绝经后2型糖尿病女性患者骨密度与血清促甲状腺激素水平的关系

The relationship between bone mineral density and serum TSH level in postmenopausal women with type 2 diabetes

目的通过测定甲状腺功能正常的绝经后2型糖尿病妇女的骨密度,探讨正常范围内促甲状腺激素(TSH)的水平与骨密度的关系。方法选取在我院内分泌科住院治疗的甲功正常的绝经后T2DM女性患者220例,根据血清TSH水平,以1.60m U/L和2.90 m U/L为界,将入选患者分为3组,即A组(0.27 m U/L^1.60 m U/L)、B组(1.60 m U/L^2.90 m U/L)、C组(2.90 m U/L^4.20 m U/L)。比较各组的一般情况、生化指标、骨密度(BMD)的差异。结果 1与B组相比,A组患者左股骨颈、转子和全髋部BMD降低,差异有统计学意义(P<0.05),而AC、BC两两比较差异无统计学意义(P>0.05,P>0.05);2对于甲功正常的绝经后T2DM女性患者,血清FT3与全髋部BMD呈正相关(r=0.292,P=0.039),TSH、FT4与全髋部BMD无相关(r=0.078,P=0.594;r=-0.043,P=0.771);3校正年龄、绝经年限、BMI后,FT3与全髋部BMD仍呈正相关(r=0.401,P=0.006),TSH、FT4与全髋部BMD仍无相关(r=0.013,P=0.929;r=0.039,P=0.797);4在多元线性回归中,FT3仍与全髋部BMD独立相关(B=0.114,P=0.006)。结论在甲功正常的绝经后T2DM妇女中,低TSH会降低全髋BMD;血清FT3与全髋BMD呈正相关,而TSH、FT4与全髋部BMD无相关。

Objective To investigate the relationship between normal range of thyroid stimulating hormone （TSH） and hip bone mineral density （BMD） in postmenopausal women with type 2 diabetes by BMD test. Methods Two hundred and twenty postmenopausal females with type 2 diabetes were chosen from hospitalized patients in our endocrinology. They were divided into 3 groups according to their levels of serum TSH, group A （0. 27 - 1.60 mU/L）, group B （ 1.60 - 2.90 mU/L）, and group C （2.90 -4. 20 mU/L）. Their general condition, biochemical parameters, and BMD were compared. Results （ 1 ） BMD of the left femoral neck, trochanter, and total hip decreased significantly in group A comparing to that in group B （ P 〈 0.05 ）, while there was no statistical difference between group A and C, and between group B and C （ P 〉 0. 05 ）. （2） For postmenopausal females with type 2 diabetes Who had normal thyroid function, serum FT3 was positively correlated with total hip BMD （ r = 0. 292, P = 0. 039 ）, while there was no correlation between TSH, FT4 and total hip BMD （ r = 0. 078, P = 0. 594 ; r = - 0. 043, P = 0. 771 ）. （3） After adjustment for age, postmenopausal time, and BMI, serum FT3 was still positively correlated with total hip BMD （ r = 0. 401, P = 0. 006） , while there was still no correlation between TSH, FT4 and total hip BMD （ r = 0. 013, P = 0. 929 ; r = 0. 039, P = 0. 797 ）. （4） In the multiple liner regression, FT3 was still associated with total hip BMD independently （B = 0. 114, P = 0.006）. Conclusion Low TSH level decreases total hip BMD in postmenopausal females with type 2 diabetes and normal thyroid function.Serum FT3 is positively correlated with total hip BMD. FT4 and TSH are not correlated with total hip BMD.