目的

探讨男性2型糖尿病（type 2 diabetes，T2DM）患者骨质疏松与骨转换标志物的相关关系。

方法

采用回顾性病例研究设计。用双能X线骨密度仪分别测定男性102例T2DM患者腰椎骨密度，并将之分为骨质疏松组（50例）和非骨质疏松组（52例）。然后，测定其血清骨标志物总I型前胶原氨基端前肽（N-terminal peptide of typeⅠprocollagen，TPINP）、β-胶原降解产物（β-C-terminal telopeptide of type I collagen，β-CTX）、N端骨钙素（N-MID Osteocalcin，N-MID）、25羟维生素D3（25(hydroxyl)vitamin D3，25-（OH）VD3）、血清钙（Ca）、血清磷（P）、糖化血红蛋白（hemoglobin A1c，HbA1c）、肌酐等相关生化指标。同时，用Pearson相关分析分析8项骨转换指标与T2DM患者发生骨质疏松的相关性。

结果

骨质疏松组腰椎（L1～L4）和脊柱的总密度骨密度（0.91±0.10、0.96±0.12、1.04±0.10、1.03±0.10、0.98±0.08）显著低于非骨质疏松组（1.21±0.12、1.30±0.13、1.37±0.16、1.39±0.14、1.33±0.15；t值分别为13.688、13.710、12.542、14.988、14.566，P均＜0.01），骨质疏松组的TPINP、β-CTX、HbA1c[（49.16±17.94） μg/L、（615.63±131.24） ng/L、（9.81±2.37）%]高于非骨质疏松组[（35.44±2.97）μg/L、（532.00±119.23）ng/L、（8.22±0.41）%；t值分别为-4.412，-3.371，-4.687，P均＜0.01]，而25-（OH）VD3低于骨质疏松组[（17.23±4.88）μg/L比（20.02±5.53）μg/L，t=2.696，P＜0.01]。T2DM患者骨质疏松组的T-PINP、β-CTX和HbA1c与腰椎和脊柱骨密度呈负相关（r分别为-0.720、-0.615、-0.768，P＜0.01），而25-（OH）VD3与腰椎和脊柱骨密度呈正相关（r=0.808，P＜0.01）。

结论

男性T2DM患者存在不同程度的骨密度下降，TPINP、β-CTX、25-（OH）VD3和HbA1c指标有助于对T2DM患者合并骨质疏松症进行早期诊断。

Objective

To investigate the relationship of diabetic male patients with osteoporosis and the bone turnover markers.

Methods

Dual-energy X-ray absorptiometry was used to measure lumbar spine bone mineral density, 102 diabetic patients were divided into osteoporosis group (50 cases) and nonosteoporosis group (52 cases). The levels of total procollagen type I amino-terminal propeptide (TPINP), β-C-terminal telopeptide of type I collagen (β-CTX), the N end osteocalcin (N-MID), the 25(hydroxyl)vitamin D3[25-(OH) VD3], serum calcium (Ca), serum phosphorus (P), glycosylated hemoglobin (HbA1c), creatinine and other biochemical indicators were detected to analyze the related cause of the risk factors for osteoporosis in patients with T2DM.

Results

The values of osteoporosis in lumbar spine bone mineral density (0.91±0.10, 0.96±0.12,1.04±0.10, 1.03±0.10, 0.98±0.08) were decreased as compared with the non-osteoporosis group (1.21±0.12,1.30±0.13, 1.37±0.16, 1.39±0.14, 1.33±0.15, t=13.688, 13.710, 12.542, 14.988, 14.566, P＜0.01). The TPINP, β-CTX, HbA1c in the osteoporosis group[(49.16±17.94) μg/L, (615.63±131.24) ng/L, (9.81±2.37)%]were higher than the non-osteoporosis group [(35.44±2.97) μg/L, (532.00±119.23) ng/L, (8.22±0.41)%, t=-4.412,-3.371, -4.687, P＜0.01], 25-(OH)VD3 in osteoporosis group was lower than the non-osteoporosis group[(17.23±4.88) μg/L vs (20.02±5.53) μg/L; t=2.696, P＜0.01]. Correlation analysis showed T-PINP, β-CTX were negatively correlated with BMD of spine in T2DM patients with osteoporosis (r=-0.720, -0.615, -0.768, P＜0.01)and 25-(OH)VD3 was positively correlated with BMD of spine (r=0.808, P＜0.01).

Conclusions

The spine BMD in T2DM patients is decreased to some degree. The application of TPINP, β-CTX, 25-(OH) VD3 and HbA1c are helpful for the early diagnosis of osteoporosis in patients with T2DM.