老年2型糖尿病合并糖尿病足患者骨密度的临床分析

Clinical analysis of bone mineral density in elderly patients with type 2 diabetes mellitus complicated with diabetic foot

目的探讨老年2型糖尿病（T2DM）合并糖尿病足患者骨密度变化及其影响因素。方法采用双能X线骨密度仪检测T2DM、T2DM合并糖尿病足患者及健康老年人腰椎（L2～4）和股骨（Neck）的骨密度，并对其与年龄、病程、体质指数（BMI）、糖化血红蛋白、血清胰岛素、血脂、尿微量白蛋白排泄率、骨钙素及性激素等指标的关系进行多元线性回归分析。结果（1）老年T2DM组腰椎、股骨骨密度和骨质疏松患病率与同性别健康对照组比较[男性：腰椎（1．13±0．17）g／cm^2和（1．15±0．18）g／cm^2，股骨（0．87±0．13）g／cm^2和（0．90±0．16）g／cm^2，骨质疏松患病率36％和35％；女性：腰椎（0．96±0．15）g／cm^2和（0．97±0．14）g／cm^2，股骨（0．78±0．12）g／cm^2和（0．82±0．15）g／cm^2，骨质疏松患病率61％和62％]，差异无统计学意义（P〉0．05）；（2）老年糖尿病足组男性腰椎骨密度（1．05±0．17）g／cm^2、股骨（0．80±0．15）g／cm^2；女性腰椎骨密度（0．89±0．11）g／cm^2、股骨（0．72±0．13）g／cm^2，均低于同性别T2DM组和健康对照组（P〈0．01或P〈0．05），骨质疏松患病率（男性54％，女性82％）均高于T2DM组和健康对照组（P〈0．05）；（3）多元线性回归分析显示，影响老年男性糖尿病足患者骨密度的因素为年龄、BMI和空腹胰岛素水平，影响老年女性糖尿病足患者骨密度的因素为年龄、BMI和雌二醇水平。结论老年T2DM患者骨密度和骨质疏松患病率与健康老年人相似，与老年T2DM患者和健康老年人比较，老年糖尿病足患者骨密度显著降低，骨质疏松患病率显著增高。

Objective To investigate the changes of bone mineral density （BMD） and its related factors in elderly patients with type 2 diabetes mellitus （T2DM） complicated with diabetic foot. Methods The BMD of lumbar vertebrae（L2 - 4） and femur were measured by dual energy X ray absortiometry in 93 elderly T2DM patients complicated with diabetic foot （DF group）, 153 elderly T2DM patients without diabetic foot（T2DM group） and 260 healthy elderly subjects（control group）. The relationship between BMD and various factors, such as age, body mass index（BMI）, course of disease, glycosylated hemoglobin （HbAlc）, serum insulin, serum lipids, urinary albumin excretion rate, serum osteocalin and sex hormone were analyzed by multiple linear regression analysis. Results （1） The prevalence rate of osteoporosis and the values of BMD of L2-4 and femur in the T2DM group were similar to those in the control group（P〉0. 05） . （2） In male DF group, the values of BMD of L2-4 and femur were markedly lower than those in the T2DM group and the control group[ L2- 4 ： （1.05±0.17） g/cm^2 vs. （1.13±0.17）g/cm^2, and vs. （1.15±0.18） g/cm2; femur：（0.80± 0.15） g/cm^2 vs. （0.87±0.13） g/cm^2, and vs. （0.90±0.16） g/cm^2,all P〈0.01]; In female DF group, the values of BMD of L2-4 and femur were significantly decreased compared with those in the T2DM group and the control group （L2-4 ： （0.89±0.11） g/cm^2 vs. （0. 96±0.15）g/cm^2, and vs. （0.97±0.14）g/cm^2; femur： （0.72±0.13）g/cm^2 vs. （ 0.78±0.12）g/cm^2, and vs. （0.82±0.15） g/cm^2 , all P〈0.05]. The prevalence rate of osteoporosis in the DF group was markedly higher than that in the T2DM group and the control group （male： 54% vs. 36%, 54% vs. 35%, both P〈0.05; female, 82% vs. 61%, 82% vs. 62%, both P〈0.05）. （3） Multiple linear regression analysis indicated that BMI and fasting serum insulin level were positively related to BMD and age was negatively related to BMD in male DF group. In female DF group, BMI and estradiol concentration were positively related to BMD and age was negatively related to BMD. Conclusions The prevalence rates of osteoporosis and the decreased BMD in T2DM patients were similar to those in healthy elderly subjects. The BMD was markedly lower and the prevalence rate of osteoporosis was significantly higher in DF patients than that in T2DM patients and healthy elderly subjects.