老年2型糖尿病发生骨质疏松的临床多因素分析

Clinical multivariate analysis of osteoporosis in elderly patients with type 2 diabetes

目的探讨老年2型糖尿病(T2DM)患者发生骨质疏松的影响因素。方法根据患者的骨密度值将患者分为骨量正常(NOP)组、低骨量(LBMD)组、骨质疏松(OP)组,对比3组在年龄、糖尿病病程、体质量指数(BMI)、胱抑素C(CysC)、经皮氧分压检查(TcPO2)、糖化血红蛋白(HbA1c)、尿C肽(U-CP)等指标之间的差异,并进行相关性分析。结果 (1)与NOP组相比,LBMD及OP组年龄、病程显著性升高,U-CP显著性下降;(2)OP组BMI、CysC显著低于NOP组;(3)OP组年龄显著高于LBMD组,而BMI显著低于LBMD组(P<0.05或P<0.01)。老年T2DM患者的BMD与年龄、病程呈负相关,与BMI、U-CP呈正相关。逐步多元回归分析显示U-CP是BMD的正性预测因子。结论老年T2DM患者并发骨质疏松与多因素有关,包括高龄、低体质量、病程长、胰岛功能差等。

Objective To investigate the influencing factors of osteoporosis in elderly patients with type 2 diabetes（T2DM）.Methods 298 patients with T2DM were divided into 3 groups（according to their bone mineral density）：normal bone mineral density（NOP） group,low bone mineral density（LBMD） group,osteoprosis（OP） group.Age,diabetes duration,body mass index（BMI）,Cystatin C（Cys C）,transcutaneous tissue oxygen tension（TcPO2）,glycosylated hemoglobin（HbA1c）,urinary C-peptide（U-CP） were compared among three groups.The correlation analysis was used to analyze the factors of OP.Results Compared with NOP group,patients in LBMD and OP group had older age,longer diabetic course,lower U-CP.BMI,Cys C level of patients in OP group were lower than those in NOP group,while the difference in age,BMI was statistically significant between OP and LBMD group（P0.01 or P0.05）.BMD in elderly patients with T2DM was negatively correlated with age,disease course,but positively correlated with BMI and U-CP.Meanwhile,BMD was independently correlated with U-CP.Conclusions Osteoporosis in elderly patients with T2DM is related to a number of risk factors,including advanced age,low body weight,long-term history of diabetes,insulin dysfunction.