IGF-1、IGF-2与2型糖尿病合并骨质疏松症老年患者骨代谢指标的关系及其临床意义  

Relationship between IGF-1,IGF-2 and bone metabolic indexes in elderly patients with T2DM complicated with osteoporosis and its clinical significance.

作　　者：孙丽娜 王星[1] 杜国慧 SUN Li-na;WANG Xing;DU Guo-hui(Department of Endocrinology,the First Hospital of Qinhuangdao,Qinhuangdao Hebei 066000,China.)

机构地区：[1]秦皇岛市第一医院内分泌科,河北秦皇岛066000

出　　处：《临床和实验医学杂志》2022年第20期2163-2167,共5页Journal of Clinical and Experimental Medicine

基　　金：河北省医学科学研究重点课题(编号:ZL20140269)。

摘　　要：目的探讨胰岛素样生长因子(IGF)-1、IGF-2与2型糖尿病(T2DM)合并骨质疏松症老年患者骨代谢指标的关系及临床意义。方法前瞻性选取2021年1月至2022年1月在秦皇岛市第一医院治疗的T2DM老年患者150例,其中非骨质疏松症患者患者100例,骨质疏松症患者50例。比较非骨质疏松症和骨质疏松症患者临床资料、IGF-1、IGF-2等差异,以及分析IGF-1、IGF-2与腰椎骨密度、25(OH)D3、骨钙素、β-CTX的相关性;多因素Logistic回归分析骨质疏松症的影响因素;同时分析骨质疏松症伴和不伴骨折患者临床资料、IGF-1、IGF-2等差异;分析IGF-1、β-CTX预测患者伴骨折的价值。结果骨质疏松症患者年龄、T2DM病程、体重指数、糖化血红蛋白(HbA1c)、β-CTX分别为(70.29±5.59)岁、(8.03±1.20)年、(24.92±2.78)kg/m^(2)、(9.30±1.24)mmol/L和(0.48±0.18)g/L,明显高于非骨质疏松症患者[(66.39±4.48)岁、(7.20±1.18)年、(23.40±2.81)kg/m^(2)、(8.82±1.18)mmol/L和(0.32±0.15)g/L],而骨钙素、IGF-1和IGF-2分别为(4.60±1.78)g/L、(98.28±24.42)ng/mL和(0.20±0.09)ng/mL,明显低于非骨质疏松症患者[(6.79±1.92)g/L、(120.32±31.18)ng/mL和(0.38±0.10)ng/mL],差异均有统计学意义(P<0.05)。IGF-1与腰椎骨密度、骨钙素呈正相关(P<0.05),与β-CTX呈负相关(P<0.05);IGF-2与腰椎骨密度呈正相关(P<0.05)。Logistic回归分析显示,年龄、体重指数、HbA1c、IGF-1是老年T2DM合并骨质疏松症的影响因素(P>0.05)。骨质疏松症伴骨折患者β-CTX为(0.55±0.18)g/L,明显高于不伴骨折患者[(0.41±0.14)μg/L],而IGF-1为(86.60±20.12)ng/mL,明显低于不伴骨折患者[(107.46±21.82)ng/mL],差异均有统计学意义(P<0.05)。IGF-1预测患者伴骨折的ROC曲线下面积为0.781,有预测价值(P<0.05);β-CTX预测患者伴骨折的ROC曲线下面积为0.607,无预测价值(P>0.05)。结论T2DM合并骨质疏松症老年患者IGF-1、IGF-2水平降低,其中IGF-1与患者骨密度及骨代谢指标有关,是患�Objective To investigate the relationship between insulin-like growth factor(IGF)-1,IGF-2 and bone metabolism in elderly patients with type 2 diabetes mellitus(T2DM)complicated with osteoporosis.Methods A total of 150 elderly patients with T2DM treated in the First Hospital of Qinhuangdao from January 2021 to January 2022 were prospective selected,including 100 patients with non osteoporosis and 50 patients with osteoporosis.The clinical data,IGF-1,IGF-2,etc.of non-osteoporotic and osteoporotic patients were compared,and the correlation between IGF-1,IGF-2 and lumbar spine bone mineral density(BMD),25(OH)D3,osteocalcin,β-CTX was analyzed.The influencing factors of osteoporosis were analyzed using multivariate Logistic regression analysis.At the same time,the differences of clinical data,IGF-1 and IGF-2 between patients with fracture and patients without fracture were analyzed.The value of IGF-1 andβ-CTX in predicting patients with fractures was analyzed.Results The age,duration of T2DM,body mass index,hemoglobin A1c(HbA1c)andβ-CTX of patients with osteoporosis were(70.29±5.59)years,(8.03±1.20)years,(24.92±2.78)kg/m^(2),(9.30±1.24)mmol/L and(0.48±0.18)g/L,respectively,which were significantly higher than those of patients without osteoporosis[(66.39±4.48)years,(7.20±1.18)years,(23.40±2.81)kg/m^(2),(8.82±1.18)mmol/L and(0.32±0.15)g/L],while osteocalcin,IGF-1 and IGF-2 were(4.60±1.78)g/L,(98.28±24.42)ng/mL and(0.20±0.09)ng/mL,respectively,which was significantly lower than that in non osteoporosis patients[(6.79±1.92)g/L,(120.32±31.18)ng/mL and(0.38±0.10)ng/mL],the differences were statistically significant(P<0.05).IGF-1 was positively correlated with lumbar BMD and Osteocalcin(P<0.05),and negatively correlated with-CTX(P<0.05).IGF-2 was positively correlated with lumbar BMD(P<0.05).Logistic regression analysis showed that age,body mass index,HbA1c and IGF-1 were the influencing factors of senile T2DM complicated with osteoporosis(P>0.05).-CTX in patients with osteoporosis and fracture was(0.55±0

关 键 词：2型糖尿病 骨质疏松症 胰岛素样生长因子-1 胰岛素样生长因子-2 骨代谢指标 

分 类 号：R580[医药卫生—内分泌] R587.1[医药卫生—内科学]