2型糖尿病周围神经病变患者振动感觉阈值和骨质疏松的相关性研究

Correlation Between Vibrating Perception Threshold and Osteoporosis in Patients with Type 2 Diabetic Peripheral Neuropathy

目的探讨2型糖尿病周围神经病变(DPN)患者振动感觉阈值(VPT)与骨质疏松(OP)之间的关系。方法选取2012年8月至2014年6月泸州医学院附属医院内分泌科确诊的2型糖尿病(T2DM)患者共230例,根据症状、体征和实验室检查,分为糖尿病周围神经病变组(DPN组,n=56)和非神经病变组(NDPN组,n=174),测定两组患者腰椎1-4(L1-4)、股骨颈、股骨大转子和wards三角骨矿密度(BMD),并比较分析VPT与L1-4、股骨颈、股骨大转子、wards三角BMD以及血钙(Ca2+)﹑踝肱指数(ABI)等指标的相关性。同时,根据BMD将所有研究对象分为单纯T2DM组(non-OP组,n=142)和T2DM合并OP组(OP组,n=88例),比较各组DPN的患病率及VPT变化趋势。采用logistic回归法,分析T2DM患者发生OP的危险因素。结果 DPN组VPT明显高于NDPN组,L1BMD、L2BMD、L3BMD、L4BMD、L1-4BMD、股骨颈BMD、股骨大转子BMD和wards三角BMD明显低于NDPN组(P<0.05或P<0.01)。相关分析显示,DPN组患者VPT与年龄、收缩压(SBP)和糖化血红蛋白(HbA1c)呈正相关(P<0.05或P<0.01),与Ca2+、L1BMD、L2BMD、L3BMD、L4BMD、L1-4BMD、股骨颈BMD、股骨大转子BMD和wards三角BMD呈负相关(P<0.05或P<0.01)。多元逐步回归分析显示,年龄、HbA1c和Ca2+是影响T2DM患者VPT水平的独立相关因素。OP组DPN的患病率和VPT水平明显高于non-OP组(P<0.01)。logistic回归分析显示,年龄和VPT是预测T2DM患者OP发病的危险因素。结论 DPN患者VPT水平与腰椎、髋部BMD密切相关,Ca2+代谢紊乱、增龄、高血糖、高血压可能是DPN和OP之间共同的发病机制和危险因素。早期测定T2DM患者VPT水平并采取措施干预,有利于早期防治或延缓DPN和OP的发生发展。

Objective To investigate the correlation between vibrating perception threshold（VPT）and osteoporosis（OP）in patients with type 2diabetic peripheral neuropathy（DPN）.Methods 230 type 2diabetes mellitus（T2DM）patients treated in Affiliated Hospital of Luzhou Medical College from August of 2012 to June of2014 were selected and divided into two groups according to the symptoms,signs and results of the lab examination,which were DPN group（56cases）and NDPN group（174cases）.Dual energy X-ray absorptiometry was used to measure the bone mineral density of lumbar spine（L1-4）,femoral neck,greater trochanter,and wards.The correlation analysis and multiple regression analysis methods were employed to analyze the correlation of vibrating perception threshold（VPT）with L1-4BMD,hip BMD,calcium（Ca2＋）,ankle brachial index（ABI）.Meanwhile,all the T2 DM patients were divided into two groups：simple T2 DM group（non-OP group,142cases）and T2 DM combined with OP group（OP group,88cases）according to the bone mineral density（BMD）,and the incidence of DPN and the VPT trends in each group were compared respectively.Binary logistic regression analysis was adopted to analyze the risk factors of OP in T2 DM patients.Results Compared with that in NDPN group,VPT in DPN group was significantly increased,and L1 BMD,L2 BMD,L3 BMD,L4 BMD,L1-4BMD and hip BMD decreased significantly（P0.05 or P0.01）.Correlation analysis showed that VPT was correlated positively with age,systolic blood pressure（SBP）and glycosylated hemoglobin（HbA1c）（P〈0.05 or P〈0.01）,but negatively with Ca2＋,L1 BMD,L2BMD,L3 BMD,L4BMD,L1-4BMD and hip BMD（P0.05 or P0.01）.Multiple regression analysis revealed that age,HbA1 cand Ca2＋were independent factors of influencing VPT in T2 DM patients.The prevalence rate of DPN and the VPT levels were significantly higher in OP group than in non-OP group（P〈0.01）.Binary logistic regression analysis found that age and VPT were independent risk factors for predicting OP in T2 DM patients.Conclusion The VPT levels in DPN patients were closely correlated with BMD of the lumbar spine and hip.DPN and OP patients may share common pathogenesis and risk factors such as metabolic disorders of Ca2＋,aging,hyperglycemia and hypertension.Early measurement and intervention of VPT levels can prevent or delay the occurrence and development of DPN and OP in T2 DM patients.