绝经后2型糖尿病患者腹腔内脏脂肪面积与骨密度的相关性

Relationship of visceral fat area with bone mineral density and retinol-binding protein 4 in the postmenopausal female with type 2 diabetes mellitus

目的探讨腹腔脂肪面积（VAT）与绝经后2型糖尿病患者骨密度的关系以及血清视黄醇结合蛋白4（RBP4）与骨密度的相关性。方法收集2010年9月至2011年6月于我院内分泌科住院治疗的绝经后2型糖尿病患者69例，年龄40～73岁。应用CT测量VAT及腹部皮下脂肪面积（SAT），应用双能X线骨密度测定仪测量骨密度（g／cm2）；根据体质指数（BMI）均值及VAT均值分为1～4组，组1：BMI〈26．0kg／m2，VAT〈155．3cm2；组2：BMI〈26．0kg／m2，VAT〉155．3cm2；组3：BMI〈26．0kg／m2，VAT〈155．3cm2；组4：BMI〈26．0kg／m2，VAT〉155．3cm2。结果绝经后2型糖尿病患者VAT与腰椎、大转子区骨密度呈负相关（r=-0．367，r=-0．301），在控制BMI、SAT对骨密度的影响后，VAT与女性绝经后2型糖尿病患者腰椎、大转子区、股骨颈及转子间骨密度均呈负相关（r分别为-0．433、-0．432、～0．300、-0．297，均P〈0．05）。LNRBP4与腰椎骨密度呈负相关（r=-0．295，P〈0．05）。组间比较显示，组3腰椎骨密度（1．00±0．20比0．79_4-0．14）、股骨颈骨密度（0．82±0．17比0．70±0．10）、转子间骨密度（1．13±0．24比0．95±0．14）、大转子区骨密度（0．76±0．18比0．58±0．11）均高于组2（P〈0．05）。对各部位骨密度所拟合的多元线性回归方程中，腰椎骨密度、股骨颈骨密度、转子间骨密度、大转子区骨密度能被自变量（年龄、糖尿病病程、BMI、VAT、糖化血红蛋白、空腹血浆胰岛素、绝经时间）的变异解释分别占51，7％、52．2％、59．8％、75．3％（均P〈0．01）。结论局部脂肪对绝经后2型糖尿病患者骨密度的影响可能取决于脂肪的分布类型，VAT是绝经后2型糖尿病患者骨密度的独立预测因子；血清RBP4可能有助于解释VAT对2型糖尿病患者骨密度的影响。

Objective To determine the associations of visceral adipose tissue area and retinol- binding protein 4（RBP4） with bone mineral density （BMD） in the postmenopausal patients with type 2 diabetes mellitus （T2DM）. Methods The cross-sectional study involved 69 postmenopausal patients with T2DM （aged 40-73 years） in our hospital,they were divided into 4 groups：group I：BMI 26.0 kg/m2 ,VAT%155.3 cm2 group 2：BMI%26.0 kg/m2 , VAT 155.3 cm2 ;group 3.. BMI% 26.0 kg/m2,VAT%155.3 cm2~group4：BMI%26.0 kg/m2,VAT155.3 cm2. The visceral adipose tissue （VAT） area and subcutaneous adipose tissue （SAT） area were obtained by computed tomography（CT） and BMD was measured by dual energy X-ray absorptiometry （DEXA）. Results VAT area had negative associations with lumbar spine BMD （LS-BMD） and greater trochanter BMD （GT-BMD） （r=-0.367,r=-0.301）, and with LS-BMD, GT-BMD, femoral neck BMD （FN- BMD） and intertroehanter BMD （IT-BMD） even after adjusting for body mass index（BMI） and SAT （r=-0.433, -0.432, -0.300, -0.297, all P〈0.05）. A negative relationship was showed between LNRBP4 and LS BMD in postmenopausal female patients （all P 〈 0.05. ） The postmenopausal female patients with T2DM were divided into four groups according to the mean values of BMI and VAT area. BMD at any site of group 3（LS-BMD： 1.00~0.20, FN-BMD： 0. 82＋0.17, IT-BMD： 1.13＋0.24, GT BMD： 0. 76＋0.18） were higher than group 2（0.79＋0. 14, 0.70＋0.10, 0.95 ＋ 0. 14, 0.58 ＋0.11）. The multiple regression indicated that the variation of predictors （age, DUR, BMI, VAT, HbAlc, FINS and PMT） explained 51.7%, 52.2%, 59.8% and 75.3% of the variation in LS-BMD, FN-BMD, IT-BMD, GT BMD among subjects, respectively（all P〈0.01）. Conclusions The influence of fat on bone density may depend on its site of VAT or SAT. VAT could be an independent determinant factor of BMD in the postmenopausal female with T2DM. Serum RBP4 may contribute to this effect.