目的: 研究2型糖尿病(type 2 diabetes mellitus, T2DM)合并骨质疏松(osteoporosis, OP)患者血清中正五聚蛋白3(pentraxin-3, PTX3)和25羟维生素D3[25(OH)2D3)]的水平与该疾病的相关性及诊断价值。 方法: 选用包头市第四医院2022年10月1日-2023年10月1日诊断为OP的患者作为研究对象,根据OP患者的空腹血糖结果分为T2DM合并OP患者为A组(31例),单纯OP患者作为B组(29例),同时寻找同一时期住院检查为骨量正常者作为对照组C组(29例)。使用酶联免疫吸附法检测每组血清中PTX3和25(OH)2D3水平,监测各组患者空腹血糖,利用统计学方法分析血清中PTX3和25(OH)2D3的水平与T2DM合并OP发生的相关性。结果: A组患者血清中PTX3的水平明显高于B、C组,25(OH)2D3明显低于B、C组,空腹血糖明显高于B、C组;血清中PTX3、25(OH)2D3和联合检测对预测T2DM合并OP的ROC曲线下面积分别为0.647(95%CI:0.506-0.788)、0.914(95%CI:0.844-0.984)、0.974(95%CI:0.941-1.000);PTX3、25(OH)2D3联合检测对T2DM合并OP诊断的ROC曲线下面积显著大于PTX3、25(OH)2D3单独检测对该疾病诊断的曲线下面积。结论: T2DM合并OP患者血清中PTX3表达水平升高,25(OH)2D3表达水平降低,两者联合检测有助于T2DM合并OP的诊断。
Objective: To study the serum levels of pentraxin-3 (PTX3) and 25-hydroxyvitamin [25(OH)2D3] in patients with type 2 diabetes mellitus (T2DM) complicated with osteoporosis (OP) and their correlation with the disease and diagnostic value. Methods: Patients diagnosed with OP in Baotou Fourth Hospital from October 1, 2022 to October 1, 2023 were selected as the research objects. According to the fasting blood glucose results of OP patients, the patients with T2DM combined with OP were set as group A (31 patients), and the patients with simple OP were set as group B (29 patients). At the same time, the patients with normal bone mass in the same period were selected as the control group, namely group C (29 patients). The levels of PTX3 and 25(OH)2D3 in serum of each group were detected by enzyme-linked immunosorbent assay, and the fasting blood glucose of each group was monitored. The correlation between the levels of PTX3 and 25(OH)2D3 in serum and the occurrence of T2DM combined with OP was analyzed by statistical method. Results: The serum PTX3 level in group A was significantly higher than that in group B and group C, 25(OH)2D3 was significantly lower than that in group B and group C, and fasting blood glucose was significantly higher than that in group B and group C. The area under the ROC curve of serum PTX3, 25(OH)2D3 and combined detection in predicting T2DM with OP was 0.647 (95%CI: 0.506-0.788), 0.914 (95%CI: 0.844-0.984) and 0.974 (95%CI: 0.941-1.000), respectively. The area under the ROC curve of combined detection of PTX3 and 25(OH)2D3 for the diagnosis of T2DM with OP was significantly larger than that of PTX3 and 25(OH)2D3 alone. Conclusion: The expression level of serum PTX3 in T2DM patients with OP is increased, and the expression of 25(OH)2D3 sdecreased. The combined detection of the two is helpful for the diagnosis of T2DM with OP.
[1] 胡俊翔, 贾晋荣, 牛丰, 等. 胰岛素联合唑来膦酸治疗围绝经期2型糖尿病并发骨质疏松症的效果分析[J]. 中国妇幼保健, 2022, 37(8): 1513-1517.
[2] 叶紫梦玮, 戴璇, 刘亚鸽, 等. 糖尿病性骨质疏松症的临床诊断方法探讨[J]. 中国骨质疏松杂志, 2021, 27(7): 1005-1010.
[3] Sheu A, Bliuc D, Tran T, et al. Fractures in type 2 diabetes confer excess mortality: the dubbo osteoporosis epidemiology study[J]. Bone, 2022, 159: 116373.
[4] Gatto M, Radu MC, Luisetto R, et al. Immunization with pentraxin3 prevents transition from subclinical to clinical lupus nephritis in lupus-prone mice: insights from renal ultrastructural findings[J]. J Autoimmun, 2020, 111(prepublish): 102443.
[5] Raffaella P, Cristina S, Barbara B, et al. The long pentraxin PTX3 in bone homeostasis and pathology[J]. Front Immunol, 2019, 10: 2628.
[6] Inforzato A, Reading PC, Barbati E,et al. The "sweet" side of a long pentraxin: how glycosylation affects PTX3 functions in innate immunity and inflammation[J]. Front Immunol, 2013, 3: 407.
[7] 王富军,王文琦. 《中国老年2型糖尿病防治临床指南(2022年版)》解读 [J]. 河北医科大学学报, 2022, 43 (12): 1365-1370.
[8] Moein A, Mohammad RJ, Reza AD. Diabetes mellitus and osteoporosis correlation: challenges and hopes[J].Curr Diabetes Rev, 2020, 16(9):984-1001.
[9] Wu X, Li K, Yang H, et al. Complement C1q synergizes with PTX3 in promoting NLRP3 inflammasome over-activation and pyroptosis in rheumatoid arthritis[J]. J Autoimmun, 2020, 106: 102336.
[10] Ramirez AG, Ramirez AG, Ramirez AG, et al. PTX3 intercepts vascular inflammation in systemic immune-mediated diseases[J]. Front Immunol, 2019, 10: 1135.
[11] Greggi C, Cariati I, Onorato F, et al. PTX3 effects on osteogenic differentiation in osteoporosis: an in vitro study[J]. Int J Mol Sci, 2021, 22(11): 5944.
[12] Grč ević D, Grević D, Sironi M, et al. The long pentraxin 3 plays a role in bone turnover and repair[J].Front Immunol, 2018, 9: 417.
[13] Eun-Jin L, Da-Hyun S, Yeon-Ju K, et al. PTX3 stimulates osteociastogenesis by increasing osteoblast RANKL production[J]. J Cell Physiol, 2014, 229(11): 1744-1752.
[14] 陆江, 武俊海, 朱道仙, 等. 雌激素缺乏对猫血液中脂质代谢、脂肪细胞因子及炎症因子表达的影响[J]. 江苏农业科学, 2019, 47(17): 183-185, 192.
[15] 谭春梅, 谭红梅, 吴君, 等. GDM孕妇脐血流动力学指标评估胎儿宫内窘迫的临床价值[J]. 北华大学学报(自然科学版), 2020, 21(2): 191-194.
[16] Weiss EP, Reeds DN, Ezekiel UR, et al. Circulating cytokines as determinants of weight loss-induced improvements in insulin sensitivity[J]. Endocrine, 2017, 55(1): 153-164.
[17] 张恬, 吕珊, 殷泉忠, 等. 维生素D缺乏与老年2型糖尿病患者发生骨质疏松、骨骼肌质量减少的相关性研究[J]. 中国骨质疏松杂志, 2019, 25(8): 1110-1115.
[18] Lee NK, Sowa H, Hinoi E, et al. Endocrine regulation of energy metabolism by the skeleton[J]. Cell, 2007,130(3): 456-469.
[19] Yoko Y, Tatsuya Y, Toru F, et al. Vitamin D receptor in osteoblasts is a negative regulator of bone mass control.[J]. Endocrinology, 2013, 154(3): 1008-1020.
