摘要
目的探索老年糖尿病患者胰岛素抵抗（IR）对维生素D（vitD）代谢和骨代谢影响。方法纳入2011年01月至2013年12月于本院内分泌科住院的65～89岁的2型糖尿病患者55例。采集病例资料，进行口服葡萄糖糖耐量试验、胰岛素和C肽释放实验，检测骨转换指标、进行双光能x线骨密度检查，分析该组患者葡萄糖代谢、I嬲寸骨代谢的影响。结果血清糖化血红蛋白（HbAlc）水平与血清维生素D3（VitD3）呈负相关（r=-0．42，P=0．019），与甲状旁腺激素（PTH）呈正相关（r=0．40，P=0．05）；空腹C肽（FCP）与PTH呈正相关（r=0．46，P=0．015）；恒稳态模型评估（HOMA）．B也与PTH呈正相关（r=0．56，P=0．004）；HOMA-C肽（CR）与骨钙素（OCN）呈正相关（r=0．461，P=0．031），也和PTH呈正相关（r=0．43，P=0．028）。空腹血糖、HbAlc以及HOMA-β、HOMA-CR以及骨转换指标和任何部位骨密度T值均无显著相关性。结论在老年糖尿病患者中，改善IR、及时纠正vitD缺乏或不足对预防骨质疏松具有重要临床意义。
Objective To determine the effects of insulin resistance （IR） on bone metabolism and vitamin D metabolism in the elderly patients with diabetes mellitus（DM）. Methods A total of 55 patients with type 2 DM at the age ranging from 65 to 89 years admitted in our department from January 2011 to December 2013 were recruited in this study. All of them were tested for oral glucose tolerance test, insulin release test and C-peptide release test. Serum levels of vitamin D3 （VitD3） and parathyroid hormone （PTH）, and biomarkers for bone metabolism, including osteocacin （OCN） and carboxy-terminal 13 collagen crosslinks （β-CTX） were also detected. Bone mineral density （BMD） was measured by dual energy X-ray absorptiometry. Correlation analysis was performed on the effects of glucose metabolism and IR on bone metabolism. Results In the cohort, the serum level of glycosylated hemoglobin （HbAlc） was negatively correlated with that of VitD3 （r =-0.42, P = 0.019）, bat positively with PTH （r = 0.40, P = 0.05）. PTH was also positively related to fasting C peptide （FCP）（ r= 0.40, P= 0.015） and Homeostasis Model Assessment（HOMA-13） （r= 0.56, P= 0.004）. Bone formation marker OCN was in a positive correlation with HOMA-calretnin （HOMA-CR, r = 0.461, P = 0.031）, while PTH was positively related to HOMA-CR either （r = 0.43, P = 0.028）. But no correlation was seen in T values of BMD from every region of the total body with blood glucose, HbAlc, HOMA-β, HOMA-CR and bone metabolic markers. Conclusion For aged patients with diabetes, it is of great clinical significance to ameliorate IR and timely treat VitD deficiency or insufficiency in order to prevent osteoporosis.
出处
《中华老年多器官疾病杂志》
2014年第7期494-498,共5页
Chinese Journal of Multiple Organ Diseases in the Elderly
基金
郑州大学第一附属医院青年创新基金项目
关键词
糖尿病
2型
胰岛素抵抗
骨质疏松
骨密度
骨质疏松性骨折
肌肉骨骼生理学现象
diabetes mellitus, type 2
insulin resistance
osteoporosis
bone density
osteoporotic fractures
musculoskeletalphysiological phenomena
