2型糖尿病患者血清胱抑素C与骨质疏松的相关性  

Relationship of serum cystatin-C levels with osteoporosis in patients with type 2 diabetes mellitus

作　　者：晏丕军[1] 欧阳芳[1] 马红艳[1] 何建华[1] 李佳[1] 白雪[1] 张志红[1] 徐勇[1] 

机构地区：[1]泸州医学院附属医院内分泌科,泸州646000

出　　处：《山西医科大学学报》2016年第1期59-63,96,共6页Journal of Shanxi Medical University

基　　金：四川省科技厅应用基础基金资助项目(14JC0158);泸州市科技局基金资助项目(2013-S-48(22/30));泸州医学院科研基金资助项目(2012QN-29);泸州医学院附属医院科研基金资助项目(12295)

摘　　要：目的探讨2型糖尿病(T2DM)患者血清胱抑素C(Cys-C)与骨质疏松(OP)之间的关系,阐明Cys-C在OP发病中的作用机制。方法测定223例T2DM患者腰椎及髋部骨密度(BMD),根据OP诊断标准把T2DM患者分为单纯糖尿病组(non-OP组,n=128)和糖尿病合并OP组(OP组,n=95),采用透免法测定血清Cys-C水平并比较,采用直线相关分析及多元逐步回归分析Cys-C与腰椎、髋部BMD、尿微量白蛋白/肌酐(UACR)、踝肱指数(ABI)、血脂和血压等指标的关系。同时将所有研究对象以Cys-C上四分位为切点分为高Cys-C组与低Cys-C组,比较两组OP的患病率及髋部BMD水平。结果 OP组血清Cys-C水平明显高于non-OP组[(0.94±0.45)mg/L vs(0.80±0.29)mg/L,P<0.01]。相关分析显示,T2DM患者血清Cys-C与年龄、糖化血红蛋白(Hb A1c)、UACR、振动感觉阈值(VPT)和BMI成正相关,与DBP、血清Ca2+、股骨颈(FN)、华氏三角(Ward’s三角)、大转子(taber)和总髋部BMD成负相关(P<0.05或P<0.01)。高Cys-C组OP的患病率明显高于低Cys-C组(55.36%vs 38.32%,P<0.05),FN BMD、Ward’s三角BMD、大转子BMD和总髋部BMD水平明显低于低Cys-C组(P<0.05或P<0.01)。结论 T2DM患者血清Cys-C水平与股骨颈、华氏三角、大转子和总髋部BMD水平密切相关,可能参与了OP,尤其是髋部OP,的发生发展。Objective To investigate the relationship between serum cystatin-C（ Cys-C） levels and osteoporosis（ OP） in patients with type 2 diabetes mellitus（ T2DM）,and to explore the role of Cys-C in the development of OP. Methods Bone mineral density（ BMD）of the lumbar spine and hip in 223 patients with T2 DM was determined. All the patients were divided into two groups： simple T2 DM group（ non-OP group,n = 128） and T2 DM combined with OP group（ OP group,n = 95）. Fasting serum Cys-C levels were measured by radioimmunoassay（ RIA） and compared between two groups. The relationship between Cys-C,lumbar spine BMD,hip BMD,urine microalbuminuria-to-creatinine ratio（ UACR）,ankle brachial index（ ABI）,blood lipid,blood pressure and other parameters were also analyzed. All T2 DM patients were also divided into high Cys-C group and low Cys-C group according to the upper quartile of Cys-C,and the incidence of OP and hip BMD levels were compared between two groups. Results Serum Cys-C level in OP group was significantly higher than that in non-OP group[（ 0. 94 ± 0. 45） mg / L vs（ 0. 80 ± 0. 29） mg / L,P〈0. 01]. Correlation analysis showed that the serum Cys-C level was positively correlated with age,glycosylated hemoglobin（ Hb A1c）,UACR,vibrating perception threshold（ VPT） and body mass index（ BMI）,but negatively correlated with diastolic blood pressure（ DBP）,serum calcium（ Ca^2 ＋）,femoral neck（ FN） BMD,trochanter BMD,Ward＇s triangle BMD and total hip BMD（ P〈0. 05 or P〈0. 01）. Compared with low Cys-C group,the prevalence of OP increased in high Cys-C group（ 38. 32% vs 55. 36%,P〈0. 05）,while FN BMD,Ward＇s triangle region BMD,trochanter BMD and total hip BMD decreased（ P〈0. 05 or P〈0. 01）. Conclusion Serum Cys-C level is closely correlated with levels of BMD at femoral neck,trochanter and Ward＇s triangle and total hip,suggesting that serum Cys-C may be involved in the occurrence and development of OP,especially hip OP.

关 键 词：2型糖尿病 胱抑素C 骨质疏松 髋部骨密度 

分 类 号：R587.1[医药卫生—内分泌]