中国2型糖尿病患者循环B型利钠肽与骨质疏松症的关联
Association of circulating B-type natriuretic peptide with osteoporosis in a Chinese type 2 diabetic population.
作者信息
Chen Pan, Yan Pijun, Wan Qin, Zhang Zhihong, Xu Yong, Miao Ying, Yang Jun
机构信息
Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China.
Department of General Medicine, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping street, Luzhou, 646000, Sichuan, China.
出版信息
BMC Musculoskelet Disord. 2021 Mar 10;22(1):261. doi: 10.1186/s12891-021-04138-3.
BACKGROUND
Altered circulating levels and genetic variation of B-type natriuretic peptide (BNP), has been associated with lower bone mineral density (BMD) values and incidence of osteoporosis in peritoneal dialysis patients, renal transplant recipients, and postmenopausal women. The potential relationship of circulating BNP with osteoporosis in patients with type 2 diabetes mellitus (T2DM), however, has not yet been studied.
METHODS
Circulating BNP levels were measured in 314 patients with T2DM, and participants were divided into normal BMD group (n = 73), osteopenia group (n = 120), and osteoporosis group (n = 121). The association of circulating BNP with diabetic osteoporosis and other parameters was analyzed.
RESULTS
Circulating BNP was significantly higher in diabetic osteoporosis subjects than normal and osteopenia groups (P < 0.01 or P < 0.05). Circulating BNP levels correlated significantly and positively with neutrophil to lymphocyte ratio, systolic blood pressure, urinary albumin-to-creatinine ratio, and prevalence of hypertension, peripheral arterial disease, diabetic retinopathy, peripheral neuropathy, and nephropathy, and negatively with triglyceride, fasting blood glucose, lymphocyte count, hemoglobin, estimated glomerular filtration rate, bilirubin, osteoporosis self-assessment tool for Asians, BMD at different skeletal sites and corresponding T scores (P < 0.01 or P < 0.05). After multivariate adjustment, circulating BNP remained independently significantly associated with the presence of osteoporosis (odds ratio, 2.710; 95% confidence interval, 1.690-4.344; P < 0.01). BMD at the femoral neck and total hip and corresponding T scores were progressively decreased, whereas the prevalence of osteoporosis was progressively increased with increasing BNP quartiles (P for trend< 0.01). Moreover, receiver-operating characteristic analysis revealed that the optimal cutoff point of circulating BNP to indicate diabetic osteoporosis was 16.35 pg/ml.
CONCLUSIONS
Circulating BNP level may be associated with the development of osteoporosis, and may be a potential biomarker for diabetic osteoporosis.
背景
B型利钠肽（BNP）循环水平的改变和基因变异，已与腹膜透析患者、肾移植受者和绝经后女性较低的骨密度（BMD）值及骨质疏松症的发生率相关。然而，2型糖尿病（T2DM）患者中循环BNP与骨质疏松症之间的潜在关系尚未得到研究。
方法
对314例T2DM患者测量循环BNP水平，并将参与者分为骨密度正常组（n = 73）、骨量减少组（n = 120）和骨质疏松组（n = 121）。分析循环BNP与糖尿病性骨质疏松症及其他参数之间的关联。
结果
糖尿病性骨质疏松症患者的循环BNP显著高于正常组和骨量减少组（P < 0.01或P < 0.05）。循环BNP水平与中性粒细胞与淋巴细胞比值、收缩压、尿白蛋白与肌酐比值以及高血压、外周动脉疾病、糖尿病视网膜病变、外周神经病变和肾病的患病率显著正相关，与甘油三酯、空腹血糖、淋巴细胞计数、血红蛋白、估计肾小球滤过率、胆红素、亚洲人骨质疏松自我评估工具、不同骨骼部位的骨密度及相应的T值显著负相关（P < 0.01或P < 0.05）。多因素调整后，循环BNP仍与骨质疏松症的存在独立显著相关（比值比，2.710；95%置信区间，1.690 - 4.344；P < 0.01）。随着BNP四分位数的增加，股骨颈和全髋部的骨密度及相应的T值逐渐降低，而骨质疏松症的患病率逐渐增加（趋势P < 0.01）。此外，受试者工作特征分析显示，循环BNP指示糖尿病性骨质疏松症的最佳截断点为16.35 pg/ml。
结论
循环BNP水平可能与骨质疏松症的发生有关，可能是糖尿病性骨质疏松症的潜在生物标志物。
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