目的 探讨微小核糖核酸（miR）-155、miR-31-5p、白脂素（Asprosin）、糖原合成酶激酶-3β（GSK-3β）水平预测2型糖尿病（T2DM）患者发生骨质疏松症（OP）的风险。 方法 选取石家庄市人民医院2024年3月至2025年10月收治的158例确诊T2DM患者作为研究对象，根据并发OP情况（骨密度测量T值）进行分组，T值≤-2.5为T2DM-OP组（54例），其余为T2DM非OP组（104例）。分析T2DM并发OP的多因素，绘制受试者工作特征（ROC）曲线分析年龄、糖化血红蛋白（HbA_1C）、病程、吸烟、饮酒、miR-155、miR-31-5p、Asprosin、GSK-3β水平对T2DM并发OP的诊断效能，采用Spearman相关性分析miR-155、miR-31-5p、Asprosin、GSK-3β水平与骨密度相关性。 结果 T2DM-OP组年龄、HbA_1C、病程、miR-155、Asprosin、GSK-3β水平较T2DM非OP组高，miR-31-5p水平较T2DM非OP组低，吸烟、饮酒占比较T2DM非OP组高（P < 0.05）。年龄、HbA_1C、病程、吸烟、饮酒、miR-155、miR-31-5p、Asprosin、GSK-3β均为T2DM并发OP的独立危险因素（OR = 1.950、1.876、2.111、2.008、1.908、2.002、2.016、1.793、1.956，P < 0.05）。年龄、HbA_1C、病程、吸烟、饮酒、miR-155、miR-31-5p、Asprosin、GSK-3β联合检测对T2DM并发OP的AUC值为0.899（95%CI：0.848 ~ 0.949），各指标单独检测AUC值分别为0.805、0.778、0.829、0.657、0.651、0.776、0.759、0.803、0.788，联合检测显著高于单独检测（P < 0.05），且联合检测的敏感度为81.50%，特异度为86.50%。miR-155、Asprosin、GSK-3β水平与骨密度呈负相关（r = -0.612、-0.596、-0.604，P < 0.05），miR-31-5p水平与骨密度呈正相关（r = 0.527，P < 0.05）。 结论 年龄、HbA_1C、病程、吸烟、饮酒、miR-155、miR-31-5p、Asprosin、GSK-3β水平与T2DM并发OP相关，各指标联合检测较单项指标具有更高的诊断效能，有望为高危患者的早期识别与预防提供新的思考。

Objective To investigate the predictive value of microRNA （miR）-155， miR-31-5p， Asprosin， and glycogen synthase kinase-3β （GSK-3β） levels in the development of osteoporosis （OP） in patients with type 2 diabetes mellitus （T2DM）. Methods A total of 158 patients diagnosed with T2DM and admitted to Shijiazhuang People's Hospital between March 2024 and October 2025 were selected as the research subjects. These patients were grouped according to the presence or absence of OP， which was determined based on the T-values from bone mineral density measurements. Patients with T-values ≤ -2.5 were classified into the T2DM-OP group （54 cases）， while the remaining patients were classified into the T2DM non-OP group （104 cases）. Multivariate factors associated with T2DM-OP were analyzed. Receiver operating characteristic （ROC） analysis was performed to assess the diagnostic efficacy of age， glycated hemoglobin （HbA_1C）， disease duration， smoking， drinking， miR-155， miR-31-5p， asprosin， and GSK-3β levels for T2DM-OP. Spearman correlation analysis was employed to explore the correlation between miR-155， miR-31-5p， asprosin， and GSK-3β levels and bone mineral density. Results The T2DM-OP group exhibited higher levels of age， HbA_1C， disease duration， miR-155， Asprosin， and GSK-3β when compared to the T2DM non-OP group. In contrast， the level of miR-31-5p in the T2DM-OP group was lower than that in the T2DM non-OP group. Moreover， the proportions of smoking and drinking were also higher in the T2DM-OP group than in the T2DM non-OP group （P < 0.05）. Age， HbA_1C， disease duration， smoking， drinking， miR-155， miR-31-5p， Asprosin， and GSK-3β were all identified as independent risk factors for T2DM complicated with OP （OR = 1.950， 1.876， 2.111， 2.008， 1.908， 2.002， 2.016， 1.793， 1.956， P < 0.05）. The combined detection of age， HbA_1C， disease duration， smoking， drinking， miR-155， miR-31-5p， Asprosin， and GSK-3β yielded an AUC value of 0.899 （95%CI： 0.848 - 0.949） for T2DM complicated with OP. The AUC values of each indicator detected individually were 0.805， 0.778， 0.829， 0.657， 0.651， 0.776， 0.759， 0.803， and 0.788 respectively. The AUC value of the combined detection was significantly higher than those of the individual detections （P < 0.05）. The sensitivity of the combined detection was 81.50% and the specificity was 86.50%. The levels of miR-155， Asprosin， and GSK-3β were negatively correlated with bone density （r = -0.612， -0.596， -0.604， P < 0.05）， whereas the level of miR-31-5p was positively correlated with bone density （r = 0.527， P < 0.05）. Conclusions Age， HbA_1C， disease duration， smoking， drinking， miR-155， miR-31-5p， Asprosin， and GSK-3β levels are all associated with T2DM complicated with OP. The combined detection of these indicators has a higher diagnostic efficacy than the individual detection of each indicator， and it is expected to provide new ideas for the early identification and prevention of high-risk patients.