2型糖尿病患者和同龄健康人群腰椎骨密度对比研究

Comparative Study on Bone Mineral Density of Lumbar Vertebrae Between Type 2 Diabetic Patients and Healthy People.

目的探讨2型糖尿病患者糖化血红蛋白、尿蛋白等指标与骨量的变化关系。方法选取2型糖尿病患者72例作为糖尿病组、健康检查者80例作为对照组,使用双能X线骨密度仪（DEXA）测量腰椎（L1-4）正位的骨密度（BMD）。以T值低于同性别健康年轻人骨密度峰值2.5个标准差作为骨质疏松的判断标准,以低于同性别健康年轻人骨密度峰值1.1-2.5个标准差作为骨量减少的判断标准,两组均数比较采用t检验,计数资料与率的比较采用2χ检验。结果 2型糖尿病组和对照组除了L1无统计学差异外（t=1.321,P〉0.05）,L2、L3、L4及L1-L4均有统计学差异（t值分别为5.394、4.856、4.929、7.152,P〈0.01）。糖尿病组骨质疏松发病率明显高于对照组（13.9%vs 7.5%）。2型糖尿病糖化血红蛋白升高和正常者的骨量改变及骨质疏松发病率无统计学差异（χ^2=0.156,P〉0.05）。2型糖尿病尿蛋白阳性和阴性者的骨量改变有统计学差异（χ^2=8.423,P〈0.01）,前者骨质疏松发病率比后者高。结论糖尿病患者骨量异常及骨质疏松发生率较同龄健康人群高,糖化血红蛋白升高对骨量改变影响不大,糖尿病肾病是发生骨质疏松的高危因素。

Objective To investigate the relationship between index of glycosylated hemoglobin A1c（HbA1c）,urine albumin and change of bone quantity.Methods 72 cases with type 2 diabetes were selected for diabetic group,and another 80 healthy people for contrast group.BMD of lumbar vertebrae（L1-4） in two groups were measured by dual energy x-ray absorptiometry（DEXA）.T value was less 2.5 standard deviation of peak value of bone mineral density for judgement standard of osteoporosis in patients than in healthy young people with same sex,and was less 1.1-2.5 standard for judgement standard of bone mass loss.T test was used for comparison of the mean between two groups.Chi-sqnare test was used for comparison of the count data and rate.Results The difference of L2,L3,L4 and L1-L4 between diabetic 2 group and contrast group had statistical significance（t value was respectively 5.394,4.856,4.929,7.125,P0.01）,except L1（t value was 1.321,P〈0.05）.The incidence of osteoporosis was obviously higher with diabetic group than contrast group（13.9% vs 7.5%）.The incidence of osteoporosis and changes in bone quantity had no statistical difference between normal and abnormal HbA1c in type 2 diabetic patients（χ^2 =0.156,P0.05）.The incidence of changes in bone quantity had statistical difference between positive and negative urine albumin in type 2 diabetic patients（χ^2=8.423,P0.01）,and the former was higher than the latter.Conclusion The incidence of changes in bone quantity and osteoporosis with diabetic patients was higher than healthy people on same age.HbAlc increasing had little influence on changes of bone quantity.Diabetic nephropathy was the high risk factor of osteoporosis.