绝经后2型糖尿病患者不同部位骨密度的变化情况及影响因素

The variation of bone mineral density of various skeletal sites in postmenopausal women with type 2 diabetes and the influential factors

目的探讨绝经后2型糖尿病女性不同部位骨密度的变化、影响因素及骨质疏松诊断率,为早期诊断、早期防治糖尿病并发骨质疏松提供理论依据。方法回顾性分析在我院内分泌科住院的绝经后2型糖尿病患者169例,采用双能X线骨密度测量仪检测腰椎1-4椎体、左侧股骨颈、Ward’s三角及全髋的骨密度,统计各年龄组不同部位的骨密度值及T≤-2.5SD所占百分比,采用多元逐步回归分析各部位骨密度影响因素。结果各部位骨密度随着年龄的增长而下降,股骨颈及Ward’s三角、全髋部位的骨密度下降幅度较大,腰椎部位骨密度下降相对平缓。随着年龄增长,腰椎和髋部骨质疏松检出率增加。其中在50～59岁年龄组中,骨质疏松检出率最高的部位是L1-L4正位,在60岁以上的年龄组中检出率最高的部位是Ward’s三角。多元回归分析结果显示L1、L2、L3、L4、股骨颈、Ward’s三角及全髋部位骨密度均与BMI呈正相关,除L3、L4外,所有部位骨密度与年龄呈负相关,L3、L4部位骨密度与绝经年限及空腹C肽有关。各部位骨密度与空腹血糖、HbA1C未见相关性。结论随年龄的增长,绝经后糖尿病患者骨质疏松症检出率随测量部位不同而不同。腰椎正位(L1-L4正位)和Ward’s三角分别是50～59岁及60岁以上女性诊断骨质疏松最敏感的部位。影响绝经后2型糖尿病患者骨密度的主要因素为年龄、BMI。低体重、高龄的糖尿病女性因定期检查骨密度预防骨质疏松骨折的发生。

Objective To investigate the variation of bone mineral density（BMD） of various skeletal sites in postmenopausal women with type 2 diabetes（T2DM）,to explore the risk factors and the diagnostic rate of osteoporosis,and to provide theoretical evidence for early diagnosis and prevention of osteoporosis complicated with T2DM.Methods The medical records of 169 postmenopausal women with T2DM were retrospectively analyzed.BMD at various skeletal sites,including lumbar spines（L1-4）,femoral neck,Ward＇s triangle,and the total hip,was measured with dual energy X-ray absorptiometry.Multiple regression method was used to analyze the risk factors.Results BMD at various skeletal sites gradually decreased with age.BMD of Ward＇s triangle,femoral neck,and the total hip significantly decreased in a large degree.However,BMD of lumbar spines decreased mildly.The detectable rate of osteoporosis at the vertebra and hip increased with age.The detectable rate of osteoporosis was the highest at lumbar spines（L1-L4） in the group of people aged from 50 to 59 years old,but at Ward＇s triangle in the group of people over 60 years old.The results of multi regressive analysis showed that the BMDs of L1-L4,femoral neck,Ward＇s triangle,and the total hip were positively associated with BMI.BMDs of all sites were negatively associated with age except that of L3 and L4.BMDs of L3 and L4 were relative to the postmenopausal years and fasting C-peptide.BMDs of all sites were not related to the fast glucose and HbA1C.Conclusion The detectable rate of osteoporosis is varied with different skeletal sites and age.The lumbar spines and Ward＇s triangle are the most sensitive sites for osteoporosis diagnose in people of 50-59 years old and over 60 years old.The risk factors of osteoporosis in postmenopausal women with T2DM are age and BMI.The regular examination of BMD should be performed for the low weight and elderly people in order to prevent osteoporotic fractures.