the bone loss speed and early diagnosis of osteoporosis.
