绝经后2型糖尿病患者骨质疏松与血微量元素的关系研究

Clinical study on the relationship between osteoporosis and serum trace elements levels in postmenopausal women with type 2 diabetes

目的：探讨绝经后2型糖尿病患者骨质疏松与血微量元素间的关系.方法：纳入绝经后女性168例,年龄48～82岁,中位数63.5岁;其中2型糖尿病患者122例,健康女性46例.所有受检者均测定血清钙、镁、锌、铜、铁含量和糖化血红蛋白含量,并测定身高和体质量.绝经后2型糖尿病患者同时测定腰椎和左侧股骨骨密度.将绝经后2型糖尿病患者纳入Ⅰ组,绝经后健康女性纳入Ⅱ组,比较2组受检者微量元素的血清含量.根据骨密度检测结果,将122例绝经后2型糖尿病患者中骨密度正常者纳入A组、骨量减少者纳入B组、骨质疏松者纳入C组,比较3组患者微量元素的血清含量;然后根据是否骨质疏松将122例绝经后2型糖尿病患者分为2组,采用Logistic回归分析法分析绝经后2型糖尿病患者骨质疏松与血微量元素的关系.结果：①绝经后2型糖尿病与血微量元素的关系.Ⅰ组受检者血液中锌、镁含量低于Ⅱ组[（91.42±10.88）μmol·L-1,（98.47±11.06）μmol·L-1,t=15.890,P=0.000;（1.46±0.14）mmol·L-1,（1.69±0.14）mmol·L-1,t=88.490,P=0.000];铜、钙、铁含量与Ⅱ组比较,差异无统计学意义[（12.95±2.43）μmol·L-1,（12.54±2.11）μmol·L-1,t=1.053,P=0.306;（1.52±0.13）mmol·L-1,（1.54±0.15）mmol·L-1,t=0.890,P=0.347;（8.07±1.16）mmol·L-1,（8.17±1.40）mmol·L-1,t=0.968,P=0.323].②绝经后2型糖尿病患者骨质疏松与血微量元素的关系.A组42例,B组40例,C组40例.3组绝经后2型糖尿病患者血液中钙、镁、铁含量比较,组间差异无统计学意义[（1.53±0.10）mmol·L-1,（1.51±0.17）mmol·L-1,（1.50±0.12）mmol·L-1,F=0.362,P=0.697;（1.47±0.13）mmol·L-1,（1.45±0.15）mmol·L-1,（1.44±0.14）mmol·L-1,F=0.325,P=0.723;（8.39±1.11）mmol·L-1,（7.94±1.28）mmol·L-1,（7.90±1.04）mmol·L-1,F=2.324,P=0.102].铜、锌含量比较,组间差异有统计学意义[（13.99±2.33）μmol·L-1,（12.83±1.89）μmol·L-1,（12.09±2.64）μmol·L-1,F=7.027,P=0.001;（96.80±11.09）μmol·L-1,（91.51±9.64）μmol·L-1,（86.21±9.39）μmol·L-1,F=11.388,P=0.000].A组患者血液中铜含量高于B组和C组（P=0.027,P=0.000）,B、C组比较,差异无统计学意义（P=0.149）;A组患者血液中锌含量高于B组和C组（P=0.020,P=0.000）,B组高于C组（P=0.018）.对血液中锌、铜、钙、镁、铁含量行二元Logistic回归分析显示,血液中铜、锌含量为绝经后2型糖尿病患者骨质疏松的保护因素（OR=0.731,P=0.006;OR=0.843,P=0.046）.结论：绝经后2型糖尿病患者骨质疏松与血液中锌、铜缺乏有关.

Objective：To explore the relationship between osteoporosis and serum trace elements levels in postmenopausal women with type 2 diabetes. Methods： One hundred and sixty-eight postmenopausal women were recruited. The subjects consisted of 122 women with type 2 diabetes（ group Ⅰ ） and 46 healthy women（ group Ⅱ ）, and ranged in age from 48 to 82 years（ Median = 63.5 yrs）. The serum level of calcium, magnesium, zinc, copper,iron and glycosylated hemoglobin were detected, and the body height and body mass were measured for all the subjects. The serum level of trace elements were compared between the two groups. Meanwhile, the bone mineral density（BMD） of lum- bar vertebrae and left femur were detected in group Ⅰ . According to the BMD, the women in group Ⅰ were divided into 3 subgroups. The women with normal BMD were recruited into group A,lower BMD women were recruited into group B,while the osteoporotic women were re- cruited into group C. The serum level of trace elements were compared between the three subgroups. Furthermore, the women in group Ⅰ were divided into osteoporosis subgroup and non-osteoporosis subgroup, and the relationship between osteoporosis and serum trace elements levels in postmenopausal women with type 2 diabetes was analyzed through logistic regression analysis. Results：The serum content of zinc and magnesium of group Ⅰ were lower than those of group Ⅱ （91.42 ＋/- 10.88 vs 98.47 ＋/- 11.06 μmoL/L, t = 15. 890, P = 0. 000 ; 1.46 ＋/-0.14 vs 1.69 ＋/-0.14 mmol/L,t = 88. 490,P = 0. 000）. There were no statistical differences in the serum content of copper, calcium and iron between the 2 groups （ 12.95 ＋/- 2.43 vs 12.54 ＋/- 2.11 μmol/L, t = 1. 053, P = 0. 306 ; 1.52 ＋/- 0. 13 vs 1.54 ＋/- 0. 15 mmol/L, t = 0. 890,P = 0.347 ;8.07 ＋/- 1.16 vs 8.17 ＋/- 1.40 mmol/L, t = 0. 968, P = 0. 323 ）. Among the 122 women with type 2 diabe- tes ,42 cases were included into group A,40 cases in group B ,40 cases in group C. There were no statistical differences in the serum content of calcium, magnesium and iron among the 3 subgroups （ 1.53 ＋/- 0 10,1.51 ＋/- 0. 17,1.50 ＋/- 0. 12 mmol/L, F = 0. 362, P = 0. 697 ; 1.47 ＋/-0.13,1.45 ＋/-0.15,1.44 ＋/-0.14 mmol/L,F =0. 325,P =0. 723;8.39 ＋/- 1.11,7.94 ＋/- 1.28,7.90 ＋/- 1.04 mmol/L, F = 2. 324 ,P = 0. 102）. There were statistical differences in the serum content of copper and zinc among the 3 subgroups（ 13.99 ＋/- 2.33, 12.83 ＋/- 1.89,12.09 ＋/- 2.64 μmol/L, F = 7. 027, P = 0. 001 ; 96.80 ＋/- 11.09,91.51 ＋/- 9.64,86.21 ＋/- 9.39 μmol/L, F = 11. 388, P = 0. 000）. The serum copper content of group A was higher than that of group B and group C （ P = 0. 027,P = 0. 000）, and there was no statistical differences between group B and group C （P = 0. 149）. The serum zinc content of group A was higher than that of group B and group C（ P = 0. 020 ,P = 0.000）, and group B surpassed group C （P = 0. 018 ）. The results of logistic regression analysis showed that the serum content of copper and zinc was the protective factor for osteoporosis of postmenopausal women with type 2 diabetes（ OR = 0. 731, P = 0. 006 ; OR = 0. 843, P = 0. 046）. Conclusion ： The osteoporosis may be associated with lack of serum zinc and serum copper for postm- enopausal women with type 2 diabetes.