老年2型糖尿病患者中血清胎球蛋白A水平与性激素及骨代谢指标的相关性研究  

Association of levels of serum fetuin A,sex hormones and bone metabolic markers in elderly patients with type 2 diabetes mellitus

作　　者：豆路沙 林冰倩 林纬[1] 林建立[1] 梁继兴[1] 李连涛[1] 黄惠彬[1] 陈刚[1] 温俊平[1] Dou Lusha;Lin Bingqian;Lin Wei;Lin Jianli;Liang Jixing;Li Liantao;Huang Huibin;Chen Gang;Wen Junping(Fujian Provincial Clinical Medical College of Fujian Medical University,Department of Endocrinology,Key Laboratory of Endocrinology,Fujian Provincial Hospital,Fuzhou 350001,China;Department of Endocrinology,Henan No.3 Provincial Peopled Hospital,Zhengzhou 450000,China)

机构地区：[1]福建医科大学省立临床医学院,福建省立医院内分泌科,福建省立医院内分泌研究室,福州350001 [2]河南省直第三人民医院内分泌科,郑州450000

出　　处：《中华糖尿病杂志》2021年第11期1049-1054,共6页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：国家重点研发计划(2018YFC2001100-5);国家自然科学基金(82070878)。

摘　　要：目的探讨老年2型糖尿病(T2DM)患者中血清胎球蛋白A水平与性激素及骨代谢指标的相关性。方法为横断面研究。选择2014年1至10月在福建省立医院内分泌科就诊的老年T2DM患者为研究对象,检测总胆固醇、高密度脂蛋白胆固醇(HDL-C)、碱性磷酸酶、血清胎球蛋白A、腰椎和股骨颈骨密度(BMD)值及血清骨代谢指标[β-胶原特殊序列(β-CTX)、骨钙素和Ⅰ型胶原氨基端延长肽(PINP)]、性激素指标(雌二醇、睾酮和游离睾酮指数)。采用t检验、秩和检验及χ^(²)检验进行不同性别组间的比较。采用Pearson相关分析法及多元线性回归分析法分析经Lg转换后的胎球蛋白A水平与临床各指标之间的相关性。结果共纳入103例老年T2DM患者,其中女48例,男55例。不同性别间老年T2DM患者血清胎球蛋白A水平差异无统计学意义(P>0.05)。女性BMD值低于男性[腰椎分别为(0.739±0.117)和(0.930±0.161)g/cm^(2),股骨颈分别为(0.650±0.095)和(0.824±0.116)g/cm^(2),均P<0.01],女性患者的β-CTX、骨钙素和PINP高于男性(均P<0.01)。男性患者的血清胎球蛋白A与β-CTX呈负相关(r=-0.307,P=0.024),与BMD及T值无相关性;女性患者的血清胎球蛋白A与股骨颈BMD呈负相关(r=-0.336,P=0.020),与腰椎BMD、股骨颈T值均无相关性。在不同性别的老年T2DM患者中,血清胎球蛋白A与雌二醇、睾酮及游离睾酮指数均无相关性(P>0.05)。多元线性回归分析结果显示,男性HDL-C(β=0.349,P<0.01)、碱性磷酸酶(β=-0.295,P=0.024)及β-CTX(β=-0.039,P=0.026)是血清胎球蛋白A水平的独立影响因素;女性总胆固醇(β=0.280,P=0.026)及股骨颈BMD(β=-0.083,P=0.05)是血清胎球蛋白A水平的独立影响因素。结论老年T2DM患者血清胎球蛋白A水平与性激素指标无相关性,胎球蛋白A是老年T2DM男性患者BMD的保护因素。Objective To evaluate the relationship of serum fetuin A levels with sex hormones and bone metabolism markers in elderly patients with type 2 diabetes mellitus(T2DM).Methods A cross-sectional study was conducted in the elderly T2DM patients admitted to the Department of Endocrinology,Fujian Provincial Hospital from January to October 2014.The level of total cholesterol,high-density lipoprotein-cholesterol(HDL-C),alkaline phosphatase,serum fetuin A,bone mineral density(BMD)of lumbar spine and femoral neck and serum bone metabolism markers[β-collagen specific sequence(β-CTX),osteocalcin and N-terminal lengthening peptide of typeⅠcollagen(PINP)],sex hormones(estradiol,testosterone and free testosterone index)were measured.The t test,rank sum test and χ^(2) test were used for comparison between groups.Pearson correlation analysis and multiple linear regression analysis were used to analyze the correlation between Lg fetuin A and clinical variables.Results A total of 103 elderly T2DM patients were enrolled,including 48 females and 55 males.There was no statistically significant difference in serum fetuin A level between genders(P>0.05).The BMD value of women was lower than that of men[lumbar BMD was(0.739±0.117)and(0.930±0.161)g/cm^(2),respectively,femoral neck BMD was(0.650±0.095)and(0.824±0.116)g/cm2,respectively,P<0.01],β-CTX,osteocalcin and PINP were higher in women than those in men(all P<0.01).Serum fetuin A was negatively correlated withβ-CTX in men(r=-0.307,P=0.024),but not with BMD and T value.Serum fetuin A was negatively correlated with bone mineral density of femoral neck(r=-0.336,P=0.020),but had no correlation with lumbar BMD and T value of femoral neck.There was no correlation between serum fetuin A and estradiol,testosterone and free testosterone index in elderly T2DM patients of different genders(P>0.05).Multiple linear regression analysis showed that HDL-C(β=0.349,P<0.01),alkaline phosphatase(β=-0.295,P=0.024)andβ-CTX(β=-0.039,P=0.026)were independent related factor of serum fetuin A l

关 键 词：糖尿病 2型 骨密度 胎球蛋白A 性激素 

分 类 号：R587.2[医药卫生—内分泌] R580[医药卫生—内科学]