老年女性2型糖尿病患者睡眠障碍与骨质疏松症的关系

Association between sleep disorder and osteoporosis in elderly female patients with type 2 diabetes mellitus

目的 探讨老年女性2型糖尿病患者睡眠障碍与骨质疏松症的关系.方法 应用匹兹堡睡眠质量指数将天津医科大学代谢病医院2011年7月至2014年7月收治的536例老年女性2型糖尿病患者分为无睡眠障碍组（258例）和睡眠障碍组（278例）,应用双能X线骨密度仪测量股骨颈、Wards三角区、大转子、腰椎L2～L4的骨密度值,测定生化指标,行口服葡萄糖耐量试验及胰岛素释放试验,比较两组骨密度值、空腹和糖负荷后胰岛β细胞功能变化,logistic回归分析睡眠障碍、骨质疏松症和相关指标的关系.本研究通过天津医科大学伦理委员会审批.结果 睡眠障碍组超敏C反应蛋白为（3.5±1.1） mg/L,糖化血红蛋白（HbAlc）为（8.0±1.9）％,皮质醇（COR）为（512±88）nmol/L,促肾上腺皮质激素（ACTH）为（6.4±2.3）pmol/L,空腹胰岛素为（13.4±4.3） mU/L,稳态模型-胰岛素抵抗指数（HOMA-IR）为4.7±0.8,均高于无睡眠障碍组[分别为（2.6 0.9） mg/L,（7.3±1.6）％,（436±76）nmol/L,（5.1±2.0）pmol/L,（12.4±4.0） mU/L,3.8±0.8]（均P＜0.05）.睡眠障碍组胰岛素敏感指数（ISI）为-4.2±0.5,低于无睡眠障碍组的-4.0±0.4,P＜0.05.睡眠障碍组股骨颈、Wards三角区、大转子、腰椎L2～L4的骨密度值低于无睡眠障碍组（均P＜0.05）,骨质疏松症患病率明显高于无睡眠障碍组（x2=13.891,P＜0.05）.Logistic回归分析显示睡眠障碍与HOMAIR、HbA1c、COR、ACTH呈正相关,与ISI呈负相关（均P＜0.05）;骨质疏松症与绝经年限、HbA1c、COR、ACTH、睡眠障碍呈正相关,与ISI呈负相关（均P＜0.05）.结论 在老年女性2型糖尿病患者,改善睡眠障碍可能有助于减少骨质疏松症的发生.

Objective To explore the association between sleep disorder and osteoporosis in elderly female patients with type 2 diabetes mellitus （T2DM）.Methods A total of 536 elderly female T2DM patients from July 2011 to July 2014 were divided into two groups of patients without sleep disorder and those with sleep disorder based upon the Pittsburgh Sleep Quality Index.The bone mineral density of femoral neck,Wards triangle,greater trochanter and lumbar spines （L2-L4） were measured by dual-energy X-ray absorptiometry.Biochemical indicators were detected in two groups.Oral glucose tolerance and insulin releasing tests were performed.We compared the differences of bone mineral density and β-cell function after fasting and glucose-load.The logistic regression analyses were performed between sleep disorder and osteoporosis and other indicators.Results The levels of high sensitivity C-reactive protein （hs-CRP）,HbA1 c,cortisol （COR）,adrenocorticotropic hormone （ACTH）,fasting insulin （FINS） and homeostasis model assessment-estimated insulin resistance （HOMA-IR） were significantly higher in patients with sleep disorder compared to those without sleep disorder [（3.5 ± 1.1） vs （2.6 ± 0.9） mg/L,（8.0 ± 1.9） ％ vs （7.3 ±1.6）％,（512 ±88） vs （436±76） nmol/L,（6.4 ±2.3） vs （5.1 ±2.0） pmol/L,（13.4±4.3） vs （12.4 ±4.0） mU/L,4.7 ±0.8 vs 3.8 ±0.8,all P ＜0.05].Insulin sensitivity index （ISI） was lower in patients with sleep disorder than that in patients without sleep disorder （-4.2 ± 0.5 vs-4.0 ± 0.4,P ＜ 0.05）.The bone mineral density of femoral neck,Wards triangle,greater trochanter and lumbar spines （L2-L4） were significantly lower and the prevalence rate of osteoporosis was significantly higher in patients with sleep disorder compared to those in patients without sleep disorder （all P ＜ 0.05）.Logistic regression analysis showed that sleep disorder was positively correlated with HOMA-IR,HbA1c,COR and ACTH （all P ＜ 0.05） and negatively with ISI （P ＜ 0.05）.Logistic regression analysis showed that osteoporosis was positively correlated with postmenopausal duration,HbA1c,COR,ACTH and sleep disorder （all P ＜ 0.05） and negatively with ISI （P ＜ 0.05）.Conclusion Sleep disorder causes osteoporosis through various mechanisms in elderly female T2DM patients.Improving sleep disorder may help to reduce the prevalence of osteoporosis.