男性2型糖尿病并阻塞性睡眠呼吸暂停低通气综合征患者骨密度的改变

The change of bone mineral density in type 2 diabete with obstructive sleep apnea hypopnea syndrome patients

目的通过测定2型糖尿病(T2DM)并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者骨密度及骨代谢指标的变化,了解两种疾病与骨质疏松的关系。方法选取2015年10月-2016年10月在我院就诊的男性T2DM并行多导睡眠仪监测(PSG)检查的患者47例,根据呼吸暂停低通气指数(AHI)分为单纯T2DM(TM)组20例、T2DM并OSAHS(TO)组27例,并选取20例健康男性人群作为正常对照组。记录所有受试者一般资料,测定空腹血糖(FPG)、糖化血红蛋白(Hb A1C)、血脂及骨代谢指标血清钙(Ca)、磷(P)、碱性磷酸酶(ALP)、总Ⅰ型前胶原氨基端延长肽(TPINP)及其特异序列β-骨胶原交联(β-CTX)的浓度,并应用双能X线骨密度仪测定受试者腰椎(L1-4)及左侧股骨颈(FN)骨密度(BMD)。结果与正常对照组比较,TM组、TO组FBG、Hb A1C、TC、TG、LDL-C、TPINP、β-CTX水平增高,L1-4、FN BMD降低,差异具有统计学意义(P<0.05);与TM组比较,TO组Hb A1C、TC、LDL-C、β-CTX水平增高,L1-4、FN BMD降低,差异具有统计学意义(P<0.05)。结论 T2DM患者有发生骨质疏松的风险,若合并OSAHS则糖脂代谢紊乱更严重、骨转换增加及骨密度下降更明显,发生骨质疏松的风险也显著提高。

Objective By studying the change of bone mineral density in type 2 diabete(T2 DM) with obstructive sleep apnea hypopnea syndrome(OSAHS) patients,to explore the relationship between T2 DM,OSAHS and osteoporosis. Methods According to the AHI,47 male type 2 diabete patients were divided into two groups:T2 DM with non OASHS(TM,AHI <5 times/h,n =20) and T2 DM with OASHS(TO,AHI ≥5 times/h,n =27),20 healthy males as control. The general information of patients were recorded.Fasting blood glucose(FPG),glycosylated hemoglobin(Hb A1 C),blood lipid and bone metabolism index of serum calcium(Ca),phosphorus(P),alkaline phosphatase(ALP),procollagen amino terminal peptide(TPINP) and its specific sequence of beta CrossLaps(β-CTX) were measured. Bone mineral density of L1-4 and femoral neck(FN) were determinated by dual energy X-ray absorptiometry(DEXA). Results Compared with the control group,TM and TO groups had higher levels of FBG,Hb A1 C,TC,TG,LDL-C,TPINP,β-CTX and lower BMD of L1-4 and FN. Compared with the TM group,TO group had higher levels of Hb A1 C,TC,LDL-C,β-CTX and lower BMD of L1-4 and FN. Conclusion T2 DM patients have the risk of suffering from osteoporosis. If combined with OSAHS,they will have more serious glucose and lipid metabolism disorder,higher bone turnover and lower bone mineral density,which will cause higher risk of suffering from osteoporosis.