绝经后2型糖尿病患者骨代谢变化及其影响因素分析

Bone metabolic changes and its influencing factors in postmenopausal women with type 2 diabetes mellitus

目的分析绝经后2型糖尿病患者骨代谢变化及其影响因素。方法根据骨密度(bone mineral density,BMD)测定结果,将患者分成骨量正常组(N组)、骨量减少组(T组)及骨质疏松组(O组),收集绝经后2型糖尿病患者临床资料,测定BMD及骨代谢指标,同时监测糖代谢、肝肾功能、激素水平等指标,对绝经后2型糖尿病BMD及骨代谢指标变化及其影响相关因素进行相关分析及回归分析。结果 O组年龄、绝经年限、BMI、Cr、ALP、E_2、BGP、FSH、LH与N组差异有统计学意义(P<0.05);T组年龄、绝经年限、BMI、Cr、E_2、BGP、β-CTX与N组差异有统计学意义(P<0.05)。Pearson相关分析发现,BMD与绝经年限、糖尿病病程、Cr、FSH、LH呈负相关(r为-0.550、-0.262、-0.343、-0.430、-0.497,P值均<0.05),与BMI、E_2呈正相关(r为0.211、0.258,P值均<0.05),与FPG、HbA1c、Ca、ALP、ALT无相关性(P>0.05)。TRAP与年龄、绝经年限、E_2、LH有相关性(r为0.235、0.167、-0.117、0.126,P值均<0.05);β-CTX与年龄、糖尿病病程、绝经年限、E_2、FSH有相关性(r为0.160、0.191、0.117、-0.229、0.196,P值均<0.05),BALP与BMI、绝经年限、E_2、FSH、LH有相关性,(r为-0.190、0.102、0.143、0.120、0.163,P值均<0.05);BGP与年龄、BMI、绝经年限、Cr有相关性(r为0.157、-0.205、0.350,P值均<0.05)。结论绝经后2型糖尿病患者BMD变化与年龄、绝经年限、激素水平、糖尿病病程、BMI、肾功能、遗传因素、生活习惯、营养运动等有关,但是,绝经年限和BMD下降速度相关性尚需进一步明确。

Objective To analysis the bone metabolic changes and its influence factors in postmenopausal women with type 2 diabetes mellitus（ T2DM）. Methods One hundred and twentyfour postmenopausal women with T2DM were erolled in the study. The bone mineral density（ BMD）was measured,and according the results the patients were divided into normal group（ group N,n =40）,osteopenia group（ group T,n = 41） and osteoporosis group（ group O,n = 43）. The bone metabolism indicators,glucose metabolism indicators,liver function,hormone level were determined.The related factors influencing the bone metabolism were examined with Pearson correlation analysis.Results There were significant differences in age,menopausal age,BMI,creatinine（ Cr）,alkaline phosphatase（ AP）,Estradiol（ E2）,bone glaprotein（ BGP）,follicle-stimulating hormone（ FSH）,luteinizing hormone（ LH） between group N and group O; there were significant differences in age,menopausal age,BMI,Cr,E2,BGP,β-Cterminal telopeptide type l collagen（ β-CTX） between group N and group T. Pearson correlation analysis showed that years of menopause,duration of diabetes,Cr,FSH and LH was negatively correlated with BMD（ r =-0. 550,-0. 262,-0. 343,-0. 430,-0. 497,P〈0. 05）,and positively correlated with BMI and E2（ r = 0. 211,0. 258,P〈0. 05）.No significant correlation between BMD decline rate and menopausal years was found by scatter plot method. The correlation between BMD and fasting blood glucose,glycosylated hemoglobin,serum calcium,serum alkaline phosphatase and alanine aminotransferase was not statistically significant（ P〈0. 05）. In addition, tartrade-resistant acid phosphatase was correlated with age, duration of menopause,E2,LH（ r = 0. 235,0. 167,-0. 117,0. 126,P〈0. 05）; β-CTX was correlated with age,course of diabetes,menopausal age,E2,FSH（ r = 0. 160,0. 191,0. 117,-0. 229,0. 196,P〈0. 05）;BALP was correlated with BMI,duration of menopause,E2,FSH,LH（ r =-0. 190,0. 102,0. 143,0. 120,0. 163,P〈0. 05）; BGP was correlated with age,BMI,duration of menopause,creatinine（ r =0. 157,-0. 205,0. 350,P〈0. 05）. Conclusion The BMD changed in postmenopausal T2DM women are related to age,duration of menopause,hormone level,duration of diabetes,body mass index,renal function,genetic factors,living habits,nutrition and other factors.