【摘要】：目的:糖尿病在全世界范圍內(nèi)是一種高發(fā)病率的全身慢性內(nèi)分泌代謝性疾病,其晚期并發(fā)癥除常見的大血管病變及微血管病變外,還有骨代謝異常引起的病變,嚴(yán)重者可導(dǎo)致骨質(zhì)疏松的發(fā)生。目前的研究顯示1型糖尿病對(duì)骨代謝的影響并無太大爭議,已得到了大部分業(yè)內(nèi)人士的認(rèn)可,但是2型糖尿病對(duì)骨代謝的影響無統(tǒng)一的定論,對(duì)其的相關(guān)研究也一直在不斷深入。骨代謝生化指標(biāo)可在一定程度上反映人體正在發(fā)生的骨轉(zhuǎn)換速率并可預(yù)測將來骨量變化的趨勢,對(duì)選擇干預(yù)治療骨質(zhì)疏松的用藥提供一定的指導(dǎo)作用。目前的研究顯示骨鈣素、骨堿性磷酸酶等與骨形成有關(guān)且呈正相關(guān)關(guān)系,I型膠原C末端肽等與骨吸收有一定的關(guān)系且呈負(fù)相關(guān)。本研究通過測定中青年男性2型糖尿病患者骨密度及相關(guān)骨代謝生化指標(biāo),以揭示不同病程的中青年男性2型糖尿病患者的病程對(duì)骨密度及相關(guān)骨代謝生化指標(biāo)的影響。方法:本研究收集在南昌大學(xué)第三附屬醫(yī)院內(nèi)分泌科2013年8月-2014年8月住院的中青年男性2型糖尿病患者80例,根據(jù)病程不同設(shè)置A、B兩組平行對(duì)照組,入組人數(shù)相同,即40例病程在5年以內(nèi)的為A組,40例病程在5-10年的為B組。所有患者入組時(shí)均需常規(guī)測量身高和體重,計(jì)算患者的體重指數(shù)(Body mass index BMI)。收集所有患者的血清標(biāo)本,采用酶聯(lián)免疫吸附(Enzyme linked immunosorbant assay,ELISA)法檢測血清骨鈣素、血清25(OH)D3、血清I型膠原羧基末端肽(Type I collagen peptide C,CTX)水平,同時(shí)常規(guī)檢測糖化血紅蛋白(Glycosylated haemoglobin,Hb A1c)、骨堿性磷酸酶(Bone alkaline phosphatase)、甲狀旁腺素(Parathyroid hormone)、血鈣(Calcium)、血磷(Phosphorus)、骨密度(Bone Mineral Density,BMD)。結(jié)果:1、病程5-10年的中青年男性2型糖尿病患者較病程小于5年的中青年男性2型糖尿病患者骨密度顯著降低(P0.01)。2、病程5-10年的中青年男性2型糖尿病患者的骨鈣素、25(0H)D3水平低于病程小于5年的中青年男性2型糖尿病患者(P0.05)。3、病程5-10年的中青年男性2型糖尿病患者的血清I型膠原羧基末端肽水平顯著高于病程小于5年的中青年男性2型糖尿病患者(P0.05)。結(jié)論:隨著2型糖尿病病程延長,骨吸收增加,骨形成下降。骨鈣素、25(0H)D3、骨堿性磷酸酶、血清I型膠原羧基末端肽等激素分泌及代謝失常,可能參與了骨質(zhì)疏松的發(fā)生發(fā)展。
[Abstract]:Objective: diabetes mellitus is a chronic endocrine and metabolic disease with high incidence all over the world. In addition to the common macroangiopathy and microangiopathy, the late complications of diabetes mellitus are also caused by abnormal bone metabolism. Severe cases can lead to osteoporosis. Current research shows that the effect of type 1 diabetes on bone metabolism is not too controversial and has been recognized by most people in the industry, but there is no uniform conclusion on the effect of type 2 diabetes on bone metabolism. Its related research has also been in depth. The biochemical indexes of bone metabolism can reflect the rate of bone turnover and predict the trend of bone mass change in the future to a certain extent, and provide some guidance for the choice of drugs for intervention in the treatment of osteoporosis. Recent studies have shown that osteocalcin, bone alkaline phosphatase and so on are positively correlated with bone formation. Type I collagen C-terminal peptide is negatively correlated with bone resorption. In this study, bone mineral density (BMD) and related bone metabolism biochemical indexes were measured in young and middle-aged male patients with type 2 diabetes, in order to reveal the effect of the course of disease on bone mineral density and related bone metabolism in young and middle-aged male patients with type 2 diabetes. Methods: a total of 80 young and middle-aged male patients with type 2 diabetes were enrolled in the Endocrinology Department of the third affiliated Hospital of Nanchang University from August 2013 to August 2014. In other words, 40 cases with disease course within 5 years were group A and 40 cases with disease course of 5 to 10 years were group B. All patients were required to routinely measure their height and weight and calculate their body mass index (Body mass index BMI).) when they entered the group. Serum levels of osteocalcin, serum 25 (OH) D3 and type I collagen carboxyl terminal peptide (Type I collagen peptide CT-CTX) were detected by enzyme-linked immunosorbent assay (Elisa) in all patients. At the same time, Glycosylated haemoglobin (HB A 1c), bone alkaline phosphatase (Bone alkaline phosphatase), parathyroid hormone (Parathyroid hormone), serum calcium (Calcium), phosphorus (Calcium), bone mineral density (Bone Mineral density). Results the bone mineral density (BMD) of type 2 diabetes mellitus in young and middle-aged male patients with disease course of 5-10 years was significantly lower than that in young and middle-aged male patients with type 2 diabetes mellitus of less than 5 years (P0.01) .2and osteocalcin 25 (0H) D3 in young and middle-aged male patients with type 2 diabetes mellitus with the course of 5-10 years was significantly lower than that in type 2 diabetes patients with disease course of 5-10 years. The level of serum carboxyl terminal peptide of type I collagen in young and middle-aged men with disease course less than 5 years was significantly higher than that in young men with disease course less than 5 years (P0.05) .3The level of carboxyl terminal peptide of type I collagen in young and middle-aged men with disease course of 5-10 years was significantly higher than that of young men with less than 5 years course. Type 2 diabetes mellitus (P0.05). Conclusion: with the prolongation of the course of type 2 diabetes mellitus, bone resorption increases and bone formation decreases. Osteocalcin 25 (0H) D3, bone alkaline phosphatase, serum type I collagen carboxyl terminal peptide and other hormones secretion and metabolic disorders, may be involved in the occurrence and development of osteoporosis.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R587.1;R580

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