[1]梁珊珊 刘昊凌 高昕媛 辛玉晶.2型糖尿病合并下肢动脉疾病患者 血清FGF-23与骨钙素的关系研究[J].国际内分泌代谢杂志,2020,40(01):10-15.[doi:10.3760/cma.j.issn.1673-4157.2020.01.003]
　Liang Shanshan,Liu Haoling,Gao Xinyuan,et al.Relationship between serum FGF-23 and osteocalcin in patients with type 2 diabetes mellitus complicated with lower extremity arterial disease[J].International Journal of Endocrinology and Metabolism,2020,40(01):10-15.[doi:10.3760/cma.j.issn.1673-4157.2020.01.003]
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2型糖尿病合并下肢动脉疾病患者 血清FGF-23与骨钙素的关系研究()
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《国际内分泌代谢杂志》[ISSN:1673-4157/CN:12-1383/R]

卷:
40
期数:
2020年01期
页码:
10-15
栏目:
论著
出版日期:
2020-01-20

文章信息/Info

Title:
Relationship between serum FGF-23 and osteocalcin in patients with type 2 diabetes mellitus complicated with lower extremity arterial disease
作者:
梁珊珊 刘昊凌 高昕媛 辛玉晶
哈尔滨医科大学附属第一医院内分泌科 150001
Author(s):
Liang Shanshan;  Liu Haoling;  Gao Xinyuan;  Xin Yujing
Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
关键词:
2型糖尿病;  下肢动脉疾病;  骨代谢;  成纤维细胞生长因子-23;  骨钙素
Keywords:
Type 2 diabetes mellitus;  Lower extremity arterial disease;  Bone metabolism;  Fibroblast growth factor-23;  Osteocalcin
DOI:
10.3760/cma.j.issn.1673-4157.2020.01.003
摘要:
目的 探讨2型糖尿病(T2DM)合并下肢动脉疾病(LEAD)患者血清成纤维细胞生长因子-23(FGF-23)与骨钙素的关系。方法 选择2017年11月到2018年5月在哈尔滨医科大学附属第一医院内分泌科住院的T2DM患者178例。通过彩色多普勒超声评估下肢动脉粥样硬化斑块程度。根据LEAD的发生情况,将患者分为单纯糖尿病组(98例)、糖尿病合并LEAD组(80例),根据血管病变严重程度将糖尿病合并LEAD组再分为非闭塞组(55例)、闭塞组(25例)。对所有患者的一般资料进行收集整理; 对患者的糖化血红蛋白、血脂、尿素氮、肌酐等生化指标以及空腹C肽进行测定。使用ELISA法检测血清FGF-23及血清骨钙素含量。应用logistic回归分析探讨LEAD的危险因素。结果 与单纯糖尿病组相比,糖尿病合并LEAD组年龄、血尿素氮、肌酐、尿酸、胆固醇、甘油三酯、空腹C肽、FGF-23水平均升高(t=2.036～6.249,P均<0.01),且糖尿病合并LEAD组高血压病史(χ2=11.193,P=0.001)、神经病变史(χ2=10.382,P=0.001)、饮酒史(χ2=4.589,P=0.032)、颈动脉彩超阳性率(χ2=33.386,P<0.001)也较高; 但骨钙素水平降低(χ2=4.189,P<0.001)。与非闭塞组相比,闭塞组骨钙素水平降低(t=3.001,P<0.05),FGF-23水平升高(t=2.233,P<0.05)。Logistic回归分析发现,年龄(OR=1.112,95% CI:1.041～1.188,P<0.05)、饮酒史(OR=3.415,95% CI:1.116～10.452,P<0.05)、FGF-23(OR=9.128,95% CI:3.610～23.080,P<0.05)、骨钙素(OR=0.369,95% CI:0.223～0.612,P<0.05)和颈动脉粥样硬化(OR=4.801,95% CI:1.552～14.855,P<0.05)是LEAD的独立影响因素。在整体和糖尿病合并LEAD组中,FGF-23水平与骨钙素水平均呈正相关(r=0.327、0.585,P均<0.001)。结论 T2DM合并LEAD患者血清骨钙素水平降低、血清FGF-23水平升高,且与LEAD的严重程度相关。T2DM合并LEAD患者血清FGF-23与血清骨钙素水平呈正相关。
Abstract:
Objective To investigate the relationship between serum fibroblast growth factor-23(FGF-23)and osteocalcin level in patients with type 2 diabetes mellitus(T2DM)complicated with lower extremity arterial disease(LEAD).Methods A total of 178 patients with T2DM admitted to the Department of Endocrinology in the First Affiliated Hospital of Harbin Medical University from November 2017 to May 2018 were selected. Atherosclerotic plaque in lower extremity was evaluated by color Doppler ultrasound. All patients were divided into simple diabetes mellitus group(n=98)and diabetes complicated with LEAD group(n=80)according to the status of LEAD. According to the severity of vascular disease, diabetes complicated with LEAD group were further divided into non-occlusion group(n=55)and occlusion group(n=25). The general data of all patients were collected, and the biochemical indicators including glycated hemoglobin, blood lipid, urea nitrogen, creatinine and fasting C peptide were measured. Serum FGF-23 and serum osteocalcin levels were measured by ELISA. Logistic regression analysis was used to investigate the risk factors of LEAD.Results Compared with simple diabetes group, age, blood urea nitrogen, creatinine, uric acid, cholesterol, triglyceride, fasting C peptide, and FGF-23 were increased(t=2.036-6.249, all P<0.01)in diabetes complicated with LEAD group. The positive rate of hypertension(χ2=11.193, P=0.001), neuropathy(χ2=10.382, P=0.001), drinking history(χ2=4.589, P=0.032), and abnormal carotid color ultrasound(χ2=33.386, P<0.001)were also higher but osteocalcin level was lower(χ2=4.189, P<0.001)in diabetes complicated with LEAD group. Compared with non-occlusion group, osteocalcin level was decreased(t=3.001, P<0.05), whereas FGF-23 level was elevated(t=2.233, P<0.05)in occlusion group. Logistic regression analysis found that age(OR=1.112, 95% CI: 1.041-1.188, P<0.05), drinking history(OR=3.415, 95% CI: 1.116-10.452, P<0.05), FGF-23(OR=9.128, 95% CI: 3.610-23.080, P<0.05), osteocalcin(OR=0.369, 95% CI: 0.223-0.612, P<0.05)and carotid atherosclerosis(OR=4.801, 95% CI: 1.552-14.855, P<0.05)were independent influencing factors of LEAD. The level of FGF-23 was positively related with osteocalcin level in all patients diabetes as well as in diabetes complicated with LEAD group(r=0.327, 0.585, all P<0.001). Conclusions The level of serum osteocalcin is lower while the level of serum FGF-23 is higher in patients with T2DM and LEAD. Both osteocalcin and FGF-23 are associated with the severity of LEAD. Serum FGF-23 level is positively correlated with serum osteocalcin level in patients with T2DM and LEAD.

参考文献/References:

[1] 郝洁,盛辉.骨质疏松症与血管相关性的研究综述[J].实用临床医药杂志,2016,20(11):221-224.DOI:10.7619/jcmp.201611084.
[2] 王贺,阳琰,张国豪,等.2型糖尿病患者下肢血管病变与血清25羟维生素D及骨密度的相关性[J].中国骨质疏松杂志,2017(11):6-9.DOI:10.3969/j.issn.1006-7108.2017.11.001.
[3] De Pergola G,Triggiani V,Bartolomeo N,et al.Independent relationship of osteocalcin circulating levels with obesity,type 2 diabetes,hypertension,and HDL cholesterol[J].Endocr Metab Immune Disord Drug Targets,2016,16(4):270-275.DOI:10.2174/1871530317666170106150756.
[4] Mokuda S,Sawada N,Matoba K,et al.Serum undercarboxylated osteocalcin level increases with 48 weeks of teriparatide treatment in pre-treated elderly rheumatoid arthritis patients who use anti-resorptive drugs[J].J Endocrinol Invest,2012,35(9):796-799.DOI:10.1007/BF03347100.
[5] Richter B,Haller J,Haffner D,et al.Klotho modulates FGF23-mediated NO synthesis and oxidative stress in human coronary artery endothelial cells[J].Pflugers Arch,2016,468(9):1621-1635.DOI:10.1007/s00424-016-1858-x.
[6] Zheng S,Zhang S,Song Y,et al.MicroRNA-297a regulates vascular calcification by targeting fibroblast growth factor 23[J].Iran J Basic Med Sci,2016,19(12):1331-1336.DOI:10.22038/ijbms.2016.7920.
[7] Zhou M,Ma X,Li H,et al.Serum osteocalcin concentrations in relation to glucose and lipid metabolism in Chinese individuals[J].Eur J Endocrinol,2009,161(5):723-729.DOI:10.1530/EJE-09-0585.
[8] Guo Q,Li H,Xu L,et al.Undercarboxylated osteocalcin reverts insulin resistance induced by endoplasmic reticulum stress in human umbilical vein endothelial cells[J].Sci Rep,2017,7(1):46.DOI:10.1038/s41598-017-00163-2.
[9] Krakauer JC,McKenna MJ,Buderer NF,et al.Bone loss and bone turnover in diabetes[J].Diabetes,1995,44(7):775-782.DOI:10.2337/diab.44.7.775.
[10] 钟柏权,邱洁,巢秋霞,等.超声在2型糖尿病患者颈部及下肢动脉中检查对动脉斑块、闭塞程度诊断价值[J].中国医药科学,2017(3):146-148.DOI:10.3969/j.issn.2095-0616.2017.03.042.
[11] Fukumoto S,Martin TJ.Bone as an endocrine organ[J].Trends Endocrinol Metab,2009,20(5):230-236.DOI:10.1016/j.tem.2009.02.001.
[12] 段培林,张爱枝.慢性肾脏病患者血清成纤维细胞生长因子23水平及其与冠状动脉钙化的关联研究[J]. 检验医学与临床, 2018,15(21):3206-3208.DOI:10.3969/j.issn.1672-9455.2018.21.013.
[13] He X,Hu X,Ma X,et al.Elevated serum fibroblast growth factor 23 levels as an indicator of lower extremity atherosclerotic disease in Chinese patients with type 2 diabetes mellitus[J].Cardiovasc Diabetol,2017,16(1):77.DOI:10.1186/s12933-017-0559-x.
[14] Dobnig H,Piswanger-S lkner JC,Roth M,et al.Type 2 diabetes mellitus in nursing home patients:effects on bone turnover, bonemass, and fracture risk[J].J Clin Endocrinol Metab,2006,91(9):3355-3363.DOI:10.1210/jc.2006-0460.
[15] Achemlal L,Tellal S,Rkiouak F,et al. Bone metabolism in male patients with type 2 diabetes[J].Clin Rheumatol,2005,24(5):493-496.DOI:10.1007/s10067-004-1070-9.
[16] Holvik K,van Schoor NM,Eekhoff EM,et al.Plasma osteocalcin levels as a predictor of cardiovascular disease in older men and women:a population-based cohort study[J].Eur J Endocrinol,2014,171(2):161-170.DOI:10.1530/EJE-13-1044.
[17] Lee NK,Sowa H,Hinoi E,et al.Endocrine regulation of energy metabolism by the skeleton[J].Cell,2007,130(3):456-469.DOI:10.1016/j.cell.2007.05.047.
[18] Ferron M,Hinoi E,Karsenty G,et al.Osteocalcin differentially regulates beta cell and adipocyte gene expression and affects the development of metabolic diseases in wild-type mice[J].Proc Natl Acad Sci U S A,2008,105(13):5266-5270.DOI:10.1073/pnas.0711119105.
[19] Hinoi E,Gao N,Jung DY,et al.The sympathetic tone mediates leptin's inhibition of insulin secretion by modulating osteocalcin bioactivity[J].J Cell Biol,2008,183(7):1235-1242.DOI:10.1083/jcb.200809113.
[20] Ferron M,Wei J,Yoshizawa T,et al.Insulin signaling in osteoblasts integrates bone remodeling and energy metabolism[J].Cell,2010,142(2):296-308.DOI:10.1016/j.cell.2010.06.003.
[21] Mabilleau G,Pereira M,Chenu C.Novel skeletal effects of glucagon-like peptide-1(GLP-1)receptor agonists[J].J Endocrinol,2018,236(1):R29-R42. DOI:10.1530/JOE-17-0278.
[22] Wang H,Yoshiko Y,Yamamoto R,et al.Overexpression of fibroblast growth factor 23 suppresses osteoblast differentiation and matrix mineralization in vitro[J].J Bone Miner Res,2008,23(6):939-948.DOI:10.1359/jbmr.080220.

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备注/Memo

备注/Memo:
通信作者:刘昊凌,Email:liuhaoling@126.com
Corresponding author: Liu Haoling, Email:liuhaoling@126.com
更新日期/Last Update: 2020-01-20