不同体重指数的社区男性2型糖尿病患者骨代谢与胰岛素抵抗的相关性研究

Relationship between bone metabolism and insulin resistance in male type 2 diabetes mellitus patients from community with different body mass indexes

目的探讨不同体重指数（BMI）的社区男性2型糖尿病（T2DM）患者骨代谢与胰岛素抵抗的相关性。方法根据BMI值将82例北京朝阳社区男性T2DM患者分为肥胖组、超重组及正常组，分别进行生化及骨转换指标检测、胰岛素-C肽释放试验及骨密度（BMD）检查，采用胰岛素抵抗指数（HOMA-IR）、胰岛素作用指数（IAI）、胰岛素分泌指数（IS）评价其胰岛功能并进行比较分析。结果3组患者年龄、腰围、WHR、总睾酮（TT）、TC、HDL-C、TG、FPG、腰椎及全髋BMD比较差异均有统计学意义（P〈0．05）。在肥胖组患者中，HOMA—IR与血清钙呈正相关（P=0．017），与骨钙素（BGP）呈负相关（P=0．020）；IAI与腰椎BMD呈正相关（P=0．002）；IS与血清钙呈正相关（P=0．021），与BGP、β-胶原降解产物（β—CTX）呈负相关（P=0．015、P=0．038）；FINS与血清钙呈正相关（P=0．046）；餐后2h胰岛素与25（OH）D呈负相关（P=0．035）；空腹C肽与I型胶原氨基末端肽（P1NP）呈正相关（P=0．035），与全髋及股骨颈BMD呈负相关（P〈0．001、P=0．002）；餐后2hc肽与P1NP呈正相关（P=0．002），与25（OH）D、全髋及股骨颈BMD均呈负相关（P=0．039、P〈0．001、P=0．001）；HblAc与BGP呈负相关（P=0．042）。Logistic回归分析结果显示，LDL—C升高是BMD减低的危险因素（OR=2．117，95％CI1．106—4．050，P=0．024），而BMI增加为其保护因素（OR=0．810，95％C10．665～0．987，P=0．037）。结论不同BMI社区男性T2DM患者的BMD有明显差异，胰岛素抵抗及血糖控制情况可影响其骨代谢，而高BMI为其BMD减低的保护因素。

Objective To investigate the relationship between bone metabolism and insulin resistance in male T2DM patients from community with different BMI. Methods Eighty-two male patients with T2DM were divided into obesity group, overweight group and normal group based on their BMI. The biochemical indicators,bone tunlover markers,insulin and C peptide releasing test and BMD were examined. HOMA-IR, IAI and IS were used to evaluate the islet function. Results Age,waist,WHR,TF,TC,HDL-C,TG,FPG and BMD of lumbar and total hip were significantly different among 3 groups （P 〈 0. 05）. In obesity group ,positive correlations were found between HOMA-IR and serum Ca （P = 0. 017 ） , IAI and BMD of lumbar（ P = 0. 002）, IS and serum Ca （ P = 0. 021 ）, FINS and serum Ca （ P = 0. 046 ）, fasting C-peptide and N-propeptide of type 1 collagen（ P1NP,P = 0. 035 ）, postprandial C-peptide and P1 NP （ P = 0. 002）. Negative correlations were found between HOMA-IR and BGP （ P = 0.020）, IS and BGP （ P = 0.015 ） , IS and β-CTX （ P = 0.038 ）, postprandial insulin and 25 （OH） D （ P = 0. 035 ）, fasting C-peptide and BMD of total hip（P 〈 0, 001） and femoral neck （P = 0. 002）, postprandial C-peptide and 25 （OH） D （P = 0. 039 ） ,postprandial C-peptide and BMD of total hip（ P 〈 0. 001 ） and femoral neck（ P = 0. 001 ） , HbA1 c and BGP（ P = 0. 042）. Logistic regression analysisshowed that, LDL-C increasing was a risk factor （ OR = 2. 117,95 % CI 1. 106-4.050, P = 0.024 ） and BMI increasing was a protective factor （ OR = 0. 810, 95 % CI 0. 665-0. 987, P = 0. 037 ） of BMD decreasing. Conclusion In male T2DM patients with different BMI, BMD are significantly different. Insulin resistance and blood glucose control affect bone metabofism. High BMI is a protective factor for BMD decreasing.