甲状旁腺激素和25羟维生素D对2型糖尿病患者并发骨质疏松症的影响及筛查价值  

Effects of parathyroid hormone and 25-hydroxy vitamin D for T2DM patients complicated with osteoporosis and their values of screening on disease

作　　者：王志国[1] 胡咏新[2] 徐书杭[2] 张双婕 王凌云[1] 范海波[1] 陈方庆[3] 张家明[1] Wang Zhiguo Hu Yongxin Xu Shuhang Zhang Shuangjie Wang Lingyun Fan Haibo Chen Fangqing Zhang Jiaming(Department of clinical laboratory, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing Jiangsu 210028, China Department of endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing Jiangsu 210028, China 3. Department of orthopaedics and traumatology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing Jiangsu 210028, China)

机构地区：[1]南京中医药大学附属中西医结合医院,江苏省中医药研究院检验科,南京210028 [2]南京中医药大学附属中西医结合医院,江苏省中医药研究院内分泌科,南京210028 [3]南京中医药大学附属中西医结合医院,江苏省中医药研究院骨伤科,南京210028

出　　处：《中国骨质疏松杂志》2016年第9期1116-1120,共5页Chinese Journal of Osteoporosis

基　　金：江苏省科技基础实施项目(BM2012064)

摘　　要：目的探讨甲状旁腺激素(PTH)及25羟维生素D(25OHD)水平对于2型糖尿病(T2DM)并发骨质疏松症(OP)的影响,并分析其对于疾病的筛查价值。方法选取2014年9月至2015年11月收治的329例T2DM患者,根据双能X线骨密度仪(DXA)测定结果,将患者分为骨量正常组(A组,n=124)、骨量减少组(B组,n=159)、骨质疏松症组(C组,n=46),采用病例对照研究方法,分析不同骨密度组及不同季节就诊患者间PTH、25OHD水平的差异;探讨PTH、25OHD之间及与骨标志物Ⅰ型前胶原氨基端延长肽(PⅠNP)、β胶原特殊序列(β-CTX)间的相关性;采用有序Logistic回归分析PTH、25OHD对T2DM并发OP的影响,并观察其对于OP的筛查价值。结果 1.三组之间PTH水平比较,C组明显高于B组、B组明显高于A组;25OHD水平比较,C组明显低于B组、B组明显低于A组。2.秋季就诊者25OHD水平明显高于冬春季;PTH水平差异无统计学意义。3.偏相关分析表明:PTH与PⅠNP、β-CTX呈明显正相关;25OHD与PTH、PⅠNP、β-CTX呈明显负相关。4.有序Logistic回归分析PTH、25OHD对于T2DM并发OP的影响显示:PTH:OR=6.265;25OHD:OR=0.369。5.受试者工作特征曲线(ROC曲线)显示,PTH、25OHD对于OP诊断的截断点分别为:≥46.58 pg/ml、≤14.70 ng/ml。结论 PTH水平增高患者更易患骨量减少及骨质疏松症,是发病的危险因素;而25OHD水平增高是发病的保护因素。不同季节25OHD水平不同,应特别注意冬春季节25OHD的补充。PTH、25OHD的检测不仅有助于识别T2DM并发OP的发病风险,还是疾病快速、无创、敏感的筛查指标。Objective To explore the effect of parathyroid hormone（PTH） and 25-hydroxy vitamin D（25OHD） for T2 DM patients complicated with osteoporosis and their values of screening on disease.Methods A total of 329 patients with T2 DM from September 2014 to November 2015 were divided into three different groups according to the bone mineral density（BMD） results!normal BMD group（group A,124 cases）,osteopenia group（group B,159 cases）,osteoporosis group（group C,46 cases）.By using case-control study,the levels of PTH,25 OHD in different BMD groups and different patient visit seasons were compared,and the correlation between PTH and 25 OHD and Bone metabolic markers（PINP and β-CTX） were also analyzed.Furthermore,we analyzed the relationship of PTH,25 OHD and osteopenia,osteoporosis by using Ordinal Logistic regression analysis,and the value on screening osteoporosis in T2 DM patients by using ROC curve analysis.Results 1.The level of PTH in group C were significantly higher than those in group B,and group B were significantly higher than those in group A.On the contrary,the level of 25 OHD in group C were significantly lower than those in group B,and group B were significantly lower than those in group.2.The level of 25 OHD in the patients visit in autumn were significantly than those in the patients visit in spring and in winter,and there were no significantly difference on the level of PTH between the different patients visit seasons.3.Partial correlation analysis showed that PTH were significantly positive correlated with PINP and β-CTX,25 OHD were significantly negative correlated with PTH,PINP and β-CTX.4.Ordinal Logistic regression analysis of PTH and 25 OHD reveal：PTH：OR =6.265.25OHD：OR =0.369.The level of PTH was positively correlated with the incidence of osteopenia and osteoporosis,which is the risk factor of the disease.But the level of 25 OHD was the opposite,which is the protective factor of the disease.5.Receiver operating characteristic curve（ROC curve） indicated：the cut

关 键 词：糖尿病 2型 骨质疏松症 甲状旁腺激素 25羟维生素D 

分 类 号：R681[医药卫生—骨科学]