| Objective: The purpose of this study was to observe the correlation between serum retinol-binding protein 4(RBP4)and bone metabolism parameters in patients with type 2 diabetes mellitus under different blood glucose fluctuations.Methods: A total of 208 patients with type 2 diabetes who were admitted to the Department of Endocrinology,Hebei Provincial People’s Hospital from May 2018 to September 2018 were selected.According to the standard deviation of blood glucose level(SDBG),the patients were divided into the normal group and the abnormal group.After informed consent,the fasting venous blood of the next morning was retained,and the age,gender and other basic data of each subject were recorded.The liver and kidney function,lipid metabolism and other biochemical indicators were detected by the automatic biochemical analyzer.Bone metabolism and thyroid function were measured by electrochemical luminescence assay.The glycosylated hemoglobin(HbA1c)was detected by high pressure liquid chromatography.Serum RBP4 levels were determined by applying the human retinol binding protein 4 enzyme-linked immunosorbent assay kit.Data was analyzed using SPSS 21.0 statistical software.Results:1 Comparison of various indexes between normal blood glucose fluctuation group and abnormal blood glucose fluctuation group1.1 comparison of general indicators between the normal group and the abnormal groupGender,smoking,drinking,age,duration of diabetes,body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),serum albumin(Alb),alkaline phosphatase,serum calcium,blood phosphorus were not statistically significant between the two groups(P>0.05).1.2 comparison of liver function and renal function indexes between the normal group and the abnormal groupThe alanine aminotransferase(ALT)and aspartate aminotransferase(AST)in the abnormal group were higher than the normal group,and the difference was statistically significant(P<0.05),γ-glutamyltransferase(γ-GT),urea niteogen(BUN),uric acid(UA),creatinine(Cr),the differences between the two groups were not statistically significant(P > 0.05).1.3 comparison of lipid metabolism indexes between the normal group and the abnormal groupThere were no significant differences in total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),triglyceride(TG)and high density lipoprotein cholesterol(HDL-C)between the two groups(P>0.05).1.4 comparison of glucose metabolism indexes between the normal group and the abnormal groupHb A1 c,PPGE,SDBG,LAGE and MBG in the abnormal group were significantly higher than those in the normal group,and the difference was statistically significant(P < 0.05),however,the FBG level in the abnormal group was higher than that in the normal group,but the difference was not statistically significant(P > 0.05).1.5 comparison of thyroid hormones between the normal group and the abnormal groupThere were no significant differences in total triiodothyronine(TT3),total thyroxine(TT4),and thyroid stimulating hormone(TSH)between the two groups(P>0.05).1.6 comparison of bone metabolism indexes between the group with normal blood glucose fluctuation and the group with abnormal blood glucose fluctuationIn the abnormal group,25-hydroxy vitamin D3 and N-terminal propetide of type 1procollagen(PINP)were lower than those in the normal group,and the difference was statistically significant(P< 0.05);The levels of β-Crosslaps(β-CTX)in the abnormal group were higher than those in the normal group,and the difference was statistically significant(P<0.05);There was no significant difference in parathyroid hormone and osteocalcin levels between the two groups(P>0.05).1.7 comparison of serum RBP4 level between the normal group and the abnormal groupSerum RBP4 level in the abnormal group was significantly higher than that in the normal group,and the difference was statistically significant(P< 0.01).2 Effects of blood glucose fluctuation on bone metabolism index and RBP42.1 Effects of blood glucose fluctuations on 25(OH)D3 levelsBefore adjusting for confounding factors,abnormal blood glucose fluctuations were compared with normal ones,25(OH)D3 level decreased by 0.150ng/m L,showing a statistically significant difference.When ALT,AST,Hb A1 c,PPGE,LAGE,MBG,and RBP4(Model 2)were corrected,the glucose fluctuations had no effect on 25(OH)D3 levels.After adjusting OC,β-CTX,PINP and PTH on the basis of Model 2,the level of 25(OH)D3 in the group with abnormal blood glucose fluctuation was significantly reduced.The results showed that abnormal blood glucose fluctuation was an independent risk factor of 25(OH)D3.2.2 Effects of blood glucose fluctuations on osteocalcin levelsModel 1 without adjusting confounders and Model 2 and Model 3 after adjusting relevant indicators did not find the effect of abnormal blood glucose fluctuations on osteocalcin levels.2.3 Effects of blood glucose fluctuations on β-CTX levelsModel 1 results suggested that the abnormal group had significantly increased β-CTX levels compared with the normal group.In Model 2,after ALT,AST,Hb A1 c,PPGE,LAGE,MBG,and RBP4 were corrected,abnormal blood glucose fluctuations had no effect on β-CTX levels.On the basis of Model 2,other bone metabolism indexes were adjusted,and the levelof β-CTX was significantly increased in the abnormal group.The results showed that abnormal blood glucose fluctuation was an independent risk factor of β-CTX.2.4 Effects of blood glucose fluctuations on PINP levelsThe results of unadjusted confounders(Model 1),corrected ALT,AST,Hb A1 c,PPGE,LAGE,MBG,RBP4(Model 2)and ALT,AST,Hb A1 c,PPGE,LAGE,MBG,RBP4,25(OH)D3,OC,β-CTX,and PTH(Model 3)results showed that abnormal blood glucose fluctuations significantly reduced the level of PINP compared with normal.The results showed that abnormal blood glucose fluctuation was an independent risk factor for PINP.2.5 Effects of blood glucose fluctuations on PTH levelBefore adjusting confounders(Model 1)and after adjusting ALT,AST,Hb A1 c,PPGE,LAGE,MBG and RBP4(Model 2),the results showed that abnormal blood glucose fluctuations had no effect on PTH level.After correcting other bone metabolism indexes based on Model 2,abnormal blood glucose fluctuations significantly reduced PTH level.It indicates that abnormal blood glucose fluctuation is an independent risk factor of PTH.2.6 Effects of blood glucose fluctuations on RBP4 levelModel 1 results showed that abnormal blood glucose fluctuations significantly increased the level of RBP4 in patients with type 2 diabetes.Model 2 results showed that abnormal blood glucose fluctuations significantly reduced the level of RBP4,with statistical differences.However,after correction of all bone metabolism indexes on the basis of Model 2,abnormal blood glucose fluctuations did not affect RBP4.After adjusting for confounders,abnormal glucose fluctuations were identified as independent risk factors for 25(OH)D3,β-CTX,PINP,and PTH.Glucose fluctuation is not an independent risk factor for osteocalcin and RBP4.Conclusion:1.Serum RBP4 level in the abnormal glucose fluctuation group was significantly higher than that in the normal group.In patients with type 2 diabetes mellitus,the abnormal fluctuation of blood glucose showed significant differences in bone metabolism compared with the normal group.The higher the fluctuation of blood glucose,the lower the levels of 25(OH)D3,and PINP,and the higher the level of β-CTX,which was more conducive to bone resorption.2.Abnormal blood glucose fluctuation is an independent risk factor for 25-hydroxy vitamin D3,β-CTX,PINP and PTH. |
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