绝经后2型糖尿病患者髋部骨几何结构参数及影响因素

Geometry parameters of the hip in postmenopausal women with type 2 diabetes mellitus and the influential factors

目的探讨绝经后2型糖尿病(T2DM)患者髋部骨几何结构参数的变化并分析主要影响因素。方法回顾性纳入在湘雅二医院内分泌科住院的绝经后T2DM患者(150例)及健康对照者(160名),采用双能X线骨密度仪及其配置的髋部骨强度分析(hip structural analysis,HAS)软件,检测腰椎(L1-4)总体、左侧股骨颈(FN)和髋部总体(TH)骨密度(BMD)以及髋部骨几何结构,采用多元逐步线性回归分析髋部骨几何参数影响因素。结果绝经后T2DM患者腰椎(L1-4)、FN及TH的BMD与健康对照组差异无统计学差异;绝经后T2DM组股骨颈干角(NSA)较健康对照组增加,股骨颈截面面积(FN-CSA)减少(P<0.05)。体重指数(BMI)、FN-BMD和TH-BMD与截面面积(CSA)、截面力矩(CSMI)、截面模量(Z)和皮质厚度(ACT)呈正相关(P<0.01),与屈曲应力比(BR)呈负相关(P<0.01)。校正空腹血糖(FBG)、糖化血红蛋白(Hb A1c)和病程影响因素后,年龄、绝经年限与FN、转子间(IT)2个部位骨结构指标CSA、CSMI、Z、ACT(FN-CSA、FN-CSMI、FN-Z、FN-ACT、IT-CSA、IT-CSMI、IT-Z、IT-ACT)及股骨干(FS)部位骨结构指标CSA、ACT(FS-CSA、FS-ACT)呈负相关(P<0.01),与FN、IT、FS 3个部位的BR(FN-BR、IT-BR、FS-BR)呈正相关(P<0.01),与FS部位的CSMI、Z(FS-CSMI、FS-Z)无明显相关。校正年龄和BMI影响因素后,除病程与FN-CSMI呈正相关(P<0.05)外,FBG、Hb A1c和病程与髋部骨几何结构参数之间均无相关性,同时股骨颈NSA与各影响因素间无相关性。校正BMD后,多元逐步回归分析发现髋部骨几何结构参数主要影响因素为BMI和绝经年限。结论绝经后T2DM患者表现为NSA增大和FNCSA降低的骨几何结构改变,可能与T2DM患者髋部高骨折风险相关。BMD、BMI和绝经年限为影响髋部骨几何结构参数的主要影响因素。

Objective To investigate the variation of geometry parameters of the hip in postmenopausal women with type 2 diabetes mellitus （T2DM）, to explore the influential factors.Methods The medical records of 150 postm-enopausal women with T 2DM and 160 health controls in the Second Xiangya Hospital were included in this cross-sectional study.Bone mineral density （BMD） at lumbar spines （L1 -L4）, the left femoral neck and the total hip, was measured with dual energy X-ray absorptionmetry .Hip structural analyses were done using the validated Beck ’s method on hip scans from dual energy x-ray absorptiometry .Multiple regression method was used to analylse the influential factors .Results There was no statistical significance for the BMD at L 1 -L4 and proximal femur regions between the T 2DM and control group.Postmenopausal women with T2DM group had decreased femoral neck cross sectional area （FN-CSA） and upper neck shaft angle （NSA） vs controls （P〈0.05）.BMI, FN-BMD and TH-BMD all showed positive correlation with CSA , sectional modulus （ Z） , cross-sectional moment of inertia （ CSMI） and average cortical thickness （ ACT） , while negative correlation with bucking ratio （BR） （P〈0.01）.Adjusted for fasting blood-glucose （FBG）, HbA1c and course of dia-betes, ages and years since menopause （YSM） showed negative correlation with FN-CSA、 FN-CSMI、 FN-Z、 FN-ACT、IT-CSA、 IT-CSMI、 IT-Z、 IT-ACT、FS-CSA and FS-ACT （P〈0.01）, and positive correlation with FN-BR, IT-BR and FS-BR （P〈0.01）, but no correlation with FS-CSMI and FS-Z.FBG, HbA1c and course of diabetes showed no correla-tion with the variation of geometry parameters .However, adjusted for ages and body mass index （BMI）, course of diabe-tes, course of diabetes showed positive correlation with FN-CSMI （P〈0.05） and NSA showed no correlation with all the influential factors .Adjusted for TH-BMD, the stepwise multiple linear regression showed that the main influential factors geometry parameters of the hip were BMI and YSM .Conclusions Postmenopausal women with T 2DM have higher NSA and lower FN-CSA of the hip geometry parameters than those in control group , which may be associated with their docu-mented higher hip fracture risk .The main influential factors of geometry parameters of the hip in postmenopausal women with T2DM are BMD, BMI, and years since menopause .