老年2型糖尿病患者血清CYR61、Caveolin-1水平与骨质疏松症的关系

Research on the diagnostic value of serum CYR61 and Caveolin-1 levels in elderly diabetic patients with osteoporosis

摘要:

目的 分析老年2型糖尿病患者血清高半胱氨酸蛋白61（CYR61）、小凹蛋白-1（Caveolin-1）水平与骨质疏松症的关系。方法 回顾性分析2020年1月—2024年1月西安高新医院和西安市第五医院收治的305例老年2型糖尿病患者的临床资料。根据患者是否合并骨质疏松，分为骨质疏松组101例和非骨质疏松组204例。收集两组患者的基本资料，比较其空腹血糖、糖化血红蛋白（HbA1c）、空腹胰岛素、胰岛素抵抗指数（HOMA-IR）、I型前胶原N端前肽（PⅠNP）、骨钙素（OCN）、25羟维生素D₃［25（OH）D₃］；采用X射线检测患者的骨密度；比较两组患者的血清CYR61和Caveolin-1水平；采用多因素逐步Logistic回归模型分析评估老年2型糖尿病患者合并骨质疏松症的影响因素；采用Pearson法分析CYR61、Caveolin-1水平与骨代谢情况的关系；绘制受试者工作特征（ROC）曲线评估CYR61、Caveolin-1对老年2型糖尿病患者合并骨质疏松症的诊断价值。结果 骨质疏松组患者的OCN、PⅠNP、25（OH）D₃、骨密度、血清CYR61和Caveolin-1水平均低于非骨质疏松组（P <0.05），空腹血糖、空腹胰岛素和HOMA-IR均高于非骨质疏松组（P <0.05）。多因素逐步Logistic回归分析结果显示：OCN水平高［O^R =0.765（95% CI：0.654，0.895）］、PⅠNP水平高［O^R =0.839（95% CI：0.785，0.898）］、25（OH）D₃水平高［O^R =0.754（95% CI：0.670，0.850）］、CYR61水平高［O^R =0.971（95% CI：0.961，0.981）］、Caveolin-1水平高［O^R =0.710（95% CI：0.624，0.808）］和全身骨密度水平高［O^R =0.032（95% CI：0.006，0.160）］均为老年2型糖尿病患者合并骨质疏松症的保护因素（P <0.05）； HOMA-IR水平高［O^R =1.534（95% CI：1.032，2.280）］为老年2型糖尿病患者合并骨质疏松症的危险因素（P <0.05）。患者血清CYR61水平与OCN（r =0.185，P =0.001）、PⅠNP（r =0.276，P =0.000）、25（OH）D₃（r =0.188，P =0.001）、全身骨密度水平（r =0.119，P =0.038）均呈正相关，Caveolin-1水平与OCN（r =0.254，P =0.000）、PⅠNP（r =0.118，P =0.040）、25（OH）D₃（r =0.114，P =0.046）、全身骨密度水平（r =0.220，P =0.000）均呈正相关。CYR61、Caveolin-1两者联合检测诊断2型糖尿病患者合并骨质疏松症的特异性为76.0%（95% CI：0.695，0.817），敏感性为83.2%（95% CI：0.744，0.899）。结论 老年2型糖尿病患者血清CYR61、Caveolin-1水平降低与骨质疏松症发生风险增加相关，两者与骨代谢指标及骨密度呈正相关，联合检测对老年2型糖尿病患者合并骨质疏松症具有较高诊断价值。

Abstract:

Objective To analyze the relationship between serum Cysteine-rich angiogenic inducer 61 (CYR61) and Caveolin-1 levels and osteoporosis in elderly patients with diabetes.Methods A retrospective collection of clinical data from elderly diabetic patients admitted to Xi'an Gaoxin Hospital and Xi'an Fifth Hospital from January 2020 to January 2024 was conducted, including a total of 305 cases. Based on whether patients had comorbid osteoporosis, they were divided into an osteoporosis group (n = 101) and a non-osteoporosis group (n = 204). Basic information from the two groups was collected, and their glucose metabolism [fasting plasma glucose, glycated hemoglobin (HbAlc), fasting insulin (FINS), insulin resistance index (HOMA-IR) ], bone metabolism markers [N-terminal propeptide of type I procollagen (PⅠNP), osteocalcin (OCN), 25-hydroxyvitamin D₃ [ (25(OH)D₃], bone density], and serum CYR61 and Caveolin-1 levels were compared. Logistic regression analysis was used to evaluate the risk factors for osteoporosis in elderly patients with diabetes, and the relationship between CYR61, Caveolin-1 levels, and bone metabolism was analyzed using Pearson correlation. The ROC curve was used to evaluate the predictive value of CYR61 and Caveolin-1 levels in the development of osteoporosis in elderly patients with diabetes mellitus.Results A comparison of OCN, PⅠNP, 25(OH)D₃, bone mineral density, and serum levels of CYR61, Caveolin-1, fasting blood glucose, fasting insulin, and HOMA-IR between osteoporosis and non-osteoporosis groups showed statistically significant differences (P < 0.05) by t-test. The osteoporosis group had lower levels of OCN, PⅠNP, 25(OH)D₃, bone mineral density, serum CYR61, and Caveolin-1 compared to the non-osteoporosis group, while fasting blood glucose, fasting insulin, and HOMA-IR were higher in the osteoporosis group. Stepwise logistic regression analysis revealed that higher HOMA-IR levels in type 2 diabetes patients [O^R = 1.534 (95% CI: 1.032, 2.280) ] were a risk factor for osteoporosis (P < 0.05). Higher levels of OCN [O^R = 0.765 (95% CI: 0.654, 0.895) ], PⅠNP [O^R = 0.839 (95% CI: 0.785, 0.898) ], 25(OH)D₃ [O^R = 0.754 (95% CI: 0.670, 0.850) ], CYR61 [O^R = 0.971 (95% CI: 0.961, 0.981) ], Caveolin-1 [O^R = 0.710 (95% CI: 0.624, 0.808) ], and whole-body bone mineral density [O^R = 0.032 (95% CI: 0.006, 0.160) ] were protective factors against osteoporosis (P < 0.05). Correlation analysis showed that serum CYR61 levels were positively correlated with OCN (r = 0.185, P = 0.001), PⅠNP (r = 0.276, P = 0.000), 25(OH)D₃ (r = 0.188, P = 0.001), and whole-body bone mineral density (r = 0.119, P = 0.038). Similarly, Caveolin-1 levels were positively correlated with OCN (r = 0.254, P = 0.000), PⅠNP (r = 0.118, P = 0.040), 25(OH)D₃ (r = 0.114, P = 0.046), and whole-body bone mineral density (r = 0.220, P = 0.000). ROC curve analysis demonstrated that both CYR61 and Caveolin-1 had good diagnostic efficacy for osteoporosis in type 2 diabetes patients, with a combined specificity of 76.0% (95% CI: 0.695, 0.817) and sensitivity of 83.2% (95% CI: 0.744, 0.899).Conclusion A decrease in serum CYR61 and Caveolin-1 levels in elderly patients with type 2 diabetes is associated with an increased risk of osteoporosis; both levels are positively correlated with bone metabolism indices and bone mineral density, and their combined detection has high diagnostic value for this complication.