老年2型糖尿病瘦素、骨密度变化及相关因素的研究

Bone density,leptin level and other related factors in elder patients with type 2 diabetes

目的探讨老年2型糖尿病(T2DM)患者骨密度变化及其与瘦素、性激素及各种骨转换因子的相关关系。方法采用单能定量CT(QCT)对53例2型糖尿病患者及40例健康老年人进行脊柱骨密度(BMD)测定,并分析受试者的骨密度与体质量指数(BMI)、腰臀比(WHR)、血清瘦素(leptin)、性激素、骨钙素(BGP)、骨特异性碱性磷酸酶(B-ALP)、抗酒石酸酸性磷酸酶-5b(TRACP-5b)等指标间的关系。结果①T2DM组脊柱BMD均值显著低于对照组(P<0.05),T2DM组血浆瘦素浓度较对照组显著升高(P<0.05)。②相关性研究显示,T2DM组瘦素水平与L1椎体及脊柱BMD均值呈显著负相关(r=-0.443,r=-0.373,P<0.05)。③多元线性回归分析表明,T2DM组中瘦素、E2、T分别是BMD变化的独立相关因素。结论老年2型糖尿病患者存在不同程度的骨密度下降。瘦素是老年T2DM患者骨量减少的影响因素,但不是直接因素。

Objective To investigate the changes of bone mineral density （BMD） and the relationship of BMD to serum leptin concentrations, body mass index （BMI）, waist hip ratio （WHR）, estradiol（ E2 ）, testosterone（T） , biochemical markers of bone turnover as well as other factors in the elderly subjects with Type 2 diabetes mellitus（T2DM）. Methods BMDs of spine were measured by QCT in patients with T2DM （n = 53 ） and health controls （n =40）. The relationship of BMD with serum leptin concentrations, BMI, WHR, E2, T, bone Gla protein, bone alkaline phosphatase, tartrate resistant acid phosphatase 5b levels were also analyzed. Results The spine BMD values in the T2DM patients were significantly decreased compared with control （ P 〈 0. 05 ） and the serum leptin levels were significantly higher than controls （ P 〈 0.05 ）. Serum leptin concentrations was negatively correlated with L1 BMD and spine mean BMD in the T2DM patients （ r = - 0. 443,r = -0. 373;both P 〈 0. 05 ）. Multiple regression analysis showed that serum leptin concentrations, E2 and T were independent related factors influencing BMD in T2DM . Conclusion The spine BMD in elderly T2DM patients is lower than that of control group. Serum leptin does not have a significant direct influence on bone mass in elderly T2DM patients.