老年门诊人群骨密度和糖脂代谢指标的相关性研究

Relationship between bone mineral density and glucolipid metabolism index of elderly outpatient

目的 观察老年门诊人群骨密度和糖脂代谢指标的相关性.方法 老年门诊就诊的60岁及以上患者196例,采用骨密度超声分析仪（QUS）对其进行骨密度的测定,根据检测结果分为骨量正常组、骨量减少组和骨质疏松组.并对患者进行问卷调查,包括年龄、身高、体重、疾病史以及空腹血糖、糖化血红蛋白、血脂、血钙、血磷、骨转换指标测定,分析老年骨质疏松的影响因素及和糖脂代谢指标的相关性.结果 空腹血糖、糖化血红蛋白、Ⅰ型胶原羧基端肽β特殊序列、25-羟维生素D3与骨密度T值呈相关关系（P分别为0.000,0.004,0.015,0.018;相关系数分别为-0.320,-0.207,-0.173,0.169）,进一步的多因素分析显示,空腹血糖与老年骨量下降呈相关性（P=0.011,相对危险度1.709,95％可信区间1.133 ～ 2.579）.伴有糖尿病的骨质疏松患者Ⅰ型胶原羧基端肽β特殊序列高于非糖尿病组（P =0.029）,而骨痛症状却较少（P=0.013）.结论 空腹血糖是老年门诊人群骨密度下降的危险因素.高血糖患者较易患骨质疏松,其骨代谢改变特点是：骨形成下降、骨吸收增加.在治疗2型糖尿病的同时,对老年人早期进行骨密度测定有重大意义.

Objective To investigate the relationship between bone mineral density and glucolipid metabolism index of elderly outpatient. Methods Bone mineral density was investigated by Quantitative ultrasound （QUS） in 196 patients aged above 60 years who received physical examination in outpatient department. All subjects answered the questionnaire, which contained the information on age, height, weight, previous disease history. Additionally, fasting plasma glucose, glycosylated hemoglobin, blood lipids, blood calcium, blood phosphorus and bone turnover markers were also measured. The relationship between these factors and glucolipid metabolism were investigated. Results Fasting plasma glucose, glycosylated hemoglobin, β-C-terminal cross-linked telopeptides of type I collagen, 25- hydroxy vitamin D3 were correlated with bone mineral density （P=0.000, 0.004, 0.015, 0.018 respectively ）. Fasting plasma glucose were correlated with bone mineral density （P= 0.011 ）. ~ crosslaps carboxy terminal telopeptides of collagen type 1 in diabetic osteoporosis group was significantly higher than the non-diabetic group, but less pain symptoms. Conclusion Fasting plasma glucose, is a risk factor for decreased bone mineral density of elderly outpatient. The bone metabolism change characteristic is： decreased bone formation, increase bone resorption. It is strongly recommended that patients with type 2 diabetes should timely undergo bone mineral density measurement.