老年男性Ⅱ型糖尿病患者的骨代谢研究

Bone metabolism in elderly male patients with type 2 diabetes mellitus

目的 了解老年男性Ⅱ型糖尿病（T2DM）患者骨代谢的变化及影响骨代谢的相关因素,对Ⅱ型糖尿病并发骨质疏松（osteoporosis,OP）作出早期预防和诊治.方法 采用双能X线吸收法（DEXA）测定40例男性糖尿病患者和健康对照者腰2～4椎的骨密度（BMD）,同时测定骨钙素（BGP）、血清Ⅰ型前胶原羧基末端前肽（PICP）、Ⅰ型胶原降解产物（ICTP）、抗酒石酸酸性磷酸酶（TrACP-5b）、糖化血红蛋白（HbA1c）.结果 糖尿病患者BMD及BGP、PICP均低于非糖尿病者,而ICTP及TrACP-5b均高于非糖尿病者（P＜0.05）,BMD与糖尿病病程、ICTP、TrACP-5b、HbA1c呈显著负相关（P＜0.05）.结论 老年男性糖尿病患者存在BMD显著下降,其骨代谢特点是骨吸收增加,骨形成降低,血糖控制不良是糖尿病并发骨质疏松的危险因素之一.

Objective To understand the features of bone metabolism and risk factors in the elderly with type 2diabetes mellitus and achieve early diagnosis and treatment of type 2diabetes mellitus complicated with osteoporosis.Methods Bone mineral density（BMD）of lumbar 2-4was examined in forty male diabetes mellitus patients and healthy controls using dual energy X-ray absorptiometry（DEXA）.The boneγ-carboxyglutamic protein（BGP）,Procollagen type I C terminal peptide（PICP）,Type I collagen degradation products（ICTP）,tartrate-resistant acid phosphatase（TrACP-5b）and glycosylated hemoglobin（HbA1c）were measured.Results BMD,PICP and BGP in the patients with diabetes mellitus were lower than that in the patients without diabetes mellitus.But ICTP and TrACP-5bin the patients with diabetes mellitus were higher than those in the patients without diabetes mellitus.A negative correlation was observed between the BMD and the course of diabetes mellitus,ICTP TrACP-5bHbA1 c.Conclusion BMD in the elderly patients with diabetes mellitus declines significantly with age.Elevated bone reabsorption and reduced bone formation are the two features of their bone metabolism Poor glucose control is one of the risk factors for osteoporosis in old male diabetes patients.