老年2型糖尿病骨质疏松与骨容积改变影响因素研究

Risk factors analysis for osteoporosis and bone volume changes in elderly patients with type 2 diabetes mellitus

目的研究老年2型糖尿病（type2diabetesmellitus，T2DM）患者骨质疏松（osteoporosis，OP）的发生情况及其危险因素，并探讨骨容积改变的影响因素。方法采用双能x线骨密度仪测定47例老年T2DM患者的腰椎L2-4骨密度（BMD），参照WHO规定的OP诊断标准来判定其有无合并OP，并测定血生化指标（血清骨碱性磷酸酶、骨钙素、甲状旁腺素、I型胶原c端肽、25羟维生素D、血钙、血脂、糖化血红蛋白、空腹及餐后2h血糖、胰岛素等），同时应用容积定量CT（volumetricquantitativeCT，vQCT）测定腰椎L3的骨容积，并分析其与血生化等指标的相关性。结果老年T2DM患者OP发生率为46．8％，Logistic回归分析显示，BMI、餐后2h血糖是OP发生的独立危险因素，而空腹血糖、胰岛素、糖化血红蛋白、骨碱性磷酸酶等与OP发生无关。相关分析显示，容积定量CT测量所得L3每单位高度容积（cm3／cm）与年龄和骨碱性磷酸酶呈负相关（r=-0．343，P〈0．05；r=-O．466，P〈0．05），与BMI和血钙呈正相关（4=0．403，P〈0．01；r=0．376，P〈0．05o结论老年T2DM人群有较高的OP患病率，低体重指数、餐后高血糖都是OP发生的高危因素，而骨小梁容积改变与年龄、BMI、血钙、骨碱性磷酸酶等因素相关。因此在对老年T2DM患者的诊治中，要注意稳定体重、控制餐后血糖以及补充钙等要点，对进一步延缓骨质量改变及预防OP发生有重要意义。

Objective To investigate the risk factors for osteoporosis and bone volume change in elderly patients with type 2 diabetes mellitus （T2DM）. Methods 47 elderly patients with T2DM were recruited. The bone mineral density （BMD） of lumbar spines （L2-4） was measured with dual energy X ray absorptiometry （DXEA） and the bone volume of lumbar spines （L3） was measured with volumetric quantitative computed tomography （vQCT）. According to BMD, patients were divided into osteoporosis group and without osteoporosis group. Biochemical indicators were detected at the same time. Results The incidence of osteoporosis in elderly patients with T2DM was 46.8 %. Multiple logistic regression analysis showed that body mass index （BMI） and 2-hour postprandial blood glucose （2hPBG） were the risk factors for osteoporosis in elderly patients with T2DM. Correlation analysis indicated that age, BMI, blood BAP and calcium status were related to bone volume changes in elderly patients with T2DM. Conclusions There is a higher morbidity of osteoporosis in elderly patients with T2DM. The occurrence of osteoporosis is related with many factors in elderly patients with T2DM. Patients with low BMI, older age, poor calcium status should be paid more attention to prevent the bone volume changes and to delay occurrence of osteoporosis.