老年男性2型糖尿病患者骨代谢指标变化研究

目的 通过测定男性2型糖尿病(T2DM)患者及健康人群的骨代谢及相关指标,探讨T2DM对骨代谢的影响及其相关因素. 方法 对50例老年男性T2DM患者的血生化、骨代谢、性激素与维生素等指标进行检测,根据糖尿病病程将其分为T2DM 1组(病程＜10年)及T2DM 2组(病程≥10年),根据糖化血红蛋白(HbA1c)水平将其分为T2DM 3组(HbA1c ＜8％)及T2DM 4组(HbA1c≥8％),同时选取我院55例体检健康者作为对照组.结果 (1)T2DM组患者睾酮(T)、Ⅰ型前胶原氨基末端(N端)前肽(PINP)、Ⅰ型前胶原氨基末端(C端)前肽(PICP)、25-羟维生素D3水平明显低于对照组,抗酒石酸碱性磷酸酶(TrACP-5b)水平明显高于对照组,差异有统计学意义(P＜0.05).(2) T2DM 2组血PINP水平明显低于T2DM 1组,差异有统计学意义(P＜0.05),而对于T、TrACP-5b和25-羟维生素D3,T2DM 1组和T2DM 2组之间无明显统计学差异(P＞0.05).(3) T2DM 3组患者的25-羟维生素D3水平明显高于T2DM 4组,而TrACP-5b水平明显低于T2DM 4组,差异均有统计学意义(P均＜0.05),2组间血T、PINP、PICP无明显统计学差异(P＞0.05).(4)T与PINP、PICP、25-羟维生素D3、TrACP-5b无明显相关性,HbAlc与25-羟维生素D3、TrACP-5b存在显著相关性(r=-0.309、0.421,P＜0.05). 结论 (1)与正常对照组相比,T2DM患者的骨形成降低,而骨吸收增加.(2)随着病程增加,T2DM患者骨质形成速率进一步减慢,而骨吸收无明显增加.(3)血糖控制不佳可致骨形成减缓、骨质吸收增加而影响骨代谢.

Investigation on markers of bone metabolism in old male patients with type 2 diabetes mellitus

Objective By measuring indicators of bone metabolism and related indicators,to investigate the influence of diabetes on bone metabolism and related factors in patients with type 2 diabetes mellitus（T2DM）.Methods Fifty elderly male patients with T2DM were recruited.Blood biochemical indexes,bone metabolism,sex hormones and vitamins were determined.According to duration of diabetes,patients were divided into group 1（duration<10 years） and group 2（duration≥10 years）;according to HbA1c levels,patients were divided into group 3（HbAlc <8%）and group 4 （HbAlc≥8%）.Meanwhile,55 people whose physical examinations were normal in our hospital were selected as the control group.Results（1）Testosterone,PINP,PICP and 25-OH VitD₃（25OHD₃ ） in patients were significantly lower than those in control group and TrACP-5b was obviously higher than that in control group（P<0.05）.（2） PINP in group 2 was significantly lower than that in group 1（P<0.05）.Whereas,there were no statistical differences of testosterone, TrACP-5b,25OHD₃ between group 1 and group 2.（3）25OHD₃ in group 3 was higher than that in group 4,while TrACP-5b was lower than that in group 4（P<0.05）.No significant difference was found in terms of serum testosterone,PINP and PICP.（4）Testosterone was not related with PINP,PICP,25OHD₃ and TrACP-5b,while HbAlc was significantly related to 25OHD₃ and TrACP-5b（r=-0.309,0.421,P<0.05）.Conclusions（1） Reduced bone formation and increased bone resorption appear in T2DM patients.（2） Along with the increasing duration of T2DM,the rate of bone formation further slow down,yet no significant bone resorption is found.（3） Poor blood glucose control can influence bone metabolism through increasing bone resorption and slowing bone formation down.