目的：探讨2型糖尿病男性患者骨密度与骨代谢生化指标间的关系。方法：选取我科2014年1月至2015年12月入院的2型糖尿病男性患者102例，采用双能X线骨密度仪，测定腰椎(L2~L4)、股骨上端[包括股骨颈(Neck)、华氏三角(Ward)及股骨粗隆(Troch)]和全身的骨密度(bone mineral density，BMD)值；根据T值将这些患者分为骨量正常组(44例)、骨量减少组(36例)和骨质疏松组(29例)，采用酶联免疫法测定各组碱性磷酸酶(alkaline phosphatase，ALP)、N-端中段骨钙素(N-MID-OT)、总Ⅰ型胶原氨基端延长肽(type 1 amino-terminal propeptide，tP1NP)和β胶原特殊序列(β-CTX)的浓度，比较三组骨代谢指标的变化，并对BMD与各项骨代谢指标进行相关性分析。结果：随着骨密度的降低，骨代谢指标的水平逐渐增高，其中，N-MID-OT和β-CTX的水平在三组间的差异皆有统计学意义(P<0.05)；tP1NP在骨质疏松组和其余两组有统计学差异(P<0.05)；ALP在三组间无统计学差异(P>0.05)。骨量减少组中，N-MID-OT与Neck、Troch及全身的BMD呈负相关(r=−0.754，−0.663，−0.743；P<0.05)，β-CTX与Ward的BMD呈负相关(r=−0.273；P<0.05)；骨质疏松组中，N-MID-OT与所有部位的BMD呈负相关(r=−0.736，−0.562，−0.715，−0.521，−0.436；P<0.05)，β-CTX与Neck、Ward及全身的BMD呈负相关(r=−0.532，−0.614，−0.764；P<0.05)。结论：2型糖尿病男性患者骨密度与骨代谢指标呈负相关，两者联合评估有助于早期预防骨质疏松。
Investigation of the relationship between the bone turnover markers and bone mineral density in male type 2 diabetes patients
Objective: To assess the relationship between bone mineral density (BMD) and serum bone turnover markers (BTMs) in male type 2 diabetes mellitus (T2DM) patients. Methods: 102 T2DM men who were hospitalized from January 2014 to December 2015 were enrolled. BMD of the lumbar vertebrae (L2~L4), the proximal femur and the whole body was tested using dual X absorptiometry. All the subjects were divided into 3 groups according to T score. The concentrations of serum N-MID-OT, tP1NP, β-CTX and ALP were examined using ELISA method. The changes of BMD and BTMs among 3 groups were compared and the correlation between BMD and each BTMs was analyzed. Results: BMD of each location in the osteoporotic group was significantly lower than that in the normal bone mass group (P<0.05). The concentrations of N-MID-OT, tP1NP and β-CTX in the osteoporotic group were significantly higher than those in the normal bone mass group (P<0.05). The concentration of N-MID-OT was negatively correlated with BMD of each location and that of β-CTX was negatively correlated with BMD of femoral neck, Troch and whole body in the osteoporotic group (P<0.05). Conclusion: BMD was negatively correlated with BTMs in male T2DM patients and the evaluation of both BMD and BTMs will make contributions to the prevention of osteoporosis at an early stage.