促甲状腺激素水平与老年2型糖尿病患者骨密度的相关性研究

The association of thyrotropin level with bone mineral density in elderly type 2 diabetic patients

目的探讨老年2型糖尿病患者血清促甲状腺激素水平对骨代谢的影响及临床意义。方法选取172例甲状腺激素水平正常的老年2型糖尿病(2DM)患者,采用双能X线骨密度仪进行腰椎L1-4骨密度测量,按T值分为骨量正常组(NC)和骨量减少/骨质疏松组(OP)。记录各组患者年龄、性别、身高、体重,计算体重指数(BMI),检测空腹血糖(FPG)、糖化血红蛋白(Hb A1c)、25羟维生素D3(25-OH-D3),N端骨钙素(NMID)、I型胶原羧基末端肽β特殊序列(βCTX)、I型前胶原羧基末端肽(PICP)、促甲状腺激素(TSH)水平。结果与NC组相比,OP组TSH、BMI偏低,差异有统计学意义(P<0.05)。骨代谢指标中,OP组I型胶原羧基末端肽β特殊序列(βCTX)明显高于NC组(P<0.01),而I型前胶原羧基末端肽(PICP)明显低于NC组(P<0.01)。BMD与TSH、BMI呈正相关。多元逐步回归结果提示,TSH和BMI是腰椎骨密度的主要影响因素。结论老年2型糖尿病患者骨密度与TSH水平密切相关,TSH水平偏低的老年2型糖尿病患者更容易发生骨密度的降低。

Objective To explore the correlation between bone mineral density（BMD） and thyrotropin（TSH） level in elderly patients with type 2 diabetes.Methods One hundred and seventy-two elderly patients with type 2 diabetes whose thyroid stimulating hormone（TSH） level in normal range were chosen from hospitalized patients in our endocrinology department.BMDs of lumbar spine 1-4（L1-4） were measured by dual energy X-ray absorptiometry（DXA）.According to the levels of T score,the patients were divided into two groups：normal BMD group（NC） and osteopenia/osteoporosis group（OP）.The data of all cases were collected,including age and gender,height,weight and body mass index（BMI）.The levels of serum fasting glucose,glycosylated hemoglobin（HbA1c）,bone metabolic markers and TSH were measured.Results Compared with the NC group,TSH and BMI were lower in the OP group（P 〈0.05）.The level of β-C-terminal telopeptides of type I collagen（βCTX） in the OP group was higher than that of the NC group（P 〈 0.01）.The level of type I procollagen carboxyl-terminal peptide（PICP） was lower than that of the NC group（P 〈 0.01）.BMD was positively associated with TSH and BMI.Multiple stepwise regression analysis revealed that TSH and BMI were the main factors that influenced BMDs of lumbar spine.Conclusion BMD is closely related to the level of TSH in elderly type 2 diabetic patients,and patients with lower TSH levels are more likely to have low BMD.