2型糖尿病患者钙调激素和骨密度的变化及其相关性分析的研究

Research about the changes of calcium regulation hormone and bone mineral density in patients with type 2 diabetes mellitus

目的：观察T2DM患者钙调激素和骨密度（BMD）的变化，并对其进行相关性分析。方法选取T2DM （T2DM ）患者117例和健康体检（NC）者63名。将T2DM患者分别分为病程≤10年组、病程＞10年组，HbA1 c≤8％组、HbA1 c＞8％组，以及BMD正常组、骨量减低组、骨质疏松（OP）组。比较各组血清25羟维生素D3[25（O H ）D3）]、甲状旁腺激素（PTH）水平和腰椎（L1-L4）、股骨颈、全髋及全身BMD水平。结果（1）与NC组比较，T2DM 组25（OH）D3减低[（44.94±17.40） vs （35.57±12.30） nmol／L]（P＜0.01）；股骨颈、全髋 BMD 下降[（0.927±0.173） vs （0.848±0.136） g／cm2；（0.934±0.140） vs （0.873±0.150） g／cm2]（P＜0.01或 P＜0.05）；PTH升高[（5.62±3.93） vs （8.50±4.15） pmol／L]（P＜0.01）。（2）与病程≤10年组比较，病程＞10年组股骨颈和全髋BMD 下降[（0.882±0.111） vs（0.814±0.148）g／cm2；（0.908±0.139） vs （0.840±0.157）g／cm2]（P＜0.05）；PTH 升高[（7.06±3.74） vs （10.55±9.09） pmol／L]（P＜0.05）。（3）与HbA1c≤8％组比较，HbA1c＞8％组股骨颈、全髋 BMD 减低[（0.891±0.130） vs （0.830±0.131）g／cm2；（0.949±0.130） vs （0.832±0.161） g／cm2]（P＜0.05）；PTH增高[（7.21±3.98） vs （9.96±8.80） pmol／L]（P＜0.05）。（4）T2DM 组OP和骨量减低者比例高于NC组（P＜0.05），且OP组病程、HbA1c、PTH较BMD正常组和骨量减低组长或增高（P＜0.05）。（5） Logistic回归分析显示，BMD与病程、HbA1c及PTH呈负相关，与25（OH）D3呈正相关。结论 T2DM患者BMD下降及OP发生率升高，以糖尿病病程长和血糖控制差者为著。

Objective To research the changes of calcium regulation hormone and bone mineral density （BMD） in type 2 diabetes mellitus （T2DM ） patients and analyze the main impact factors. Methods 117 T2DM patients （T2DM group ,M/F=52/65 ,age 40-79 years） and 63 age‐ and gender‐matched healthy people （NC group） were selected in this study. According to the course of diabetes ,blood glucose control and the value of BMD ,T2DM patients were divided into subgroups ：course≤10 years ,and〉10 years ;HbA1 c≤8% ,and〉8% ;normal BMD ,osteopenia ,and osteoporosis （OP）. Serum 25‐hydroxy vitamin D3 [25（OH）D3 ]and Parathormone （PTH） were measured and BMDs of lumbar spine （L1 -L4 ） , femoral neck ,total hip ,and whole body were evaluated for all the subjects. Result （1）Compared with NC group ,the level of serum 25（OH）D3 and BMDs of femoral neck and total hip decreased significantly in T2DM group[ （35.57 ± 12.30）nmol/L ,（0.848 ± 0.136）g/cm2 ,（0.873 ± 0.150）g/cm2 vs（44.94 ± 17.40）nmol/L ,（0.927 ± 0.173）g/cm2 ,（0.934 ± 0.140）g/cm2 ,respectively ,P〈0.01 or P〈0.05）]. The level of PTH increased in T2DM group[ （8.50 ± 4.15） vs（5.62 ± 3.93）pmol/L ,P〈0.01]. （2）Compared with the group duration of diabetes≤10 years ,BMD of femoral neck and total hip decreased in patients with duration of diabetes〉10 years[ （0.814 ± 0.148） ,（0.840 ± 0.157） vs （0.882 ± 0.111） ,（0.908 ± 0.139） g/cm2 ,respectively ,P〈0.05]. The level of PTH increased [（10.55 ± 9.09） vs （7.06 ± 3.74）pmol/L , P〈0.05）]. 25（OH）D3 and total body BMD have no significant difference（P〉0.05）. （3）Compared with HbA1c≤8% group ,BMD of femoral neck and total hip in HbA1c〉 8% group decreased [（0.830 ± 0.131） ,（0.832 ± 0.161） vs （0.891 ± 0.130） ,（0.949 ± 0.130）g/cm2 ,respectively ,P〈0.05]. The level of PTH increased [（9.96±8.80） vs （7.21±3.98）pmol/L ,P〈0.05]. 25（OH）D3and total body BMD have no significant difference（P〉 0.05）. （4）The rates of OP and osteopenia （41.03% ,47.86% ） in T2DM were higher than those in NC group （26.98% ,33.33% ） （χ2 =4.367 ,4.669 ,P〈0.05）. The duration of diabetes and the levels of HbA1c and PTH were longer or higher in OP group than those with normal BMD or osteopenia （P〈0.05）. （5）Logistic regression analysis showed that BMD negatively correlated with the duration of diabetes ,HbA1c ,and PTH （β= 0.076 ,0.213 ,0.112 ,respectively ,P〈 0.05） ,and positively correlated with 25（OH）D3 （β= -0.043 ,P〈0.05）. Conclusion The values of BMD decreased and the incidence of OP is higher in T2DM patients ,particularly in patients with longer diabetic duration and poor glycemic control.