甲状腺功能状态与老年T2DM患者肌肉相关指标及趋化素、25(OH)D的相互关系  

Relationship between thyroid function status and muscle-related indicators,as well as chemokines and 25(OH)D in elderly patients with type 2 diabetes mellitus

作　　者：郑华东[1] 徐丽 李明 岳斌 Zheng Huadong;Xu Li;Li Ming;Yue Bin(Department of Gerontology,Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,China;Department of Endocrinology,Xi’an GemFlower Changqing Hospital,Xi’an 710018,China)

机构地区：[1]西安交通大学第二附属医院老年病科,西安710004 [2]西安宝石花长庆医院内分泌科,西安710018

出　　处：《中华内分泌外科杂志（中英文）》2024年第6期824-829,共6页Chinese Journal of Endocrine Surgery

基　　金：陕西省科技项目基金(2018SF-266)。

摘　　要：目的探讨甲状腺功能状态与老年2型糖尿病(T2DM)患者肌肉、骨代谢相关指标及血清趋化素(chemerin)、25羟基维生素D[25(OH)D]水平的相互关系。方法选取2022年3月至2024年3月西安交通大学第二附属医院老年病科收治158例老年T2DM患者为研究对象,根据是否并发骨质疏松症(OP),分别纳入并发组(61例)、未并发组(97例)。比较两组基线资料、肌肉(握力、肌肉含量)、骨代谢[骨钙素、骨特异性碱性磷酸酶(BAP)]相关指标及血清Chemerin、25(OH)D水平,采用偏相关系数分析上述指标与并发OP的偏相关性,对比不同甲状腺功能状态患者肌肉、骨代谢相关指标及血清指标水平,并采用交互作用系数γ分析甲状腺功能异常状态与肌肉、骨代谢相关指标及血清指标交互的影响。结果两组T2DM病程、甲状腺功能状态、糖化血红蛋白(HbA1c)、肌肉含量、骨钙素及25(OH)D、BAP、Chemerin水平比较,差异有统计学意义(t/χ^(2)=4.564、7.900、8.184、-2.028、-7.708、-6.927、3.167、14.298,P<0.05);经偏相关系数分析显示,甲状腺功能状态(甲亢、甲减)、肌肉含量、骨钙素、BAP、Chemerin、25(OH)D与老年T2DM患者并发OP显著相关(偏相关性系数=0.814、0.827、-0.675、-0.759、0.732、0.848、-0.702,P<0.05);老年T2DM伴甲亢患者骨钙素、BAP、Chemerin水平高于甲减患者及甲功正常患者,且甲减患者高于甲功正常患者,差异有统计学意义(F=118.845、7.444、54.253,P<0.05);交互作用分析显示,甲减、甲亢与骨钙素、Chemerin之间均存在相乘及相加交互作用,协同效应可明显高于两者效应之和数倍,增加并发OP风险(RERI=8.216、15.472,SI=1.414、2.053,P<0.001)。结论甲状腺功能状态与老年T2DM并发OP患者肌肉、骨代谢相关指标及血清Chemerin、25(OH)D水平密切相关,甲状腺功能异常与骨钙素、Chemerin同时暴露可协同增加并发OP风险,联合应用可作为临床预测OP的新型辅助方案,并对临�ObjectiveTo explore the relationship between thyroid function status and related indicators of muscle and bone metabolism,as well as serum levels of chemerin and 25-hydroxyvitamin D[25(OH)D]in elderly patients with type 2 diabetes mellitus(T2DM).MethodsA total of 158 elderly T2DM patients admitted to Department of Gerontology,Second Affiliated Hospital of Xi’an Jiaotong University from Mar.2022 to Mar.2024 were selected as the study subjects.According to whether they had osteoporosis(OP),they were included in the concurrent group(61 cases)and the non-concurrent group(97 cases).The baseline data,muscle(grip strength,muscle content),bone metabolism[osteocalcin,bone-specific alkaline phosphatase(BAP)]related indicators,and serum Chemerin and 25(OH)D levels were compared between the two groups.The partial correlation coefficient was used to analyze the partial correlation between the above indicators and the concurrent OP in elderly patients with T2DM.The levels of muscle,bone metabolism-related indicators and serum indicators were compared among patients with different thyroid function status,and the interaction coefficientγwas used to analyze the interactive effects of abnormal thyroid function status on muscle,bone metabolism-related indicators and serum indicators.ResultsThere were significant differences in the duration of T2DM,thyroid function status,glycosylated hemoglobin(HbA1c),muscle content,osteocalcin,25(OH)D,BAP,and Chemerin levels between the two groups(t/χ^(2)=4.564,7.900,8.184,-2.028,-7.708,-6.927,3.167,14.298,P<0.05).Partial correlation analysis showed that thyroid function status(hyperthyroidism,hypothyroidism),muscle content,osteocalcin,BAP,Chemerin,and 25(OH)D were significantly associated with the occurrence of OP in elderly T2DM patients(partial correlation coefficients=0.814,0.827,-0.675,-0.759,0.732,0.848,-0.702,P<0.05).The levels of osteocalcin,BAP,and Chemerin were higher in elderly T2DM patients with hyperthyroidism than in those with hypothyroidism and normal thyroid function,and those

关 键 词：甲状腺功能 老年 2型糖尿病 骨代谢 25羟基维生素D 骨质疏松 

分 类 号：R587.1[医药卫生—内分泌]