2型糖尿病患者骨骼肌量与骨折风险的相关性

Association of lean mass with risk of fracture in type 2 diabetes mellitus

目的探究2型糖尿病患者骨骼肌量与骨折风险的关系。方法选取2014年1月至2015年9月在东南大学附属中大医院内分泌科住院治疗的2型糖尿病患者106例,男性44例,女性62例,平均年龄(58.1±12.9)岁,应用双能X线吸收检测仪(dual energy X-ray absorptiometry,DXA)行体成分分析及骨密度(bone mineral density,BMD)测定,通过问卷调查获取患者基础信息,采用骨折风险预测工具FRAX模型计算患者10年任何重要部位骨质疏松性骨折(major osteoporotic fracture,MOF)概率、髋部骨折(hip fracture,HF)概率,并采用亚洲人骨质疏松自我筛查工具(osteoporosis self-assessment tool for Asians,OSTA)模型计算骨折风险,分析骨折风险、各部位骨密度与四肢和躯干肌肉量、骨骼肌指数(relative skeletal muscle index,RSMI)、全身体脂率、年龄、糖尿病病程、糖化血红蛋白(glycosylated hemoglobin,HbA1c)等指标的相关性。控制性别、年龄、病程、HbA1c及各部位BMD,对骨折风险和身体成分各指标行偏相关分析。结果偏相关结果显示:总体MOF与总肌肉百分比呈正相关(r=0.223);HF与躯干肌肉量、总肌肉量/(身高)2呈负相关(r=-0.240、-0.255),与总肌肉百分比呈正相关(r=0.225)。老年女性患者,MOF与躯干肌肉量、全身总肌肉量、总肌肉量/(身高)2、RSMI呈负相关(r=-0.396、-0.382、-0.443、-0.393);躯干肌肉量、双下肢肌肉量、全身总肌肉量、总肌肉量/(身高)~2、RSMI与HF呈负相关(r=-0.512、-0.436、-0.478、-0.558、-0.446),与OSTA呈正相关(r=0.842、0.688、0.803、0.694、0.574),相关性与总体比较,差异均有统计学意义(均P<0.05)。结论 2型糖尿病患者肌肉量是其骨折风险的影响因素,增加肌肉量、控制血糖水平对2型糖尿病患者骨质疏松及骨折的防治具有重要意义。

Objective To explore association of lean mass with risk of fracture in type 2 diabetes. Methods We detected body composition and bone mineral density （BMD） of 106 patients with type 2 diabetes. All patients aged 40 - 90 years were hospitalized in our hospital from January 2014 to September 2015. We conducted questionnaire and estimated risk of fracture with FRAX and osteoporosis self-assessment tool for Asians （ OSTA） , then analyzed the association between risk of fracture and lumbar BMD, body composition, age, course of diabetes and glyeosylated hemoglobin （HbAlc）. After adjusting gender, age, course of diabetes, HbAlc and BMD, we performed partial correlations between risk of fracture and body composition. Results We found that, for overall, MOF was positively correlated to percentage of lean mass （ r = 0. 223 ）. In addition, probability of hip fracture showed negative correlation with lean mass at trunk, total lean mass/height2 （ r = - 0. 240, - 0. 255 ） ,as well as positive correlation to percentage of lean mass （ r = 0. 225 ）. For elderly women, there were negative correlations between MOF and lean mass at trunk, total lean mass, total lean mass/height2 , relative skeletal muscle index （RSMI） （r= -0.396, -0.382, -0.443, -0.393）; Lean mass at trunk and legs, total lean mass, total lean mass/height2 , RSMI were negatively correlated to hip fracture （HF） risk （ r = - 0. 512, - 0. 436, -0.478, -0.558, -0.446）, while positively correlated to OSTA （r = 0.842, 0.688, 0.803, 0.694,0. 574） （ all P 〈 0. 05）. Conclusion It suggested that muscle mass was one of the predictors of fracture risk, and exercising lean mass was important for prevention of fracture for patients with type 2diabetes.