血清骨形成蛋白4水平与2型糖尿病患者骨密度相关性分析

背景　骨形成蛋白4（BMP4）是促进骨形成的重要因子，同时影响胰岛素的分泌。而目前关于2型糖尿病患者血清BMP4水平及其与骨密度的相关性鲜有报道。目的　探讨2型糖尿病患者血清BMP4与骨密度的关系。方法　前瞻性收集2017年在中国医科大学附属第四医院第一内分泌代谢内科住院治疗的2型糖尿病患者128例的临床资料，收集患者的一般资料、实验室检查指标，采用酶联免疫吸附试验（ELISA）测定血清中BMP4水平。根据骨密度检查结果，将患者分为骨量正常组（66例）和骨量减少组（62例）。血清BMP4水平与各指标的相关性分析采用Spearman秩相关分析；2型糖尿病患者骨量减少影响因素的分析采用多因素Logistic回归分析。结果　两组患者空腹血糖（FBG）、空腹胰岛素、空腹C肽、糖化血红蛋白（HbA1c）、三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）、尿酸（UA）、胰岛素抵抗指数（HOMA-IR）比较，差异均无统计学意义（P>0.05）；骨量减少组女性所占比例高于骨量正常组，年龄高于骨量正常组、病程长于骨量正常组，体质指数（BMI）、腰围、BMP4水平低于骨量正常组（P<0.05）。Spearman秩相关分析显示，2型糖尿病患者血清BMP4水平与年龄呈负相关（rs=-0.262，P=0.003），与BMI呈正相关（rs=0.205，P=0.020）。多因素Logistic回归分析结果显示，BMP4为2型糖尿病患者骨量减少的影响因素〔OR=0.364，95%CI（0.214，0.619），P<0.05〕。结论　2型糖尿病患者中骨密度减少者血清BMP4水平明显下降，低水平BMP4与高龄、低BMI相关，BMP4是骨密度减少的独立影响因素。

Relationship between Serum BMP4 Level and Bone Density in Patients with Type 2 Diabetes Mellitus

Background　BMP4 is a major factor which can promote bone formation and influence insulin secretion.However，few studies have been done regarding the relationship between bone density and serum BMP4 level in type 2 diabetes mellitus （T2DM） patients.Objective　To explore the association between bone density and serum BMP4 level in T2DM patients.Methods　A prospective design was used.T2DM inpatients （n=128） from No.1 Department of Endocrinology and Metabolism，the Fourth Affiliated Hospital of China Medical University were enrolled during January to December 2017.Clinical data were collected，including demographic data，routine laboratory parameters，serum BMP4 detected using ELISA，and bone density （66 with normal and 62 with reduced bone density）.Spearman rank correlation analysis was used to analyze the correlation of serum BMP4 with other indices.Logistic regression was used to determine variables associated with osteopenia.Results　Compared with patients with normal bone density，those with reduced bone density had higher percentage of women，greater average age and longer average duration of T2DM，and lower average BMI，waist circumference as well as BMP4 （P<0.05），but similar average levels of fasting blood glucose，fasting insulin，fasting C-peptide，HbA1c，TG，TC，LDL，HDL，uric acid，and HOMA-IR （P>0.05）.The level of BMP4 had negative correlation with age （rs=-0.262，P=0.003） and positive correlation with BMI （rs=0.205，P=0.020）.Logistic regression analysis showed that BMP4 was independently associated with reduced bone density 〔OR=0.364，95%CI（0.214，0.619），P<0.05〕.Conclusion　The level of BMP4 in serum was significantly decreased in T2DM patients with reduced bone density.Low BMP4 was significantly correlated with advanced age and low BMI.BMP4 was an independent predicted factor of bone density.