减重代谢手术病人代谢危险因素与骨代谢血清标志物关系的研究

doi:10.16139/j.1007-9610.2020.06.010

摘要/Abstract

摘要：

目的：探讨代谢危险因素对骨代谢血清标志物的影响及其关系。方法：收集2015年1月至2020年4月于华西医院胃肠外科行减重手术的病人,并抽血检测血糖、三酰甘油（triglycerides, TG）、高密度脂蛋白（high-density lipoprotein, HDL）、骨特异碱性磷酸酶(bone specific alkaline phosphatase,B-ALP)及Ⅰ型胶原羧基末端肽（C-telopeptide of type 1 collagen, CTX）等。根据B-ALP及CTX中位数分为两组（B-ALP≤14.24 μg/L,B-ALP>14.24 μg/L;CTX≤0.36 μg/L,CTX>0.36 μg/L）。比较两组临床资料、代谢危险因素,以及这些因素与B-ALP和CTX的相关性。结果：本研究共纳入205例,男81例,女124例。B-ALP≤14.24 μg/L组在收缩压、舒张压、TG、HDL及低HDL血症例数方面与B-ALP>14.24 μg/L组比较差异有统计学意义（P<0.05）。CTX≤0.36 μg/L组在性别、皮下脂肪面积及空腹血糖方面与CTX>0.36 μg/L组比较差异有统计学意义（P<0.05）。B-ALP与年龄及HDL负相关,与收缩压、舒张压及TG正相关。CTX与年龄及空腹血糖负相关。Logistic回归分析显示,HDL高者发生B-ALP指标异常的风险明显增加（OR=2.931,95%CI：1.585~5.421,P=0.001）。皮下脂肪面积大者发生CTX指标异常的风险明显降低（OR=0.381,95%CI：0.194~0.748,P=0.005）;HDL高者发生CTX指标异常的风险明显增加（OR=2.067,95%CI：1.118~3.824,P=0.021）。结论：HDL降低、空腹血糖升高、高血压代谢危险因素以及皮下脂肪面积对减重手术病人的骨代谢指标有一定影响。

关键词: 减重代谢手术, 代谢危险因素, 骨代谢, 代谢综合征

Abstract:

Objective To investigate the influence of metabolic risk factors on serum markers of bone metabolism and their relationship. Methods The data of patients with metabolic and bariatric surgery including blood glucose, triglyceride (TG), high density lipoprotein (HDL), bone specific alkaline phosphatase (B-ALP) and carboxy terminal peptide of type I collagen (CTX) were collected from department of gastrointestinal surgery in our hospital from January 2015 to April 2020. The patients were divided into two groups according to the median of B-ALP (≤14.24 μg/L, >14.24 μg/L) and CTX (≤0.36 μg/L, >0.36 μg/L). The clinical data and metabolic risk factors were compared between two groups and the clinical and metabolic factors correlated with parameters including B-ALP and CTX were analyzed. Results A total of 205 patients were included in this study with 81 males and 124 females There were significant differences in the parameters including systolic blood pressure, diastolic blood pressure, TG, HDL and the cases with lower HDL between B-ALP≤14.24 μg/L group and B-ALP>14.24 μg/L group (P<0.05). Between CTX ≤0.36 μg/L group and CTX >0.36 μg/L group, there were significant differences in gender, subcutaneous fat area and fasting blood glucose (P<0.05). B-ALP correlated with age and HDL negatively, and with systolic blood pressure, diastolic blood pressure and TG positively. CTX correlated with age and fasting blood glucose negatively. Logistic regression analysis showed that the risk of abnormal B-ALP increased significantly in patients with higher HDL (OR=2.931, 95% CI:1.585-5.421, P=0.001). Patients with larger area of subcutaneous fat decreased risk of abnormal CTX significantly (OR=0.381, 95% CI:0.194-0.748, P=0.005), while those with higher HDL had higher risk of abnormal CTX significantly (OR=2.067, 95% CI:1.118-3.824, P=0.021). Conclusions It was shown that lower HDL, higher fasting hyperglycemia and hypertension have influence on bone metabolism indexes of patients with metabolic and bariatric surgery.

Key words: Metabolic and bariatric surgery, Metabolic risk factors, Bone metabolism, Metabolic syndrome

中图分类号:

R589

张贵祥, 陈刚, 李正正, 陈亿, 杜潇, 程中. 减重代谢手术病人代谢危险因素与骨代谢血清标志物关系的研究[J]. 外科理论与实践, 2020, 25(06): 493-497.

ZHANG Guixiang, CHEN Gang, LI Zhengzheng, CHEN Yi, DU Xiao, CHENG Zhong. Relationship between metabolic risk factors and serum markers of bone metabolism in patients with metabolic and bariatric surgery[J]. Journal of Surgery Concepts & Practice, 2020, 25(06): 493-497.

图/表 3

表1

表2

表3

参考文献 16

[1]	Garnero Patrick SC. Principles of Bone Biology[M]. San Diego, CA, USA: Academic Press, 2020.
[2]	Bauer DC. Clinical use of bone turnover markers[J]. JAMA, 2019-07-11[online ahead of print].
[3]	Bezerra dos Santos Magalhaes K, Magalhaes MM, Diniz ET, et al. Metabolic syndrome and central fat distribution are related to lower serum osteocalcin concentrations[J]. Ann Nutr Metab, 2013, 62(3):183-188. doi: 10.1159/000342561 URL
[4]	Thomas T, Burguera B, Melton LJ 3rd, et al. Role of serum leptin, insulin, and estrogen levels as potential mediators of the relationship between fat mass and bone mineral density in men versus women[J]. Bone, 2001, 29(2):114-120. pmid: 11502471
[5]	Tilg H, Moschen AR. Adipocytokines: mediators linking adipose tissue, inflammation and immunity[J]. Nat Rev Immunol, 2006, 6(10):772-783. doi: 10.1038/nri1937 URL
[6]	Seibel MJ. Biochemical markers of bone turnover: part Ⅰ: biochemistry and variability[J]. Clin Biochem Rev, 2005, 26(4):97-122.
[7]	Hussein RM. Biochemical relationships between bone turnover markers and blood glucose in patients with type 2 diabetes mellitus[J]. Diabetes Metab Syndr, 2017, 11 Suppl 1:S369-S372. doi: 10.1016/j.dsx.2017.03.018 URL
[8]	Oz SG, Guven GS, Kilicarslan A, et al. Evaluation of bone metabolism and bone mass in patients with type-2 diabetes mellitus[J]. J Natl Med Assoc, 2006, 98(10):1598-1604.
[9]	Starup-Linde J. Diabetes, biochemical markers of bone turnover, diabetes control, and bone[J]. Front Endocrinol (Lausanne), 2013, 4:21.
[10]	Starup-Linde J, Eriksen SA, Lykkeboe S, et al. Biochemical markers of bone turnover in diabetes patients--a meta-analysis, and a methodological study on the effects of glucose on bone markers[J]. Osteoporos Int, 2014, 25(6):1697-1708. doi: 10.1007/s00198-014-2676-7 pmid: 24676844
[11]	Starup-Linde J, Vestergaard P. Biochemical bone turnover markers in diabetes mellitus - a systematic review[J]. Bone, 2016, 82:69-78. doi: 10.1016/j.bone.2015.02.019 pmid: 25722065
[12]	Brownbill RA, Ilich JZ. Lipid profile and bone paradox: higher serum lipids are associated with higher bone mi-neral density in postmenopausal women[J]. J Womens Health (Larchmt), 2006, 15(3):261-270. doi: 10.1089/jwh.2006.15.261 URL
[13]	Jeong TD, Lee W, Choi SE, et al. Relationship between serum total cholesterol level and serum biochemical bone turnover markers in healthy pre- and postmenopausal women[J]. Biomed Res Int, 2014, 2014:398397.
[14]	Kanazawa I, Yamaguchi T, Sugimoto T. Relationship between bone biochemical markers versus glucose/lipid metabolism and atherosclerosis; a longitudinal study in type 2 diabetes mellitus[J]. Diabetes Res Clin Pract, 2011, 92(3):393-399. doi: 10.1016/j.diabres.2011.03.015 URL
[15]	Kha HT, Basseri B, Shouhed D, et al. Oxysterols regulate differentiation of mesenchymal stem cells: pro-bone and anti-fat[J]. J Bone Miner Res, 2004, 19(5):830-840. doi: 10.1359/jbmr.040115 URL
[16]	Yang Y, Liu G, Zhang Y, et al. Association between bone mineral density, bone turnover markers, and serum cholesterol levels in type 2 diabetes[J]. Front Endocrinol (Lausanne), 2018, 9:646. doi: 10.3389/fendo.2018.00646 URL

变量	B-ALP（μg/L）		P值	CTX（μg/L）		P值
变量	≤14.24（n=103）	>14.24（n=102）	P值	≤0.36（n=104）	>0.36（n=101）	P值
男/女	37/66	44/58	0.291	29/75	52/49	0.001^b)
年龄（岁）	33.88±10.43	32.40±9.89	0.298	34.00±10.15	32.27±10.15	0.223
BMI	35.58±5.80	36.23±6.64	0.457	35.28±5.49	36.54±6.87	1.145
皮下脂肪面积（cm²）	401.91±147.83	430.69±152.79	0.172	393.02±144.38	440.12±153.91	0.025^b)
内脏脂肪面积（cm²）	215.63±130.28	227.48±158.79	0.560	216.50±125.68	226.70±162.88	0.616
高血压（有/无）	46/57	55/47	0.185	45/59	56/45	0.081
收缩压（mmHg）	128.83±14.05	132.94±15.29	0.046^a)	129.55±14.18	132.24±15.34	0.194
舒张压（mmHg）	82.10±11.13	86.23±13.02	0.015^a)	82.98±12.91	85.36±11.47	0.166
糖尿病（有/无）	63/40	64/38	0.816	66/38	61/40	0.651
空腹血糖（mmol/L）	6.67±2.64	6.95±3.08	0.476	7.03±3.20	6.29±2.38	0.011^b)
高TG血症（有/无）	50/53	57/45	0.293	51/53	56/45	0.359
TG（mmol/L）	1.99±1.45	2.74±2.10	0.003^a)	2.21±1.74	2.52±1.92	0.225
低HDL血症（有/无）	56/47	77/25	0.002^a)	63/41	70/31	0.190
HDL（mmol/L）	1.63±1.33	1.09±0.60	<0.001^a)	1.44±1.14	1.29±0.98	0.305
LDL（mmol/L）	2.57±0.96	2.73±1.01	0.266	2.67±0.96	2.63±1.02	0.777

变量	B-ALP		CTX
变量	r值	P值	r值	P值
年龄	-0.191	0.006	-0.143	0.040
BMI	0.122	0.082	0.128	0.067
皮下脂肪面积	0.088	0.210	0.125	0.074
内脏脂肪面积	0.073	0.301	0.086	0.218
收缩压	0.163	0.019^a)	0.062	0.380
舒张压	0.184	0.008^a)	0.052	0.462
空腹血糖	0.009	0.903	-0.155	0.026^a)
TG	0.245	<0.001^a)	0.049	0.483
HDL	-0.201	0.004^a)	-0.127	0.069
LDL	0.033	0.637	0.002	0.976

项目	B-ALP		CTX
项目	OR（95%CI）	P值	OR（95%CI）	P值
BMI
≤35.51	1.00		1.00
>35.51	0.846（0.451~1.585）	0.601	1.025（0.545~1.929）	0.938
内脏脂肪面积（cm²）
≤184.30	1.00		1.00
>184.30	1.390（0.741~2.608）	0.305	1.542（0.816~2.913）	0.182
皮下脂肪面积（cm²）
≤423.20	1.00		1.00
>423.20	0.693（0.357~1.347）	0.280	0.381（0.194~0.748）	0.005^a)
IFG或糖尿病
有	1.00		1.00
无	0.929（0.497~1.738）	0.818	1.027（0.548~1.923）	0.935
高血压
有	1.00		1.00
无	0.791（0.437~1.431）	0.438	0.625（0.344~1.133）	0.121
高TG血症
有	1.00		1.00
无	1.049（0.571~1.927）	0.877	0.967（0.525~1.779）	0.913
HDL（mmol/L）
≤1.06	1.00		1.00
>1.06	2.931（1.585~5.421）	0.001^a)	2.067（1.118~3.824）	0.021^a)
LDL（mmol/L）
≤2.63	1.00		1.00
>2.63	0.830（0.464~1.486）	0.531	1.103（0.615~1.979）	0.742