2型糖尿病患者骨代谢生化指标和钙调激素与骨密度关系的研究

Research on the relationship between bone mineral density and biochemical index of bone metabolism, calmodulin hormone in type 2 diabetic patients

目的 观察2型糖尿病（T2DM）患者骨代谢生化指标、血清25-羟维生素D3[25 （OH）D3]和甲状旁腺激素（PTH）水平,分析其对骨密度的影响并探讨T2DM患者骨量的变化.方法 选择天津医科大学总医院T2DM患者127例（男57例,女70例）作为糖尿病组;另选年龄、性别相匹配的健康体检者68名作为对照组.按糖尿病病程或HbA1c将糖尿病组分为4个亚组,A组：病程≤10年,B组：病程＞10年,C组：HbA1c≤8％,D组：HbA1c＞ 8％;按骨量不同分为3个亚组：骨密度正常组（T值＞-1.0 SD）;骨量减少组（-2.5 SD ＜T值≤-1.0 SD）;骨质疏松组（T值≤-2.5 SD）.测定所有受试者血钙、磷、镁、碱性磷酸酶（ALP）、24 h尿钙、25（OH）D3和PTH,采用双能X线骨密度仪对所有受试者进行骨密度测定.结果 糖尿病组血钙、血镁、25（OH）D3、股骨颈和全髋骨密度较对照组显著降低（t=0.235～ 1.884,P均＜0.05）,PTH较对照组显著升高（t=1.067,P＜0.01）;A组、B组血钙、血镁、25（OH）D3较对照组显著降低,且B组血镁低于A组（P均＜0.05）,PTH显著高于对照组,且B组高于A组（P＜0.01）;C组、D组血钙、血镁、25（OH）D3较对照组显著降低（P均＜0.05）,PTH显著高于对照组（P ＜0.01）;A组、B组股骨颈、全髋骨密度较对照组显著下降（P均＜0.05）;D组股骨颈、全髋骨密度较对照组和C组均明显降低（P均＜0.01）,全身骨密度低于对照组（P＜0.05）;C组各部位骨密度较对照组差异均无统计学意义;糖尿病组骨质疏松和骨量减低[39.37％（50/127）,47.24％（60/127）]的比例显著高于对照组[26.47％（18/68）,32.35％ （22/68）,x2=3.852,4.708,P均＜0.05）],并且糖尿病骨质疏松组糖尿病病程、HbA1c、PTH也均较骨密度正常组和骨量减低组明显升高（P均＜0.05）Logistic回归分析显示糖尿病病程、HbA1c、PTH是糖尿病患者骨密度降低的危险因素.结论 T2DM患者存在骨代谢紊乱,维生素D水平下降,PTH水平升高和骨密度的下降,以糖尿病病程长和血糖控制差者为著.

Objective To observe the levels of biochemical index of bone metabolism,25-hydroxy vitamin D3[25 （OH） D3] and parathormone （PTH） in patients with type 2 diabetes mellitus （T2DM）,and analyze their effects on bone mineral density（BMD） and discuss the changes of bone mass in T2DM patients.Methods One hundred and twenty-seven patients with T2DM were selected,including 57 male cases and 70 female cases as diabetes group ; 68 healthy people （sex and age matched） were choosed as control group.Diabetes group was divided into 4 subgroup according to diabetic duration or HbA1c,group A：diabetic duration ≤ 10 years,group B：diabetic duration 〉 10 years,group C：HbA 1 c ≤ 8%,group D：HbA 1 c 〉 8% ; meanwhile diabetes group was divided into 3 subgroup according to BMD,normal BMD group：T 〉-1.0 SD; osteopenia group：-2.5 SD 〈 T ≤-1.0 SD ; osteoporosis group：T ≤-2.5 SD.Blood calcium,phosphorus,magnesium,alkaline phosphatase （ALP）,24 h urinary calcium,25 （OH）D3 and PTH were measured.BMD was determined by using dual-energy X-ray absorptiometry （DEXA）.Results Compared with control group,blood calcium,magnesium,25（OH）D3,femoral neck and total hip BMD in diabetes group were significantly decreased （t =0.235-1.884,all P 〈0.05）,PTH was significantly increased （t =1.067,P 〈 0.01）.Blood calcium,magnesium,25（OH） D3 in group A,group B were significantly decreased than those in control group,and blood magnesium in group B was also lower than that of group A（all P 〈0.05）,the level of PTH in group A,group B was significantly increased than that in control group,and its value in group B was also higher than that in group A（P 〈0.01）.Compared with control group,blood calcium,magnesium,25（OH） D3 in group C,group D were significantly decreased （all P 〈 0.05）,the level of PTH was significantly increased （P 〈0.01）.Femoral neck and total hip BMD in group A,group B were declined significantly than those in control group （all P 〈 0.05）.Femoral neck and total hip BMD in group D were declined significantly than those in control group and group C（all P 〈 0.01）,the whole body BMD was significantly lower than that in control group （P〈0.05）.Each part of BMD in group C had no significant difference compared with control group.The rate of osteoporosis and osteopenia in diabetes group[39.37% （50/127）,47.24% （60/127）] were significantly higher than those in control group [26.47% （18/68）,32.35% （22/68）,x2=3.852,4.708,all P〈 0.05],and diabetic duration,HbAlc,and PTH in osteoporosis group were significantly higher than those in normal BMD group and osteopenia group （all P〈 0.05）.Logistic regression analysis showed that diabetic duration,HbA 1 c,PTH and were the risk factors of decease of BMD in diabetic patients.Conclusions Patients with T2DM have bone metabolic disorders,decrease of vitamin D levels,increase of PTH and reduction of BMD.It would be more significant in patients with longer diabetic duration and poor glycemic control.