目的 探讨老年2型糖尿病（type 2 diabetes mellitus,T2DM）患者血清脂钙蛋白2（lipocalin-2,LCN2）的水平与骨密度（bone mineral density,BMD）以及骨转换标志物之间的相关性。方法 选取60岁以上的老年2型糖尿病患者161例,根据血清LCN2水平从低到高进行三分位分组,分别比较组间各临床指标的差异,并分析血清LCN2水平与血糖、血脂、BMD以及骨转换指标的相关性。结果 老年2型糖尿病患者男性较女性有着更高的腰椎和髋部BMD（P<0.01）,女性的血清骨钙素（osteocalcin,OC）及血清I型胶原C-末端肽（type I collagen C-terminal peptide,CTX）水平较男性增高（P<0.01）;按照血清LCN2水平从低到高进行三分位分组进行组间比较,发现随着血清LCN2水平的升高,血清维生素D、股骨颈BMD和全髋BMD增加（P<0.05）;Spearman相关分析显示,血清LCN2与随机血糖、血清总胆固醇（TC）及血清低密度脂蛋白胆固醇（LDL-C）呈负相关（P<0.05）;老年T2DM患者血清LCN2与血清CTX呈负相关,与股骨颈BMD、总髋BMD呈正相关（P<0.05）;回归分析显示,血清LCN2可能是老年T2DM患者股骨颈及总髋BMD的保护性因素（P<0.05）。结论 老年2型糖尿病患者血清LCN2与股骨颈BMD、总髋BMD呈正相关,与血清CTX呈负相关;血清LCN2可能是股骨颈和总髋BMD的保护性因素,但尚需进一步的纵向研究和机制研究来明确其因果关系及具体作用。
Abstract
Objective To explore the correlation between serum lipocalin-2 (LCN2) levels, bone mineral density (BMD) and bone turnover markers in elderly patients with type 2 diabetes mellitus (T2DM). Method A total of 161 elderly patients with type 2 diabetes mellitus over 60 years old were selected and divided into three groups according to the serum LCN2 level from low to high. The differences of various clinical indicators were compared between the groups, and the correlation between serum LCN2 level and blood glucose, blood lipid, BMD and bone turnover markers was analyzed. Results In elderly patients with T2DM, men have higher lumbar and hip BMD (P<0.01) than women, and the levels of serum osteocalcin and serum type I collagen C-terminal peptide in women are higher than that in men (P<0.01). Patients were divided into 3 groups for intergroup comparison according to the third percentile of serum LCN2 level from low to high, and it was found that with the increase of serum LCN2 level, Serum vitamin D, femoral neck BMD, and total hip BMD were increased (P<0.05). Spearman correlation analysis showed that serum LCN2 was negatively correlated with random blood glucose, serum TC and serum LDL-C (P<0.05); Serum LCN2 was negatively correlated with serum CTX, and positively correlated with femoral neck BMD and total hip BMD in elderly patients with T2DM (P<0.05). Further regression analysis showed that serum LCN2 may be a protective factor for femoral neck and total hip BMD in elderly patients with T2DM (P<0.05). Conclusion In elderly patients with type 2 diabetes, serum LCN2 was positively correlated with femoral neck BMD and total hip BMD, and negatively correlated with serum CTX. Serum LCN2 may be a protective factor for femoral neck and total hip BMD, but further longitudinal studies and mechanism studies are needed to clarify its causal relationship and specific role.
关键词
2型糖尿病 /
脂钙蛋白2 /
骨密度 /
骨转换标志物
Key words
type 2 diabetes mellitus /
lipocalin 2 /
bone mineral density /
bone turnover marker
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基金
湖南省科技创新计划项目“老年2型糖尿病患者睡眠状况、血清褪黑素水平与骨质疏松和OPG/RANKL的相关性”（2021SK53111）; 长沙市卫生健康委科研计划项目“长沙市HIV/AIDS患者骨质疏松患病率调查及抗骨质疏松药物应用对比研究”（KJ-B2023036）
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