中老年2型糖尿病患者骨标志物和骨密度随年龄及性别的变化及相互关系

目的探讨中老年2型糖尿病患者骨标志物和骨密度随年龄及性别的变化及相互关系。方法采用RocheE170全自动电化学发光免疫分析仪检测患者的骨钙素（OC）、总I型前胶原氨基端肽（tPINP）和I型胶原羧基端肽（8-CTX），用美国GELunar双能x线吸收仪检测患者正位腰椎（L1-L4）及一侧股骨近段股骨颈的骨密度（BMD）。结果男性和女性患者的骨标志物无显著性差异（P〉0．05），女性患者BMD均低于男性（P〈0．05）；女性患者的骨标志物均与年龄呈正相关，在40-49岁最低，50岁以后显著升高，随后维持在较高水平。腰椎（L-Lt）的密度在50岁以后显著降低，股骨颈的密度在60岁以后也显著下降，OC与股骨颈密度负相关，tPINP和β—CTX与腰椎和股骨颈密度均呈负相关。男性患者的骨标志物与年龄和骨密度均无相关性，各年龄段骨标志物均无明显变化，腰椎骨密度也无明显改变，仅股骨颈密度60岁以后显著降低。结论骨标志物OC、tPINP和8-CTX是反映中老年女性2型糖尿病患者随年龄变化的骨转换的敏感和较特异的指标，能较好地预测BMD，50岁以后女性患者BMD降低与高骨转换水平有关；中老年男性2型糖尿病患者的骨标志物与年龄和骨密度无相关性，骨标志物和骨密度是骨强度的独立指标，互相之间没有必然联系。

The relationship of markers of bone and bone density along with age and gender in type 2 diabetes mellitus patients

Objective To discuss the relationship between markers of bone and bone mineral density along with age and gender in type-2 DM patients. Methods Detected markers of bone （osteocalcin,tPINP and i3-CTX） of type-2 DM patients with automatic electrochemiluminescence immunoassay analyzer（Roche E170） and the BMD of the first to the fourth lumbar vertebrae and proximate femur neck of type-2 DM patients with Dual-energy X-ray absorptiometry（GE Lunar,American）. Results The markers of bone in male and female type-2 DM patients have no statistical difference （P~0.05） ,BMD of female patients is lower than male patients（P〈0.05）. In female type-2 DM patients, markers of bone which are direct correlated to the age keep the lowest level at 40 to 49, significantly rise up after 50-years-old, then stay at the high level. The BMD of lumbar vertebrae （L1-L4） decreases sharply after 50;so does it of proximate femur neck after 60. OC negatively correlates to the BMD of femur neck ,tPINP and t3-CTX have negative correlations with BMD of lumbar vertebrae and femur neck respectively. On the other hand,in male type-2 DM patients,the markers of bone have no relevance with BMD and age, the markers of bone and the BMD of lumbar vertebrae have no remarkable changes at all ages,the BMD of femur neck decreases after the age of 60 . Conclusion In female type-2 DM patients, markers of bone （OC,tPINP and 13-CTX） were the specific and sensitive markers which reflect the bone variety along with age and could prognosis the BMD; after 50-years-old, the low level of BMD relates to the highly bone variety level. In male type-2 DM patients, Markers of bone have nothing to do with age and BMD, the markers of bone and BMD which reflect bone strength are interdependent.