【摘要】 目的探讨2型糖尿病(T2DM)患者血清胱抑素C(Cys-C)与骨质疏松(OP)之间的关系,阐明Cys-C在OP发病中的作用机制。方法测定223例T2DM患者腰椎及髋部骨密度(BMD),根据OP诊断标准把T2DM患者分为单纯糖尿病组(non-OP组,n=128)和糖尿病合并OP组(OP组,n=95),采用透免法测定血清Cys-C水平并比较,采用直线相关分析及多元逐步回归分析Cys-C与腰椎、髋部BMD、尿微量白蛋白/肌酐(UACR)、踝肱指数(ABI)、血脂和血压等指标的关系。同时将所有研究对象以Cys-C上四分位为切点分为高Cys-C组与低Cys-C组,比较两组OP的患病率及髋部BMD水平。结果 OP组血清Cys-C水平明显高于non-OP组[(0.94±0.45)mg/L vs(0.80±0.29)mg/L,P<0.01]。相关分析显示,T2DM患者血清Cys-C与年龄、糖化血红蛋白(Hb A1c)、UACR、振动感觉阈值(VPT)和BMI成正相关,与DBP、血清Ca2+、股骨颈(FN)、华氏三角(Ward’s三角)、大转子(taber)和总髋部BMD成负相关(P<0.05或P<0.01)。高Cys-C组OP的患病率明显高于低Cys-C组(55.36%vs 38.32%,P<0.05),FN BMD、Ward’s三角BMD、大转子BMD和总髋部BMD水平明显低于低Cys-C组(P<0.05或P<0.01)。结论 T2DM患者血清Cys-C水平与股骨颈、华氏三角、大转子和总髋部BMD水平密切相关,可能参与了OP,尤其是髋部OP,的发生发展。更多还原

【Abstract】 Objective To investigate the relationship between serum cystatin-C( Cys-C) levels and osteoporosis( OP) in patients with type 2 diabetes mellitus( T2DM),and to explore the role of Cys-C in the development of OP. Methods Bone mineral density( BMD)of the lumbar spine and hip in 223 patients with T2 DM was determined. All the patients were divided into two groups: simple T2 DM group( non-OP group,n = 128) and T2 DM combined with OP group( OP group,n = 95). Fasting serum Cys-C levels were measured by radioimmunoassay( RIA) and compared between two groups. The relationship between Cys-C,lumbar spine BMD,hip BMD,urine microalbuminuria-to-creatinine ratio( UACR),ankle brachial index( ABI),blood lipid,blood pressure and other parameters were also analyzed. All T2 DM patients were also divided into high Cys-C group and low Cys-C group according to the upper quartile of Cys-C,and the incidence of OP and hip BMD levels were compared between two groups. Results Serum Cys-C level in OP group was significantly higher than that in non-OP group[( 0. 94 ± 0. 45) mg / L vs( 0. 80 ± 0. 29) mg / L,P < 0. 01]. Correlation analysis showed that the serum Cys-C level was positively correlated with age,glycosylated hemoglobin( Hb A1c),UACR,vibrating perception threshold( VPT) and body mass index( BMI),but negatively correlated with diastolic blood pressure( DBP),serum calcium( Ca2 +),femoral neck( FN) BMD,trochanter BMD,Ward’s triangle BMD and total hip BMD( P < 0. 05 or P < 0. 01). Compared with low Cys-C group,the prevalence of OP increased in high Cys-C group( 38. 32% vs 55. 36%,P < 0. 05),while FN BMD,Ward’s triangle region BMD,trochanter BMD and total hip BMD decreased( P < 0. 05 or P < 0. 01). Conclusion Serum Cys-C level is closely correlated with levels of BMD at femoral neck,trochanter and Ward’s triangle and total hip,suggesting that serum Cys-C may be involved in the occurrence and development of OP,especially hip OP.更多还原