2型糖尿病合并骨质疏松患者骨代谢指标变化研究

Changes of bone metabolism indexes in patients with type 2 diabetes mellitus and osteoporosis

目的探讨2型糖尿病合并骨质疏松患者骨代谢相关指标的变化情况。方法选取遵义医学院附属医院自2017年1月至2018年1月收治的123例2型糖尿病患者为研究对象,根据是否伴有骨质疏松,将患者分入单纯2型糖尿病组(单一组,n=89)、2型糖尿病合并骨质疏松组(合并组,n=34);同时选取同期健康体检者纳入健康组(n=49)。检测并比较3组研究对象的空腹血糖、糖化血红蛋白、血钙、血磷、甲状旁腺激素、骨钙素N端中分子片段、β-胶原降解产物、25羟基维生素D水平,以及L2、L3、L4骨密度水平。结果单一组、健康组骨钙素N端中分子片段、25羟基维生素D水平均高于合并组,且健康组高于单一组,差异有统计学意义(P <0. 05)。单一组、健康组β-胶原降解产物、空腹血糖、糖化血红蛋白、甲状旁腺激素水平均低于合并组,且健康组低于单一组,差异有统计学意义(P <0. 05)。单一组、健康组、合并组血钙、血磷水平两两比较,差异均无统计学意义(P> 0. 05)。单一组、健康组腰椎L2、L3、L4骨密度水平均高于合并组,差异有统计学意义(P <0. 05)。结论 2型糖尿病会增加骨质疏松的发生风险,导致患者骨形成下降、骨吸收增加。因此,糖尿病治疗过程中应加强骨质疏松防治干预。

Objective To investigate the changes of bone metabolic markers in patients with type 2 diabetes mellitus complicated with osteoporosis. Methods A retrospective study was performed on 123 cases of patients with type 2 diabetes mellitus who were admitted from January 2017 to January 2018. According to the presence or absence of osteoporosis,patients were divided into simple type 2 diabetes mellitus group( single group,n = 89) and type 2 diabetes mellitus combined with osteoporosis group( combined group,n = 34). At the same time,subjects who underwent physical examination during the same period were selected into the healthy group( n = 49).Fasting blood glucose,glycosylated hemoglobin,serum calcium,serum phosphorus,parathyroid hormone( PTH),osteocalcin N-terminal molecular fragment( N-MID),β-collagen degradation products(β-CTX),25 hydroxyl vitamin D( 25 OHD) levels,and bone mineral density( BMD) levels of L2,L3 and L4 were measured and compared among the three groups. Results The levels of N-MID and25 OHD in the single group and healthy group were higher than those in the combined group( P < 0. 05). The levels of β-CTX,fasting blood glucose,glycosylated hemoglobin and parathyroid hormone in the single group and healthy group were lower than those in the combined group( P < 0. 05). There was no significant difference in serum calcium and phosphorus levels among the single group,the healthy group and the combined group( P > 0. 05). The BMD levels of L2,L3 and L4 in the single group and the healthy group were all higher than those in the combined group( P < 0. 05). Conclusion Type 2 diabetes can increase the incidence of osteoporosis,leading to reduced bone formation and increased bone resorption. Interventions for osteoporosis should be strengthened during the treatment of diabetic patients.