糖尿病合并骨质疏松症致病因素相关性分析

Correlation among the risk factors of diabetes mellitus complicated with osteoporosis

目的探讨糖尿病合并骨质疏松症患者骨密度(BMD)变化、骨代谢指标与血糖浓度的关系,观察不同浓度的葡萄糖对人成骨细胞代谢状态的影响。方法收集2010年1月至2015年12月福建省立医院住院的356例糖尿病患者的临床资料。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。按空腹血糖(FBG)浓度将患者分为<14 mmol/L组(A组)及≥14 mmol/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)。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组的体重指数(BMI)、三酯甘油(TG)、胆固醇(TC)、FBG、糖化血红蛋白(Hb A1c)及腰椎1-4、股骨颈及全髋BMD均明显高于B组,差异均有统计学意义(均P<0.05)。男性糖尿病患者中骨质疏松组ALP水平为(3.21±0.22)mmol/L,低于骨量减少组[(3.75±0.24)mmol/L]和骨量正常组[(4.31±0.14)mmol/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,FBG与腰椎BMD呈负相关(r值为-0.403,P<0.05),与骨碱性磷酸酶(NBAP)及骨钙素(BGP)呈负相关(r值分别为-0.178、-0.165,P<0.05)。结论监测血脂、BMD、Ca2+、Hb A1C、FBG、ALP和BGP水平有助于糖尿病患者骨质疏松症的筛查,高FBG可能与糖尿病患者BMD降低有关。糖尿病患者FBG>14 mmol/L时加重骨量流失。血糖浓度越高,成骨细胞分泌ALP和BGP的代谢活性下降。

Objective To analyze the relationship between bone mineral density （BMD） changes, bone metabolism indexes and blood glucose concentration in diabetic patients with osteoporosis, and observe the effect of different concentrations of glucose on the metabolism of human osteoblasts. Methods From January of 2010 to December of 2015, 356 diabetes patients （180 males and 178 females） were collected 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 FBG levels, all subjects were divided into group A （FBG〈14 mmol/L） and group B （FBG〉14 mmol/L）. ＂Ihen on the basis ofT scores, the subjects were divided into 3 subgroups： normal BMD subgroup（T〉-1.0 SD）, osteopenia subgroup （ -2.5 SD〈T〈-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 BMI, triglyceride（TG）, cholesterol（TC）, HbAlc, BMD of L 1-4, femoral neck and total hip in group A were significantly higher than those in group B （respectively, P〈0.05）. In male diabetes patients, ALP level [ （3.21 ± 0.22） mmol/L] of osteoporosis subgroup was significantly lower than that [（3.75± 0.24） mmol/L and （4.31 ± 0.14） mmol/L] of osteopenia and normal subgroups（P〈0.05）. After adjustment of gender, age, BMI and weight, the FBG was negatively correlated with SCr and BMD of lumbar spine （r values were -0.403, P〈0.05）, and negatively correlated with ALP and NBAP （r values were -0.178 and -0.165, P〈0.05）. Conclusion Blood lipid, BMD, Ca^2＋, HbA1C, monitoring FBG, ALP and BGP is helpful to the screening of osteoporosis in diabetes patients. Higher FBG may be related to decreased BMD in diabetes patients. The higher the blood glucose concentration, the lower the metabolism of ALP and BGP secreted by osteoblasts.