| Background: The main influencing factors of T2 DMon bone metabolism include end-glycation end products(AGE),insulin,insulin-like growth factor-1(IGF1),peroxisome proliferator receptor gamma(PPARγ),and incretin: Glucose-dependent insulinotropic peptides(GIP),glucagon-like peptides 1 and 2(GLP-1 and GLP-2),bone-derived hormones osteocalcin and osteosclerosis protein.A number of studies have confirmed that osteosclerosis protein and bone mineral density are significantly related in patients with type 2 diabetes,but positive and negative correlation reports have been mixed.Type 2 diabetes is a disease closely related to the inflammatory response,and it has been confirmed that TNF-α is obviously related to type 2 diabetes,but in type 2 diabetes patients,whether TNF-α has an effect on bone density,TNF-α and bone sclerosis The correlation of proteins is still to be further studied.Osteosclerosis protein not only affects bone metabolism through Wnt,but also promotes the occurrence of atherosclerosis.In patients with type 2 diabetes,there is no clinical data to analyze the relationship between osteosclerosis protein and atherosclerosis occlusive disease of the lower extremities.Purpose: This study analyzed the bone mineral density,osteosclerosis protein,TNF-α and related bone metabolism indexes in 90 patients with type 2 diabetes.The aim was to explore the correlation analysis of osteosclerosis protein,TNF-α and bone mineral density and bone metabolism related products in patients with type 2 diabetes.Methods: This study collected 90 patients with type 2 diabetes who were hospitalized from September 2019 to January 2020 in the Department of Geriatrics,Tianjin Medical University Metabolic Disease Hospital,including 53 females and 37 males.The diagnosis of type 2 diabetes is based on the standards established in the 2018 edition of ADA Diabetes Medical Diagnosis and Treatment Standards.Obtain basic information such as height,weight,BMI,and course of diabetes from the medical records of hospitalization.BMD was measured using dual-energy X-ray absorptiometry,and the study population was divided into normal bone mass group,bone mass reduction group,and osteoporosis group according to gender.Refer to the 2011 "Guideline for the diagnosis and treatment of primary osteoporosis" 》 Standards formulated.The selected subjects were fasted at least 8 hours before drawing blood,and the blood was taken on the following day.Mainly include: fasting blood glucose(FPG),glycated hemoglobin(Hb A1c),calcium(Ca),phosphorus(P),alkaline phosphatase(APL)levels.Plasma was obtained by centrifugation and stored in a refrigerator at-20 ° C.ELISA method to detect osteosclerosis protein,TNF-α,type 1 procollagen N-terminal propeptide(PINP),serum type 1 collagen cross-linked C-terminal peptide(CTX),human 1,25 dihydroxyvitamin D3(1.25(OH)2D3),human parathyroid hormone(PTH).Statistical analysis uses SPSS version 22.0 software to analyze the data.If the data are continuous variables that are normally distributed,they are expressed as mean ± standard deviation(SD),and those that are not normally distributed are expressed as median,median quartile,and P value.The average value was analyzed by unpaired t test.The SPSS software was used to analyze the categorical data by one-way ANOVA.Use Pearson or Spearman’s test to verify the bivariate correlation analysis.A stepwise model of multiple linear regression analysis was used to identify independent predictors of serum osteosclerosis protein or TNF-α,respectively.The use of binary logistics regression analysis of independent risk factors for lower extremity arteriosclerosis obliterans.P <0.05 was considered as statistically significant.Results: 1.A total of 90 patients with T2 DM were included in this study,including 53 female patients,including 6 with normal bone quality,17 with reduced bone mass,and 30 with osteoporosis.There were 37 male patients,11 with normal bone mass,20 with decreased bone mass,and 6 with osteoporosis.Whether the type 2 diabetic population was complicated with arteriosclerosis obliterans of lower extremities was divided into 59 patients in AD group(combined)including 36 women and 17 men,and 34 patients in NAD group(not combined)including 17 women and 17 men.2.The age of osteoporosis group in women with diabetes is significantly higher than that of the other two groups.Compared between the two groups,the normal bone mass group(58.6 ± 6.4)and the osteoporosis group(68.3 ± 8.2)have statistically significant differences.(P = 0.007),there was no statistically significant difference between the osteopenia group(62.1 ± 7.3)and the osteoporosis group(68.3 ± 8.2)(P> 0.05).There was no significant difference between the normal bone mass group and the bone mass reduction group(P> 0.05).In the male population,BMI,course of disease,height,weight,and age were not significantly different among the three groups(P> 0.05).3.The comparison of BMD values of different genders is statistically significant in lumbar spine L1-L4,femoral neck,wards triangle,gross trochanter,and total hip(P <0.001).Male bone mineral density values are higher than females.And the bone mineral density value of lumbar vertebra L1-L4 is the highest(male: 1.1 ± 0.20 g / cm2;female: 0.90 ± 0.13 g / cm2).4.The three groups of females in the CTX-1 osteoporosis group were significantly lower than those with normal bone mass and decreased bone mass(P = 0.028).Osteosclerosis protein levels were significantly higher than the other two groups,the difference was statistically significant(P = 0.009);1.25 dihydroxyvitamin D3 osteoporosis group was lower than the other two groups(P = 0.028).Fasting blood glucose,glycated hemoglobin,calcium,phosphorus,alkaline phosphatase,P1 NP,PTH were not statistically significant(P> 0.05).There was no statistically significant difference in fasting blood glucose,glycated hemoglobin,calcium,alkaline phosphatase,P1 NP,and CTX-1 levels among men(P> 0.05).Osteosclerosis protein,1.25 dihydroxyvitamin D3,and PTH were not statistically different between the three groups(P> 0.05).There was no statistical difference between the three groups of inflammation indicators CRP and TNF-α(P> 0.05).5.Bivariate correlation analysis between osteosclerosis protein and related clinical indicators and bone metabolism markers(person).In female population,osteosclerosis protein was positively correlated with serum levels of P1 NP,CTX-1,PTH,correlation coefficients were r = 0.464,0.446,0.477,P <0.01;osteosclerosis protein was negatively correlated with serum level of 1.25(OH)2D3,The coefficient is: r =-0.518,P <0.01.TNF-α also showed a positive correlation with serum levels of P1 NP,CTX-1,and PTH,with correlation coefficients of r = 0.388,0.305,0.388,P <0.05,and a negative correlation with the serum level of 1.25(OH)2D3.The coefficients were: r =-0.518,P <0.01.However,there is no obvious correlation between osteosclerosis protein and TNF-α.In the male population,osteosclerosis protein also showed a positive correlation with serum levels of P1 NP,CTX-1,PTH,r = 0.709,0.513,0.563,P <0.01;a negative correlation with serum levels of 1.25(OH)2D3,the coefficient is : R =-0.560,P <0.01,and there is no obvious TNF-α correlation index in the male population.6.The bivariate correlation analysis results of P1 NP and CTX-1 with various indicators showed that female P1 NP was negatively correlated with 1.25-dihydroxy VD3(r =-0.768,P <0.01),and with osteosclerosis protein,PTH,TNF-α There was a positive correlation(r = 0.368,0.648,0.388,P <0.01).CTX-1 was negatively correlated with 1.25-dihydroxy VD3(r =-0.427),and positively correlated with bone mineral density values of PTH,wards triangle,tuberosity,and total hip(r = 0.439,0.314,0.298,0.281,P < 0.05).P1 NP was negatively correlated with 1.25-dihydroxy VD3(r =-0.602,P <0.01),and positively correlated with osteosclerosis protein,PTH,and lumbar spine L1-L4(r = 0.709,0.677,0.343,P <0.01).CTX-1 was negatively correlated with 1.25-dihydroxy VD3(r =-0.391,P = 0.017),and positively correlated with PTH and osteosclerosis protein(r = 0.437,0.513,0.298,0.281,P <0.05).7.In the female model,bone sclerosis protein was used as the dependent variable,and PINP,1.25(OH)2D3,PTH,lumbar spine L1-L4 and femoral neck BMD were used as independent variables for multiple linear regression analysis.Osteosclerosis protein and 1.25(OH)2VD3 It was negatively correlated(β =-0.524,adjusted R2 = 0.26,P <0.001).The linear retrospective equation is Y = 137.692-0.26X1.25(OH)2VD3.Multivariate linear regression analysis was performed with TNF-α as the dependent variable and P1 NP,1.25(OH)2D3,PTH,and Hb A1 c as independent variables.Osteosclerosis protein was negatively correlated with 1.25(OH)2VD3 and positively correlated with Hb A1 c.Linear regression equation : Y = 357.895-5.348X1.25(OH)2VD3 + 12.784 XHb A1c.In the male model,osteoclastin was used as the dependent variable,and PINP,CTX-1,1.25(OH)2D3,and PTH were used as independent variables for multiple linear regression analysis.Osteosclerosis protein and P1 NP were linearly correlated(β = 0.709,Adjusted R2 = 0.489,P <0.001),which was positively correlated with glycated hemoglobin.The linear regression equation is: Y = 8.529 + 4.005XP1 NP.8.Comparing the female AD group with the NAD group,the bone density values of the wards triangle(.54 ±.14),gross trochanter(.64 ±.11)and total hip(.83 ±.12)were statistically significant.Significance(P <0.05),and the bone mineral density of AD group was significantly lower than that of NAD group.Age,BMI and P1 NP were statistically different between AD group and NAD group(P <0.05).Group A(66.7 ± 8.3)was older than NAD group(62.0 ± 8.1).The P1 NP and BMIA groups were lower than the NAD group.However,there was no significant difference in osteosclerosis protein,TNF-α and 1.25 dihydroxy VD3 between the two groups.P1NP(OR = 1.630,95% CI: 1.021-2.601,P = 0.40)and age(OR = 0.670,95% CI: 0.461-0.972,P = 0.035)were independent risk factors for lower extremity arteriosclerosis obliterans.9.Analysis of bone mineral density data between male AD group and NAD group showed that there was no statistically significant difference in bone mineral density between L1-L4,wards triangle,femoral neck trochanter and total hip in AD group and NAD group(P> 0.05).The difference between age AD group and NAD group was statistically significant(P <0.05).The age of AD group(63.1 ± 6.4)was higher than that of NAD group(56.2 ± 8.5).There was no statistically significant difference in the other indicators between the two groups.Binary logistics regression analysis of age(OR = 1.179,95% CI: 1.029-1.351,P = 0.018)is an independent risk factor for arteriosclerosis obliterans of the lower extremities.Conclusions: 1.Osteosclerosis protein levels are higher in women with type 2 diabetes and osteoporosis 2.There is no obvious correlation between osteosclerosis protein and TNF-α.Female patients with osteosclerosis protein,TNF-α and 1.25(OH)2VD3 were negatively correlated,TNF-α and glycated hemoglobin were positively correlated.Bone sclerosis protein and P1 NP are positively correlated in male patients 3.P1NP(OR = 1.630,95% CI: 1.021-2.601,P = 0.40)and age(OR = 0.670,95% CI:.461-.972,P = 0.035)are lower extremity arteriosclerosis obliterans in female diabetic patients Independent risk factors.Age(OR = 1.179,95% CI: 1.029-1.351,P = 0.018)is an independent risk factor for lower extremity arteriosclerosis obliterans in male diabetic patients. |
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