2型糖尿病血清脂质运载蛋白2与骨密度关联的性别差异  

Sex-specific association of serum lipocalin-2 with bone mineral density in patients with type 2 diabetes mellitus

作　　者：沈秀荣 章惜 叶山东 陈超[1] 周婉 张世鲁 储思佳 王炜[1] SHEN Xiu-rong;ZHANG Xi;YE Shan-dong;CHEN Chao;ZHOU Wan;ZHANG Shi-lu;CHU Si-jia;WANG Wei(Department of Endocrinology,The First Affiliated Hospital of University of Science and Technology of China,Hefei 230001,China;Graduate School of Wannan Medical College,Wuhu 241000,Anhui,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)内分泌科,合肥230001 [2]皖南医学院研究生学院,安徽芜湖241000

出　　处：《中华骨质疏松和骨矿盐疾病杂志》2022年第4期336-343,共8页Chinese Journal Of Osteoporosis And Bone Mineral Research

基　　金：国家自然科学基金(81971264,81800713);安徽省中央引导地方科技发展专项资金(2017070802D147)。

摘　　要：目的探讨中老年2型糖尿病(type 2 diabetes mellitus,T2DM)患者血清脂质运载蛋白2(lipocalin-2,LCN2)与骨密度的相关性及其性别差异。方法选取2019年8月至2020年12月中国科学技术大学附属第一医院内分泌科住院治疗的中老年T2DM患者129例(男性71例,女性58例),收集静脉血检测空腹血糖(fasting plasma glucose,FPG)及糖化血红蛋白(glycosylated hemoglobin A1c,HbA1c)、25羟维生素D(25-hydroxy vitamin D,25-OHD)、Ⅰ型胶原羧基端肽交联(cross-linked C-telopeptide of type 1 collagen,CTX)、Ⅰ型原胶原氨基端肽(procollagen type 1 N-terminal propeptide,P1NP)、血清钙(serum calcium,Ca)、血清磷(serum phosphorus,P)等指标,同时采用双能X线吸收仪测定不同部位(腰椎、髋部、前臂)骨密度,采用酶联免疫吸附实验检测血清LCN2水平。结果女性血清LCN2水平骨质疏松组(135.98±15.56)ng/mL较骨量正常组(209.57±110.79)ng/mL及骨量减少组(188.17±88.03)ng/mL显著降低,差异有统计学意义(P=0.043)。根据血清LCN2水平从低到高将患者分为T1、T2、T33组,女性T3组桡骨前1/3骨密度(0.64±0.12)g/cm^(2)较T1和T2组(0.54±0.13)g/cm^(2)、(0.56±0.13)g/cm^(2)高,差异有统计学意义(P=0.030);男性各组血清LCN2水平差异无统计学意义(P>0.05)。女性血清LCN2与腰椎(L1-4)骨密度呈正相关(r=0.339,P=0.009),与桡骨前1/3骨密度亦呈正相关(r=0.299,P=0.023);男性血清LCN2与腰椎(L1-4)无相关性(r=-0.039,P=0.749),与桡骨前1/3骨密度呈正相关(r=0.237,P=0.047)。Logistics回归分析结果显示,无论男性或女性,年龄是中老年T2DM并发骨质疏松的独立影响因素。女性血清LCN2水平可能是中老年T2DM合并骨质疏松的保护性因素(OR=0.986,95%CI:0.974~0.997)。结论T2DM患者血清LCN2与桡骨前1/3骨密度呈正相关,血清LCN2可能是女性中老年T2DM患者并发骨质疏松的保护性因素。Objective To investigate the relationship between serum lipocalin-2(LCN2)and bone mineral density(BMD)in the middle-aged and elderly patients with type 2 diabetes mellitus(T2DM).Methods A total of 129 T2DM patients(71 males and 58 females)were recruited from Department of Endocrinology,The First Affiliated Hospital of University of Science and Technology of China from August 2019 to December 2020.Fasting plasma glucose(FPG),glycosylated hemoglobin A1c(HbA1c),25-hydroxy vitamin D(25-OHD),cross-linked C-telopeptide of type 1collagen(CTX),procollagen type 1 N-terminal propeptide(P1NP),serum calcium(Ca)and serum phosphorus(P)were measured.Meanwhile,bone mineral density(BMD)at different sites was determined by dual energy X-ray absorptiometry.Serum LCN2 level was detected by enzyme-linked immunosorbent assay.Results In females,serum LCN2 levels in the osteoporosis group(135.98±15.56)ng/mL were significantly lower than those in the normal bone mass group(209.57±110.79)ng/mL and the osteopenia group(188.17±88.03)ng/mL(P=0.043).The patients were divided into three groups according to serum LCN2 levels,namely T1,T2,and T3 groups.The BMD of the anterior 1/3 of the radius in T3 group(0.64±0.12)g/cm^(2)was higher than that in T1 and T2 groups(0.54±0.13)g/cm^(2),and(0.56±0.13)g/cm^(2)(P=0.030).In males,there was no significant difference in serum LCN2 level among all groups.Serum LCN2 positively correlated to lumbar BMD(L1-4)(r=0.339,P=0.009)and BMD(r=0.299,P=0.023)in the anterior 1/3 of radius in females.In males,serum LCN2 was not correlated with lumbar spine(L1-4)(r=-0.039,P=0.749)and positively correlated to BMD in the anterior 1/3 of the radius(r=0.237,P=0.047).Logistic regression analysis showed that age was an independent factor influencing both male and female T2DM patients with osteoporosis.Serum LCN2 level could be protective factor for osteoporosis in middle-aged and elderly patients with T2DM in women(OR=0.986,95%CI:0.974-0.997).Conclusion Serum LCN2 positively correlated to BMD of the anterior 1/3 of the ra

关 键 词：2型糖尿病 血清脂质运载蛋白2 骨密度 

分 类 号：R681[医药卫生—骨科学]