维生素D对糖尿病合并骨质疏松患者血清骨保护素、趋化素水平的影响

目的观察维生素D(Vit D)对2型糖尿病(type 2 diabetes mellitus,T2DM)合并骨质疏松(osteoporosis,OP)的患者血清骨保护素(osteoprotectin,OPG)及趋化素(Chemerin)水平的影响,初步探讨两者在疾病进展中的作用。方法选取2020年7～12月于我院就诊的新诊断T2DM合并OP的患者123例,根据患者血清中25-羟基维生素D25(OH) D]水平将其分为3组,分别为Vit D正常组(40例)、Vit D不足组(42例)和Vit D缺乏组(41例),同期选取我院体检中心健康人员40例作为对照(NC组)。Vit D不足组及Vit D缺乏组分别给予Vit D2注射液15 mg,肌肉注射,每4周1次,连续治疗12周。收集患者一般资料,检测治疗前后血清中TC、TG、HDL-C、LDL-C、25(OH) D、FPG、FINS、Hb A1c、OPG及Chemerin水平,同时利用双能X线骨密度仪检测治疗前后患者股骨颈骨密度(bone mineral density,BMD),并分析各因素与股骨颈BMD之间的相关性。结果治疗12周时,Vit D不足组及Vit D缺乏组血清TG、Hb A1c、OPG、Chemerin均较治疗前显著降低,而HDL-C、25(OH) D、股骨颈BMD均较治疗前显著升高(P0.05)。Vit D不足组中,治疗4周时血清Hb A1c、25(OH) D水平及股骨颈BMD较治疗前无显著变化(P0.05),TG、OPG、Chemerin较治疗前显著降低(P0.05),HDL-C较治疗前显著升高(P0.05)。在Vit D缺乏组中,治疗4周时患者血清中HDL-C、25(OH) D水平及股骨颈BMD均较治疗前显著升高(P0.05),血清TG、OPG、Chemerin水平均较治疗前显著降低(P0.05)。血清TG、LDL-C、Hb Alc、25(OH) D、OPG及Chemerin是股骨颈BMD的影响因素(P0.05)。结论Vit D可能通过升高血清Vit D水平,降低OPG、Chemerin而影响T2DM合并OP患者的骨密度。

Effect of vitamin D on levels of serum osteoprotegerin and chemerin in patients with diabetes mellitus and osteoporosis

Objective To observe the effect of vitamin D (VitD) on serum levels of osteoprotectin (OPG) and chemerin in patients with type 2 diabetes mellitus (T2DM) complicated with osteoporosis (OP), and to explore the preliminary.roles in the progression of disease Methods A total of 123 patients with T2DM complicated with OP who were admitted to our hospital from July 2020 to December 2020 were selected and divided into 3 groups according to the levels of serum 25(OH)D, which were VitD normal group (40 cases), VitD insufficient group (42 cases), and VitD deficiency group (41 cases). During the same period, 40 healthy persons from the physical examination center of our hospital were selected as the control group (NC group). VitD insufficient group and VitD deficiency group were given VitD2 15mg by intramuscular injection, once every 4 weeks for 12 consecutive weeks. The general data of patients were collected. The serum levels of TC, TG, HDL-C, LDL-C, 25(OH)D, FPG, FINS, HbA1c, OPG, and chemerin were detected before and after treatment. Bone mineral density (BMD) of the femoral neck was measured with dual-energy X-ray absorptiometry before and after treatment. The correlation between various factors and femoral neck BMD was analyzed. Results After 12 weeks of treatment, serum TG, HbA1c, OPG, and chemerin in the VitD-insufficient group and the VitD-deficient group decreased significantly compared to those before treatment, while HDL-C, 25(OH)D, and femoral neck BMD increased significantly compared to those before treatment (P<0.05). In VitD- insufficient group, serum levels of HbA1c, 25(OH)D, and femoral neck BMD at 4 weeks did not changed significantly (P>0.05), TG, OPG, and chemerin decreased significantly (P<0.05), and HDL-C increased significantly compared to those before treatment (P<0.05). In the VitD-deficient group, the serum levels of HDL-C, 25(OH)D, and femoral neck BMD increased significantly after 4 weeks of treatment (P<0.05), and the serum levels of TG, OPG, and chemerin decreased significantly compared to those before treatment (P<0.05). Femoral neck BMD was significantly positively correlated with serum 25(OH)D and HDL-C, and negatively correlated with OPG, chemerin, and HbA1c. Serum TG, LDL-C, HbA1c, 25(OH)D, OPG, and chemerin were influencing factors of femoral neck BMD. Conclusion VitD may affect BMD of patients with T2DM complicated with OP by increasing the level of serum VitD and decreasing OPG and chemerin.