Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
Department of Diabetes, Osaka City General Hospital, Osaka, Japan.
J Diabetes Investig. 2020 Jan;11(1):174-183. doi: 10.1111/jdi.13071. Epub 2019 Jun 5.
AIMS/INTRODUCTION: Osteoporosis is known to be intimately related to sympathetic nerve activity. We examined the relationship of plasma leptin with cortical and trabecular bone components in patients with type 2 diabetes mellitus.
The present cross-sectional study included 182 type 2 diabetes mellitus patients (93 men, 89 women). Cortical thickness (CoTh) and trabecular bone mineral density (BMD) were determined at the 5.5% distal radius using an LD-100 ultrasonic bone densitometry device. Plasma leptin along with physical and laboratory measurements was simultaneously determined.
Plasma leptin, but not body mass index (BMI), was inversely correlated with CoTh (ρ = -0.487, P < 0.001), while BMI, but not plasma leptin, was positively correlated with trabecular BMD (ρ = 0.369, P < 0.001). In multivariable regression analysis, after adjustments for age, sex, duration of diabetes, glycated hemoglobin A1c, albumin, estimated glomerular filtration rate, parathyroid hormone and handgrip strength, plasma leptin was inversely associated with CoTh (β = -0.258, P < 0.001), but not trabecular BMD. Furthermore, plasma leptin level retained a significant association with CoTh after further adjustment for BMI (β = -0.237, P < 0.001) and BMI plus waist-to-hip ratio (β = -0.243, P < 0.001). In contrast, the "sex × leptin" interaction was not significant (P = 0.596).
Leptin level in plasma, independent of BMI and BMI plus waist-to-hip ratio, was shown to be inversely associated with CoTh, but not trabecular BMD, suggesting that hyperleptinemia resulting from obesity might contribute to cortical porosis in patients with type 2 diabetes mellitus.
目的/引言：已知骨质疏松症与交感神经活动密切相关。我们研究了 2 型糖尿病患者血浆瘦素与皮质和小梁骨成分的关系。
本横断面研究纳入了 182 例 2 型糖尿病患者（男 93 例，女 89 例）。使用 LD-100 超声骨密度仪测定 5.5%远端桡骨的皮质厚度（CoTh）和小梁骨骨密度（BMD）。同时测定血浆瘦素及体格和实验室检查。
血浆瘦素与 CoTh 呈负相关（ρ=-0.487，P<0.001），但与 BMI 无关，而 BMI 与小梁 BMD 呈正相关（ρ=0.369，P<0.001）。多变量回归分析显示，在校正年龄、性别、糖尿病病程、糖化血红蛋白 A1c、白蛋白、估算肾小球滤过率、甲状旁腺激素和握力后，血浆瘦素与 CoTh 呈负相关（β=-0.258，P<0.001），与小梁 BMD 无关。此外，进一步调整 BMI 后，血浆瘦素水平与 CoTh 仍有显著相关性（β=-0.237，P<0.001），进一步调整 BMI 和腰围-臀围比后，血浆瘦素水平与 CoTh 仍有显著相关性（β=-0.243，P<0.001）。相反，“性别×瘦素”的相互作用无统计学意义（P=0.596）。
血浆瘦素水平与 BMI 和 BMI 加腰围-臀围比独立相关，与 CoTh 呈负相关，与小梁 BMD 无关，提示肥胖引起的高瘦素血症可能导致 2 型糖尿病患者皮质疏松症。
