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Received:April 20, 2020 Published Online:November 20, 2020
Received:April 20, 2020 Published Online:November 20, 2020
中文摘要: 目的 通过观察自然绝经后2型糖尿病(T2DM)女性的骨代谢指标与部分脂代谢指标的变化,探讨其与部分脂代谢指标的差异性。方法 共选取2019年1月至3月147名45~72岁自然绝经2年以上的妇女,按T2DM诊断标准分为T2DM组47名和非T2DM组100名;所有女性均由同一医师使用同一台双能X射线吸收测定法(DEXA)扫描,同时对腰椎(L3~4)和髋部(全髋、股骨颈、Wards三角大粗隆、大粗隆)进行标准骨密度(BMD)扫描,得出各部位BMD及部分T值，并根据T值结果将两组对象再分为骨质疏松、骨量减低和骨量正常亚组;同时用常规方法测定血清骨代谢标志物［Ⅰ型前胶原氨基端前肽(PINP)、β-胶原降解产物（β-CTX）］、皮质醇、脱氢表雄酮、雄烯二酮等生化指标，用液相色谱-质谱联用技术检测部分脂代谢标记物［磷脂酰胆碱（PC）、心磷脂（CL）、鞘脂类（SM）］在一定离子质荷比下的定量水平。比较各组间代谢标志物水平的差异。结果 T2DM组和非T2DM组骨代谢标记物、脂代谢标记物及皮质醇、脱氢表雄酮、雄烯二酮、骨密度和T值比较差异无统计学意义(P>0.05)。不同骨量水平下比较：三组β-CTX差异有统计学意义（F=3.196，P=0.044），骨质疏松组的β-CTX高于骨量减低组和骨量正常组(P<0.05)；PC(18[DK]∶0/20[DK]∶4)随着骨量水平的降低呈递增趋势(F=183.528，P=0.000)；三组PC(36[DK]∶2)差异有统计学意义（F=101.891，P=0.000），骨量减低组的PC(36[DK]∶2)高于骨量正常组和骨质疏松组(P<0.05)；PC(36[DK]∶5)随着骨量水平的降低呈递增趋势（F=227.552，P=0.000）；SM(d16[DK]∶0/18[DK]∶1)随着骨量水平的降低呈递减趋势（F=54.975，P=0.000）。结论 部分脂代谢指标的变化提示脂代谢与骨代谢之间存在相关性,可供临床医师通过检测脂代谢指标的变化,更早发现、预防以及诊治骨质疏松症。
Abstract:Objective To observe the changes of bone metabolism indexes and some lipid metabolism indices in postmenopausal women with type 2 diabete mellitus (T2DM) to explore the relationship between them.Methods A total of 147 women aged 45-72 years,with natural menopause of more than 2 years were selected and divided into T2DM group ( n=47) and non-T2DM group( n=100) according to the diagnostic criteria for T2DM;all the women were scanned using the same dual energy X-ray absorptiometry (DEXA) to obtain the standard bone mineral density (BMD) values and partial T values of lumbar spine (L3-4) and hip (total hip,femoral neck,Ward′s triangle trochanter,greater trochanter).At the same time, the serum levels of bone metabolism markers［procollagen type I N-terminal propeptide(PINP), β-collagen degradation product(β-CTX)］and cortisol, dehydroepiandrosterone and androstenedione were detected by conventional methods. The quantitative levels of some lipid metabolism markers［phosphatidylcholine(PC), cardiolipin(CL), sphingolipids(SM)］ at a certain mass-to-charge ratio were detected by liquid chromatography-mass spectrometry technology.Results There were no statistical differences in bone metabolism markers,lipid metabolism markers,levels of cortisol,dehydroepiandrosterone and androstenedione,BMD and T values between two groups ( P >0.05).There was a significant difference in β-CTX at different bone mass levels ( F=3.196, P=0.044),and it was higher in osteoporosis group than those in bone mass reducing group and normal bone mass group ( P <0.05).At different bone mass levels,PC (18[DK]∶0/20[DK]∶4) showed an increasing trend with the decrease of bone mass level ( F=183.528, P=0.000);PC (36[DK]∶2) in bone mass reducing group was significantly higher than those in normal bone mass group and osteoporosis group ( F=101.891, P=0.000);PC (36[DK]∶5) increased statistically with the decrease of bone mass level ( F=227.552, P=0.000);SM(d16[DK]∶0/18[DK]∶1) significantly decreased with the decrease of bone mass level( F=54.975, P=0.000).ConclusionChanges in some lipid metabolism indicators suggest that there is a correlation between lipid metabolism and bone metabolism,which can be used by clinicians to detect,prevent,and treat osteoporosis earlier.
keywords: Type 2 diabetes mellitus Postmenopausal women Bone metabolism Lipid metabolism Osteoporosis
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基金项目:新疆维吾尔自治区科技支疆项目计划(指令性)项目(2018E02061)
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