2型糖尿病患者骨代谢生化指标和钙调激素与骨密度的相关性

Relationship between biochemical markers of bone metabolism and bone mineral density in patients with type 2 diabetes mellitus

目的探讨2型糖尿病患者骨代谢生化指标和钙调激素与骨密度关系。方法选择2015年8月至2016年8月期间泸州市中医医院内分泌科收治的2型糖尿病患者100例为观察组,同期健康体检者100例为对照组。观察组按骨量不同分为3个亚组,甲组为骨密度正常(T值>-1.0SD),乙组为骨量减少(-2.5SD<T值≤-1.0SD),丙组为骨质疏松(T值≤-2.5SD),测定全部受试者骨代谢生化指标和钙调激素指标,采用X线骨密度仪测定骨密度。结果两组受检者24 h尿钙、碱性磷酸酶(ALP)等指标比较差异均无统计学意义(P>0.05),观察组患者血钙、血磷、血镁、25(OH)D3水平分别为(2.21±0.14)mmol/L、(1.12±0.13)mmol/L、(0.80±0.09)mmol/L和(36.72±10.32)nmol/L,均低于对照组的(2.35±0.19)mmol/L、(1.23±0.18)mmol/L、(0.89±0.14)mmol/L与(44.89±18.20)nmol/L,血清甲状旁腺激素(PTH)水平为(8.26±3.45)pmol/L,明显高于对照组的(5.69±1.02)pmol/L,差异均有统计学意义(P<0.05);观察组患者股骨颈、全髋骨密度分别为(0.854±0.140)g/cm2与(0.845±0.112)g/cm2,较对照组的(0.948±0.186)g/cm2与(0.934±0.142)g/cm2明显降低,差异有统计学意义(P<0.05),应用双能X线骨密度仪测定骨密度,甲组14例,占14.0%,乙组47例,占47.0%,丙组39例,占39.0%;三组患者25(OH)D3比较差异无统计学意义(P>0.05);丙组患者糖尿病病程长于甲组和乙组,Hb Alc和PTH水平高于甲组和乙组,差异均有统计学意义(P<0.05)。结论 2型糖尿病患者存在骨代谢紊乱,血清甲状旁腺激素升高,25-羧维生素D3水平和骨密度降低,尤其是糖尿病病程较长、血糖控制较差者比较明显。

Objective To analyze the relationship between serum biochemical markers of bone metabolism and bone mineral density in patients with type 2 diabetes mellitus（T2 DM）.Methods A total of 100 cases of patients with T2 DM,who admitted to Luzhou Hospital of Traditional Chinese Medicine from August 2015 to August 2016,were selected as the observation group.Meantime,100 healthy subjects were selected as the control group.According to the different bone mass,the observation group was divided into 3 sub-groups：group A for normal bone density（T value-1.0 SD）,group B for osteopenia（-2.5 SDT value-1.0 SD）,group C for osteoporosis（T≤-2.5 SD）.The biochemical markers of bone metabolism and calcium regulating hormone index of all subjects were examined,and bone mineral density was measured by X-ray absorptiometry.Results There was no significant difference between the two groups in the indexes such as 24 h uwrinary calcium and alkaline phosphatase（ALP）（P0.05）.The levels of serum calcium,serum magnesium,phosphorus,25-carboxylation of vitamin D3（25（OH）D3） were（2.21±0.14） mmol/L,（1.12±0.13）mmol/L,（0.80±0.09） mmol/L and（36.72±10.32） nmol/L in the observation group,significantly lower than corresponding（2.35±0.19） mmol/L,（1.23±0.18） mmol/L,（0.89±0.14） mmol/L and（44.89±18.20） nmol/L in the control group（P0.05）.The level of parathyroid hormone（PTH） was（8.26±3.45） pmol/L in the observation group versus（5.69±1.02） pmol/L in the control group（P0.05）;the bone density of total hip and femoral neck were respectively（0.854±0.140） g/cm2 and（0.845±0.112） g/cm2 in the observation group versus（0.948±0.186） g/cm2 and（0.934±0.142） g/cm2 in the control group（P0.05）.There were 14 cases in group A（accounting for 14.0%）,47 cases in group B（accounting for 47.0%）,and 39 cases of group C（accounting for 39.0%）;there was no significant difference between the three groups in 25（OH）D3;the diabetes duration in the group C was significantly longer than that in group A and group B（P0.05）;Hemoglobin A1 c（Hb A1 c） and PTH in group C was significantly higher than those of group A and group B（P0.05）.Conclusion There is bone metabolic disorder such as increase of PTH and decrease of 25（OH）D3 and bone mineral density in patients with T2 DM,which is especially prominent in patients with longer duration of diabetes and poor glycemic control.