血清骨膜蛋白和骨硬化蛋白对老年2型糖尿病患者骨质疏松的诊断价值

Diagnostic value of serum periostin and sclerostin levels for bone mineral density in elderly patients with type 2 diabetes mellitus

摘要:

目的 探讨血清骨膜蛋白（PN）和骨硬化蛋白（SOST）与老年2型糖尿病（T2DM）患者骨密度的关系。方法 选取2020年8月—2022年3月海南医学院第二附属医院收治的192例老年T2DM患者作为研究对象，依据骨密度值分为骨量正常组、骨量减少组及骨质疏松组，每组64例。比较3组患者的临床资料，血清PN、SOST、25羟维生素D₃［25（OH）D₃］、骨钙素（OST）及I型胶原氨基端前肽（PINP）水平。多因素Logistic回归分析影响老年T2DM患者骨质疏松发生的危险因素。绘制受试者工作特征（ROC）曲线，以ROC曲线下面积（AUC）评价血清PN、SOST及两者联合对老年T2DM患者骨质疏松的诊断价值。结果 骨量正常组、骨量减少组及骨质疏松组HbA1c、HDL-C、PN、SOST、25（OH）D₃、OST及PINP水平比较，差异有统计学意义（P <0.05），骨质疏松组HbA1c、PN、SOST、OST及PINP水平高于骨量正常组和骨量减少组（P <0.05），骨质疏松组HDL-C、25（OH）D₃水平低于骨量正常组和骨量减少组（P <0.05），骨量减少组PN、SOST、OST及PINP水平高于骨量正常组（P <0.05），骨量减少组25（OH）D₃水平低于骨量正常组（P <0.05）。多因素Logistic回归分析结果显示，HbA1c［O^R=3.068（95% CI：1.084，4.157）］、PN［O^R=4.023（95% CI：2.768，10.432）］、SOST［O^R=3.629（95% CI：2.015，8.439）］、OST［O^R=3.089（95% CI：1.139，5.846）］及PINP［O^R=3.274（95% CI：1.632，7.184）］均为影响老年T2DM患者骨质疏松发生的危险因素（P <0.05）。ROC曲线分析结果显示，血清PN、SOST及两者联合对老年T2DM患者骨质疏松诊断的敏感性分别为73.44%（95% CI：0.607，0.833）、78.12%（95% CI：0.657，0.871）、71.88%（95% CI：0.591，0.821），特异性分别为80.47%（95% CI：0.723，0.867）、71.09%（95% CI：0.623，0.786）、98.44%（95% CI：0.940，0.997），AUC分别为0.769（95% CI：0.703，0.827）、0.782（95% CI：0.717，0.839）、0.905（95% CI：0.855，0.943）。结论 血清PN、SOST水平与老年T2DM患者骨质疏松相关，且血清PN、SOST两者联合对老年T2DM患者骨质疏松的诊断效能较高。

Abstract:

Objective To investigate the relationship of serum periostin (PN) and sclerostin (SOST) levels with bone mineral density in elderly patients with type 2 diabetes (T2DM).Methods A total of 192 elderly patients with T2DM who were admitted to our hospital from August 2020 to March 2022 were selected as the research objects. According to the bone mineral density, the elderly patients with T2DM were divided into normal bone mass group, osteopenia group, and osteoporosis group, 64 cases in each group. The clinical data of the three groups of patients were compared. The serum PN, SOST levels, and bone metabolism indexes [25-hydroxyvitamin D₃ [25(OH)D₃], osteocalcin (OST), and type I collagen amino-terminal propeptide (PINP) ] were compared among the three groups. Logistic multivariate regression analysis on the risk factors of osteoporosis in elderly patients with T2DM were performed. The receiver operating characteristic curve (ROC) was prepared, and the area under the curve (AUC) was used to evaluate the diagnostic value of serum PN, SOST, and their combination in the diagnosis of osteoporosis in elderly patients with T2DM.Results There were significant differences in the levels of HbA1c, HDL-C, PN, SOST, 25(OH)D₃, OST, and PINP between the normal bone mass group, the osteopenia group, and the osteoporosis group (P < 0.05). The levels of HbA1c, PN, SOST, OST and PINP in the osteoporosis group were higher than those in the normal bone mass group and the osteopenia group (P < 0.05), while the levels of HDL-C and 25(OH)D₃ were lower than those in the normal bone mass group and the osteopenia group (P < 0.05). The levels of PN, SOST, OST and PINP in the osteopenia group were higher than those in the normal bone mass group (P < 0.05), while the levels of 25(OH)D₃ were lower than those in the normal bone mass group (P < 0.05). Logistic multivariate analysis showed that HbA1c [O^R = 3.068 (95% CI: 1.084, 4.157) ], PN [O^R = 4.023 (95% CI: 2.768, 10.432) ], SOST [O^R = 3.629 (95% CI: 2.015, 8.439) ], OST [O^R = 3.089 (95% CI: 1.139, 5.846) ] and PINP [O^R = 3.274 (95% CI: 1.632, 7.184) ] were the influencing factors for the occurrence of osteoporosis in elderly patients with T2DM (P < 0.05). The results of ROC curve analysis showed that the sensitivity of serum PN, SOST and their combination for the diagnosis of osteoporosis in elderly T2DM patients was 73.44% (95% CI: 0.607, 0.833), 78.12% (95% CI: 0.657, 0.871), and 71.88% (95% CI: 0.591, 0.821), respectively; the specificity was 80.47% (95% CI: 0.723, 0.867), 71.09% (95% CI: 0.623, 0.786), and 98.44% (95% CI: 0.940, 0.997), respectively; AUC were 0.769 (95% CI: 0.703, 0.827), 0.782 (95% CI: 0.717, 0.839), and 0.905 (95% CI: 0.855, 0.943), respectively.Conclusion The levels of serum PN and SOST are correlated with bone mineral density in elderly patients with T2DM, and the combination of serum PN and SOST has higher diagnostic efficiency for osteoporosis in elderly patients with T2DM.