2型糖尿病患者尿酸与骨密度的相关性

Correlation between serum uric acid and bone mineral density in patients with type 2 diabetes

目的分析2型糖尿病(T2DM)患者骨密度(BMD)变化与血尿酸(SUA)的关系,为T2DM患者防止骨质疏松症的发生提供依据。方法于2013年4月至2014年7月以北京大学人民医院住院的264例T2DM患者为研究对象,男性133例,女性131例,采血测定各项生化指标及骨代谢指标,用双能X线骨密度仪测定患者腰椎、股骨颈及全髋BMD。按SUA水平不同将患者分为尿酸<300μmol/L组(A组)及尿酸≥300μmol/L组(B组)。同时以T值分为3个亚组:骨量正常组(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)。应用SPSS 17.0软件进行统计分析,比较组间各项生化指标、骨代谢指标及BMD的差异并进行相关性分析。结果 A组的腰围、体重、体质指数(BMI)、舒张压(DBP)、甘油三酯(TG)、血清尿素氮、血钙、血肌酐(SCr)、空腹C肽及腰椎1-4、股骨颈及全髋BMD均明显低于B组,而高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和血清抗酒石酸酸性磷酸酶-5b(TRACP-5b)高于B组,差异均有统计学意义(P<0.05,P<0.01)。男性T2DM患者中骨质疏松组的SUA水平[(296±64)μmol/L]低于骨量减少组[(338±71)μmol/L]和骨量正常组[(360±78)μmol/L],差异均有统计学意义(P<0.05)。在校正性别、年龄、BMI及体重等因素影响后,SUA与SCr及腰椎BMD呈正相关(r值分别为0.403、0.139,P<0.01,P<0.05),与骨碱性磷酸酶(BALP)及TRACP-5b呈负相关(r值分别为-0.178、-0.165,P<0.05)。结论监测SUA水平有助于T2DM患者骨质疏松症的筛查,低SUA可能与T2DM患者BMD降低有关。T2DM患者的SUA水平不宜降至过低,以免加重骨量流失。

Objective To analyze the correlation between uric acid（SUA） and bone mineral density（BMD） in type 2 diabetes mellitus（T2DM） patients, and to provide the basis for preventing osteoporosis in T2 DM patients. Methods During April of 2013 to July of 2014, 264 T2 DM patients（133 males and 131 females） served as the subjects. The biochemical and bone metabolism indexes in all subjects were detected. Dual energy X-ray bone density absorptiometry（DEXA） was used to measure the BMD of lumbar, femoral neck and total hip. According to SUA levels, all subjects were divided into group A（SUA 300 μmol/L） and group B（SUA≥300 μmol/L）. Then on the basis of T scores, the subjects were divided into 3 subgroups： normal BMD subgroup（T-1.0 SD）, osteopenia subgroup（-2.5 SDT-1.0 SD） and osteoporosis subgroup（T≤-2.5 SD）. SPSS 17.0 software was used to analyze all data and the correlation. Results The waist, weight, BMI, diastolic pressure（DBP）, triglyceride（TG）,serum urea nitrogen, blood Ca, serum creatinine（SCr）, fasting C-peptide, BMD of L1-4, femoral neck and total hip in group A were significantly lower than those in group B, and HDL-C, LDL-C and TRACP-5b in group A were significantly higher than those in group B（P〈0.05, P〈0.01）. In male T2 DM patients, SUA level（296±64 μmol/L） of osteoporosis subgroup was significantly lower than those（338±71 and 360±78 μmol/L） of osteopenia and normal subgroups（P〈0.05）. After adjustment of gender, age, BMI and weight, the SUA was positively correlated with SCr and BMD of lumbar spine（r values were 0.403, 0.139, respectively;P〈0.01, P 0.05）; but negatively correlated with BALP and TRACP-5b（r values were-0.178,-0.165, respectively; P〈 0.05）.Conclusion Monitoring SUA is helpful to the screening of osteoporosis in T2 DM patients. Low SUA may be related to decreased BMD in T2 DM patients. But too low SUA level may result in bone loss in T2 DM patients.