藏族2型糖尿病患者骨密度与相关危险因素分析

Bone mineral density of Tibetan patients with type 2 diabetes and related risk factors

目的:了解藏族2型糖尿病患者骨密度情况及其相关危险因素的关系,为今后西藏地区藏族人群临床预防和治疗2型糖尿病合并骨质疏松症患者提供一定的理论依据。方法:收集2016年1月至2018年3月于西藏自治区人民医院内分泌科住院的2型糖尿病患者的一般资料及生化指标;按照患者双能X线骨密度测量结果(DXA)的T值,将患者分为正常组(T≥-1.0)、骨量低下组(T=-1.0^-2.5)、骨质疏松组(T≤-2.5),比较3组一般资料及生化指标有无统计学差异,对有统计学差异的资料及指标再进行多重线性回归分析其危险因素。结果:本研究共纳入受试者456例(男286例,女170例),平均年龄(55.7±11.3)岁。(1)3组间(骨量正常组177例、骨量低下组202例及骨质疏松组77例)比较显示,年龄、病程、体质量指数、尿酸、高密度脂蛋白胆固醇水平差异有统计学意义(均P<0.05);3组空腹血糖、糖化血红蛋白、血钙、血镁、血磷、甘油三酯、胆固醇、低密度脂蛋白胆固醇、碱性磷酸酶、25羟基维生素D、甲状旁腺激素水平比较未见统计学差异(均P>0.05)。(2)尿酸是腰椎骨量减低的危险因素(β=0.215,P<0.05),年龄、体质量指数、尿酸是股骨颈骨量减低的危险因素(β分别为-0.329、0.177、0.173,均P<0.05)。结论:高龄、低体质量指数、低尿酸是藏族2型糖尿病患者骨量减低的危险因素,在针对藏族2型糖尿病患者的临床工作中需加以重视。

Objective:To investigate the bone mineral density of Tibetan patients with type 2 diabetes and related risk factors,and to provide a theoretical basis for the prevention and treatment of osteoporosis in type 2 diabetes among the Tibetan population in Tibet. Methods:The patients with type 2 diabetes who were hospitalized in Department of Endocrinology,The People’s Hospital of Tibet Autonomous Region,from January 2016 to March 2018 were enrolled,and their general information and biochemical parameters were collected. According to the T value of dual-energy X-ray absorptiometry,they were divided into normal group(T value ≥-1.0),low bone mass group(T value ranging from -2.5 to -1.0),and osteoporosis group(T value ≤-2.5). The three groups were compared in terms of general information and biochemical parameters,and a multiple linear regression analysis was performed for the data and parameters with differences to identify risk factors. Results:A total of 456 patients(286 male and 170 female patients)were enrolled in this study,with a mean age of 55.7±11.3 years. There were significant differences between the three groups(177 patients in the normal group,202 in the low bone mass group,and 77 in the osteoporosis group)in age,course of disease,body mass index(BMI),uric acid,and high-density lipoprotein cholesterol(all P<0.05),while there were no significant differences in fasting blood glucose,HbA1c, blood calcium,blood magnesium,serum phosphorus,triglyceride,cholesterol,low-density lipoprotein cho-lesterol,alkaline phosphatase, 25-hydroxyvitamin D,and para-thyroid hormone(all P >0.05). Uric acid was a risk factor for reduced bone mass in the lumbar vertebra(β=0.215,P <0.05),and age,BMI,and uric acid were risk factors for reduced bone mass in the femoral neck(β=-0.329, 0.177,and 0.173,all P <0.05). Conclusion:Old age,low BMI, and low uric acid are risk factors for reduced bone mass in Tibetan patients with type 2 diabetes and should be taken seriously in clinical practice.