中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2013年
34期
13-16
,共4页
中年人%男人%代谢综合征X%骨代谢%胰岛素抵抗
中年人%男人%代謝綜閤徵X%骨代謝%胰島素牴抗
중년인%남인%대사종합정X%골대사%이도소저항
Middle aged%Men%Metabolic syndrome X%Bone metabolism%Insulin resistance
目的 通过测定中年男性代谢综合征(MS)患者骨代谢指标,探讨MS对骨代谢的影响.方法 于2010年10月至2013年5月进行体检的人群中,选取110例中年男性MS患者(MS组)和36例非MS对照者(非MS组).MS组中27例骨质疏松患者归入MS伴骨质疏松组,36例骨量减少患者归入MS伴骨量减少组.计算体质量指数(BMI)、稳态模型评估法胰岛素抵抗指数(HOMA-IR);测量收缩压(SBP)、舒张压(DBP)以及腰围;测定血生化指标,包括空腹血糖(FPG)、餐后2h血糖(2 h PG)、空腹胰岛素(FINS)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C);测定骨代谢指标,包括血钙、磷、碱性磷酸酶、25羟维生素D[25-(OH)D3]、Ⅰ型前胶原氨基末端前肽(PINP)、甲状旁腺激素(PTH)、骨钙素以及尿Ⅰ型胶原羧基末端肽(U-CTX)与尿肌酐(Cr)比值(U-CTX/Cr)、尿钙与尿Cr比值(尿钙/Cr),并测定腰椎骨密度(BMD).将上述指标进行组间比较,并对MS伴骨质疏松组的BMD与其他骨代谢指标及HOMA-IR进行相关性分析.结果 MS组57.3％(63/110)诊断为骨代谢异常,非MS组有11.1％(4/36)诊断为骨代谢异常,两组骨代谢异常发生率比较差异有统计学意义(x2=6.55,P＜0.01).与非MS组比较,MS组、MS伴骨质疏松组、MS伴骨量减少组BMI、腰围、SBP、DBP、FPG、2hPG、TC、TG、LDL-C、FINS、HOMA-IR均升高(P＜ 0.01或＜0.05),HDL-C降低(P＜0.01).与非MS组比较,MS组、MS伴骨质疏松组、MS伴骨量减少组PINP、25-(OH)D3、骨钙素、BMD均降低(P＜ 0.05或＜0.01),PTH、尿钙/Cr、U-CTX/Cr均升高(P＜ 0.05或＜0.01),血钙、磷及碱性磷酸酶比较差异均无统计学意义(P＞0.05).MS伴骨质疏松组BMD与骨钙素和25-(OH)D3呈正相关(P＜0.05),与PTH、U-CTX/Cr、尿钙/Cr呈负相关(P＜0.05),与HOMA-IR亦呈负相关(P＜ 0.05).结论 中年男性MS患者存在骨代谢异常,表现为骨形成减少、骨吸收增加,并引发骨质疏松、骨量减少.其骨代谢异常与胰岛素抵抗相关.
目的 通過測定中年男性代謝綜閤徵(MS)患者骨代謝指標,探討MS對骨代謝的影響.方法 于2010年10月至2013年5月進行體檢的人群中,選取110例中年男性MS患者(MS組)和36例非MS對照者(非MS組).MS組中27例骨質疏鬆患者歸入MS伴骨質疏鬆組,36例骨量減少患者歸入MS伴骨量減少組.計算體質量指數(BMI)、穩態模型評估法胰島素牴抗指數(HOMA-IR);測量收縮壓(SBP)、舒張壓(DBP)以及腰圍;測定血生化指標,包括空腹血糖(FPG)、餐後2h血糖(2 h PG)、空腹胰島素(FINS)、總膽固醇(TC)、三酰甘油(TG)、低密度脂蛋白膽固醇(LDL-C)、高密度脂蛋白膽固醇(HDL-C);測定骨代謝指標,包括血鈣、燐、堿性燐痠酶、25羥維生素D[25-(OH)D3]、Ⅰ型前膠原氨基末耑前肽(PINP)、甲狀徬腺激素(PTH)、骨鈣素以及尿Ⅰ型膠原羧基末耑肽(U-CTX)與尿肌酐(Cr)比值(U-CTX/Cr)、尿鈣與尿Cr比值(尿鈣/Cr),併測定腰椎骨密度(BMD).將上述指標進行組間比較,併對MS伴骨質疏鬆組的BMD與其他骨代謝指標及HOMA-IR進行相關性分析.結果 MS組57.3％(63/110)診斷為骨代謝異常,非MS組有11.1％(4/36)診斷為骨代謝異常,兩組骨代謝異常髮生率比較差異有統計學意義(x2=6.55,P＜0.01).與非MS組比較,MS組、MS伴骨質疏鬆組、MS伴骨量減少組BMI、腰圍、SBP、DBP、FPG、2hPG、TC、TG、LDL-C、FINS、HOMA-IR均升高(P＜ 0.01或＜0.05),HDL-C降低(P＜0.01).與非MS組比較,MS組、MS伴骨質疏鬆組、MS伴骨量減少組PINP、25-(OH)D3、骨鈣素、BMD均降低(P＜ 0.05或＜0.01),PTH、尿鈣/Cr、U-CTX/Cr均升高(P＜ 0.05或＜0.01),血鈣、燐及堿性燐痠酶比較差異均無統計學意義(P＞0.05).MS伴骨質疏鬆組BMD與骨鈣素和25-(OH)D3呈正相關(P＜0.05),與PTH、U-CTX/Cr、尿鈣/Cr呈負相關(P＜0.05),與HOMA-IR亦呈負相關(P＜ 0.05).結論 中年男性MS患者存在骨代謝異常,錶現為骨形成減少、骨吸收增加,併引髮骨質疏鬆、骨量減少.其骨代謝異常與胰島素牴抗相關.
목적 통과측정중년남성대사종합정(MS)환자골대사지표,탐토MS대골대사적영향.방법 우2010년10월지2013년5월진행체검적인군중,선취110례중년남성MS환자(MS조)화36례비MS대조자(비MS조).MS조중27례골질소송환자귀입MS반골질소송조,36례골량감소환자귀입MS반골량감소조.계산체질량지수(BMI)、은태모형평고법이도소저항지수(HOMA-IR);측량수축압(SBP)、서장압(DBP)이급요위;측정혈생화지표,포괄공복혈당(FPG)、찬후2h혈당(2 h PG)、공복이도소(FINS)、총담고순(TC)、삼선감유(TG)、저밀도지단백담고순(LDL-C)、고밀도지단백담고순(HDL-C);측정골대사지표,포괄혈개、린、감성린산매、25간유생소D[25-(OH)D3]、Ⅰ형전효원안기말단전태(PINP)、갑상방선격소(PTH)、골개소이급뇨Ⅰ형효원최기말단태(U-CTX)여뇨기항(Cr)비치(U-CTX/Cr)、뇨개여뇨Cr비치(뇨개/Cr),병측정요추골밀도(BMD).장상술지표진행조간비교,병대MS반골질소송조적BMD여기타골대사지표급HOMA-IR진행상관성분석.결과 MS조57.3％(63/110)진단위골대사이상,비MS조유11.1％(4/36)진단위골대사이상,량조골대사이상발생솔비교차이유통계학의의(x2=6.55,P＜0.01).여비MS조비교,MS조、MS반골질소송조、MS반골량감소조BMI、요위、SBP、DBP、FPG、2hPG、TC、TG、LDL-C、FINS、HOMA-IR균승고(P＜ 0.01혹＜0.05),HDL-C강저(P＜0.01).여비MS조비교,MS조、MS반골질소송조、MS반골량감소조PINP、25-(OH)D3、골개소、BMD균강저(P＜ 0.05혹＜0.01),PTH、뇨개/Cr、U-CTX/Cr균승고(P＜ 0.05혹＜0.01),혈개、린급감성린산매비교차이균무통계학의의(P＞0.05).MS반골질소송조BMD여골개소화25-(OH)D3정정상관(P＜0.05),여PTH、U-CTX/Cr、뇨개/Cr정부상관(P＜0.05),여HOMA-IR역정부상관(P＜ 0.05).결론 중년남성MS환자존재골대사이상,표현위골형성감소、골흡수증가,병인발골질소송、골량감소.기골대사이상여이도소저항상관.
Objective To investigate the influence of metabolic syndrome (MS) on bone metabolism in middle-aged male patients with MS by measuring indicators of bone metabolism.Methods Among people who underwent physical examination from October 2010 to May 2013,110 middle-aged male patients with MS were selected and enrolled in MS group and 36 middle-aged men without MS were selected and enrolled in non-MS group.In MS group,27 patients with osteoporosis were enrolled in MS with osteoporosis group and 36 patients with decreased bone mass were enrolled in MS with decreased bone mass group.In each group:body mass index (BMI) and homeostasis model assessment for insulin resistance (HOMA-IR) was calculated;systolic blood pressure (SBP),diastolic blood pressure (DBP) and waist circumference was measured;blood biochemical indicators including fasting plasma glucose (FPG),2 h postprandial plasma glucose (2 h PG),fasting insulin (FINS),total cholesterol (TC),triglyceride (TG),low density lipoprotein-cholesterol (LDL-C) and high density hpoprotein-cholesterol (HDL-C) was tested; bone metabolic indicators including serum calcium,phosphate,alkaline phosphatase,25-hydroxy vitamin D [25-(OH)D3],procollagen type Ⅰ amino-terminal prcpeptide (PINP),parathyroid hormone (PTH),osteocalcin and urinary C-terminal telopeptide of type Ⅰ collagen (U-CTX),urine calcium,urine creatinine (Cr) were tested;bone mineral density(BMD) of lumber spine was tested too.Subjects above were compared among the four groups.The correlation of BMD with other bone metabolic indicators and HOMA-IR was also investigated in MS with osteoporosis group.Results The incidence of abnormal bone metabolism in MS group was 57.3％ (63/110),while in non-MS group was 11.1％ (4/36),and there was significant difference between two groups (x2 =6.55,P ＜ 0.01).Compared with non-MS group,MS group,MS with osteoporosis group and MS with decreased bone mass group had significant higher BMI,waist circumference,SBP,D BP,FPG,2 h PG,TC,TG,LDL-C,FINS,HOMA-IR(P ＜ 0.01 or ＜ 0.05) and lower HDL-C (P ＜ 0.01).Compared with non-MS group,MS group,MS with osteoporosis group and MS with decreased bone mass group had lower PINP,25-(OH)D3,osteocalcin and BMD (P ＜0.05 or ＜0.01) and higher PTH,urinary calcium/Cr,U-CTX/Cr(P ＜ 0.05 or ＜ 0.01).There was no significant difference in serum calcium,phosphate and alkaline phosphatase among four groups (P ＞ 0.05).BMD in MS with osteoporosis group was positively correlated with osteocalcin and 25-(OH)D3 (P ＜ 0.05),negatively correlated with PTH,U-CTX/Cr,urinary calcium/Cr and HOMA-IR (P ＜ 0.05).Conclsion Loss of bone mass and osteoporosis in middle-aged male patients with MS is due to decreased bone formation and increased bone absorption,which is closely related to insulin resistance.
