女性2型糖尿病患者骨密度及临床相关因素分析

Analysis of bone mineral density and clinical related factors in female patients with type 2 diabetes mellitus

目的：探讨女性2型糖尿病（type 2 diabetes mellitus，T2DM）患者的骨密度（BMD）变化及临床相关因素对BMD的影响。方法：采用双能x线骨密度仪测定127例女性T2DM患者和78例非糖尿病对照者正位腰椎（L2～L4）及股骨近端（Neck、Ward’s区、G．T．）的BMD，按年龄和病程分组进行比较，并对糖尿病患者的BMD与年龄、绝经年限、体重指数（BMI）、病程、糖化血红蛋白A1c（HbA1c）、血脂等指标进行多元逐步回归分析。结果：50～59岁组女性T2DM患者各部位BMD均高于对照组（P〈0．05～P〈0．01）；60～69岁和70～79岁组L2、股骨近端BMD，以及70～79岁组L3BMD均高于对照组（P〈0．05-P〈0．01）；各年龄组ward’s区BMD测定值明显低于腰椎、Neck和G．T．（P〈0．01）。T2DM病程≤5年、6—10年和〉10年组各部位BMD差异均无统计学意义（P〉0．05）。T2DM患者年龄与腰椎BMD均呈负相关（P〈0．05～P〈0．01），绝经年限与Neck、ward’s区、G．T．BMD呈负相关（P〈0．01），BMI与Neck、ward’S区、G．T．BMD呈正相关（P〈0．01），病程、HbA1C、血脂与BMD无显著相关。结论：女性T2DM患者绝经后各部位BMD明显高于或不低于非糖尿病对照者；年龄大、绝经年限长是T2DM患者BMD降低的危险因素；BMI是T2DM患者BMD的保护性因素。

Objective：To investigate the changes of bone mineral density （BMD）in female patients with type 2 diabetes mellitus （T2DM） and the possible clinical related factors involved. Methods：The BMD was measured with the dual-energy X-ray absorptiometry technique at the lumbar（ L2 - L4 ） and proximal femur of 127 female patients with T2DM and 78 non-diabetic controls. The patients and controls were divided into groups according to the age and diabetic duration. The correlation of BMD with the age, duration of menopause, body mass index （BMI）, course, HbAI c and serum lipids was studied by multivariate stepwise regression analysis. Results： The T2DM patients in 55 - 59 years-old group had a higher BMD than the controls （ P 〈 0.05 or P 〈 0. 01 ） ; the patients in 60 - 69 and 70 -79 year-old groups had a higher BMD at L2 than the controls（P 〈0.05 or P 〈0.01 ） ;and the patients in 70 -79 year-old group had a higher BMD at L3 than the controls（P 〈0.05 or P 〈0.01 ）. The BMD at Ward＇s triangle was lower than that at lumbar,neck and G. T in each group（ P 〈0.01 ）. The BMD had no significant difference in T2DM patients with a diabetic course of less than 5 years, between 6 - 10 years and more than 10 years （ P 〉 0.05 ）. Stepwise regression analysis showed that BMD at lumbar was negatively correlated with the age（P 〈 0.05 or P 〈 0. O1 ） ;BMD at neck, Ward＇s triangle and G. T. was negatively correlated with the duration of menopause（ P 〈 0.01 ）, and positively correlated with BMI （P 〈 0.01 ）. Diabetic duration, HbA1 c and serum lipids had no correlation with BMD in T2DM patients. Conclusions ： BMD in postmenopausal T2DM patients is significantly higher than or similar to that in the controls. Aging and long duration of menopause are risk factors for decreased BMD in T2DM patients. BM/may be a protective factor for bone loss.