The Relationship Between Glucose Metabolism, Metabolic Syndrome, and Bone-Specific Alkaline Phosphatase: A Structural Equation Modeling Approach
The Relationship Between Glucose Metabolism, Metabolic Syndrome, and Bone-Specific Alkaline Phosphatase: A Structural Equation Modeling Approach
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DOI：
10.1210/jc.2013-2024
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发表时间：
2013-09-01
影响因子：
5.8
通讯作者：
Cheung, Bernard M. Y.
中科院分区：
文献类型：
--
作者：
Cheung, Ching-Lung;Tan, Kathryn C. B.;Cheung, Bernard M. Y.
背景：血清碱性磷酸酶在血管钙化中起作用。它存在于各种组织中，而骨特异性碱性磷酸酶（BAP）更具体地反映了矿物质代谢。血清碱性磷酸酶糖尿病和代谢综合征（MetS）是血管钙化的两个主要危险因素，但糖尿病和代谢综合征（MetS）患者的血糖水平（总的和骨特异性的）在很大程度上是未知的。目的：我们旨在研究葡萄糖代谢、MetS组分和碱性磷酸酶之间的关系。这是一项对1999年至2004年美国人口的全国代表性样本进行的横断面研究。参与者：研究对象为1999- 2004年全国健康与营养调查中的3773名非糖尿病患者。主要结果：我们检测了血清BAP和总碱性磷酸酶。在多变量线性回归中，更新了胰岛素抵抗的稳态模型评估（HOMA 2）（β = 0.068），β细胞功能的HOMA 2（β = 0.081），胰岛素（β = 0.065），平均动脉压（β = 0.15）和高密度脂蛋白（HDL）-胆固醇胰岛素敏感性的HOMA 2（β = 0.209）与BAP呈正相关，而胰岛素敏感性的HOMA 2（β = -0.065）与BAP负相关。另一方面，只有平均动脉压和HDL-胆固醇与总碱性磷酸酶显著相关。此外，结构方程模型显示，高血压，低HDL和胰岛素抵抗对血清BAP水平有显着的直接影响，而肥胖和炎症可能对血清BAP水平有间接影响。模型拟合指数为0.995，均方根误差为0.037，标准化均方根残差为0.006。结论：葡萄糖代谢和代谢综合征与血清BAP水平密切相关。BAP如何介导糖尿病和代谢综合征的血管钙化值得进一步研究。
Context: Serum alkaline phosphatase plays a role in vascular calcification. It is found in various tissues, whereas bone-specific alkaline phosphatase (BAP) more specifically reflects mineral metabolism. The relationship of serum alkaline phosphatase (total and bone-specific) with diabetes and metabolic syndrome (MetS), 2 major risk factors of vascular calcification, is largely unknown.Objective: We aimed to investigate the relationships between glucose metabolism, components of the MetS, and alkaline phosphatase.Design and Setting: This was a cross-sectional study of a nationally representative sample of the U.S. population in 1999 through 2004.Participants: Participants were 3773 nondiabetic participants of the National Health and Nutrition Examination Survey 1999-2004.Main Outcome Measures: We measured serum BAP and total alkaline phosphatase.Results: In multivariable linear regression, updated homeostasis model assessment (HOMA2) for insulin resistance (beta = 0.068), HOMA2 for beta-cell function (beta = 0.081), insulin (beta = 0.065), mean arterial pressure (beta = 0.15), and high-density lipoprotein (HDL)-cholesterol (beta = 0.209) were positively associated with BAP, whereas HOMA2 for insulin sensitivity (beta = -0.065) was negatively associated with BAP. On the other hand, only mean arterial pressure and HDL-cholesterol were significantly associated with total alkaline phosphatase. Moreover, a structural equation model revealed that hypertension, low HDL, and insulin resistance had significant direct effects on serum BAP levels, whereas obesity and inflammation might have indirect effects on serum BAP levels. The overall model showed very good fit to the data (comparative fit index = 0.995, root mean square error of approximation = 0.037, and standardized root mean square residual = 0.006).Conclusion: Glucose metabolism and MetS are significantly related to serum BAP levels. How BAP mediates vascular calcification in diabetes and MetS warrants further studies.