2型糖尿病患者皮质醇与骨密度的相关性研究

Correlation between cortisol and bone mineral density in type 2 diabetic patients

目的探讨2型糖尿病(T2DM)患者血清皮质醇(Cor)及24 h尿游离皮质醇(UFC)水平对骨密度(BMD)的影响及临床意义。方法选取2017年1—10月于郑州大学第一附属医院内分泌科住院的187例T2DM患者,测定患者髋关节、股骨及腰椎BMD,按T值分为骨量正常组(NC组)和骨量减少/骨质疏松组(OP组)。记录各组患者性别、年龄、糖尿病病程、身高及体质量,计算体质量指数(BMI),检测空腹血糖(FBG)、餐后2 h血糖(PPG)、糖化血红蛋白(Hb A1c)、血钙磷等生化指标及骨代谢指标,分别于8、16点抽血检测血清Cor,留24 h尿检测UFC。比较两组间各指标;采用Pearson或Spearman分析两个变量的相关性;应用多重线性逐步回归分析骨密度的影响因素。结果 (1)OP组患者的糖尿病病程长于NC组、BMI小于NC组、PPG水平高于NC组,差异有统计学意义(P <0. 05)。两组性别、年龄、FBG、Hb A1c、血钙、血磷比较,差异无统计学意义(均P> 0. 05)。(2)OP组N-MID水平高于NC组,差异有统计学意义(P <0. 05)。两组PTH、Total-PINP、25-(OH) D3、CROSS比较,差异无统计学意义(均P> 0. 05)。OP组股骨颈、Wards三角、髋关节、L1～L4的BMD低于NC组,差异有统计学意义(均P <0. 05)。(3)OP组24 h UFC水平高于NC组,差异有统计学意义(P <0. 05)。两组8、16点Cor比较,差异无统计学意义(均P> 0. 05)。(4)股骨颈BMD与BMI呈正相关(r=0. 169,P=0. 021),与糖尿病病程、PPG、N-MID、24 h UFC呈负相关(r=-0. 244、-0. 161、-0. 278、-0. 204,P=0. 001、0. 028、0. 000、0. 005)。全髋BMD与BMI、25-(OH) D3呈正相关(r=0. 176、0. 156,P=0. 016、0. 033),与糖尿病病程、PPG、Total-PINP、N-MID、CROSS、24 h UFC呈负相关(r=-0. 231、-0. 177、-0. 159、-0. 315、-0. 155、-0. 253,P=0. 001、0. 015、0. 030、0. 000、0. 035、0. 000)。腰椎BMD与BMI呈正相关(r=0. 148,P=0. 043),与糖尿病病程、N-MID呈负相关(r=-0. 175、-0. 275,P=0. 016、0. 000)。(5)多重线性逐步回归分析结果显示,糖尿病病程、25-(OH) D3、NMID及24 h UFC是全髋BMD的主要影响因素。结论 T2DM患者BMD与24 h UFC水平密切相关,与血清Cor水平无关,24 h UFC水平偏高的T2DM患者更易发生骨质疏松。

Objective To investigate the effect of serum cortisol（Cor） and 24-hour urinary free cortisol （UFC） on bone mineral density （BMD） in patients with type 2 diabetes mellitus （T2DM） and its clinical significance.Methods One hundred and eighty-seven patients with T2DM were selected in Department of Endocrinology in the First Affiliated Hospital of Zhengzhou University from January of 2017 to October of 2017. BMD of hip joint, femur and lumbar vertebra were measured. According to the level of T score, the patients were divided into two groups,named normal BMD group（NC）and osteopenia / osteoporosis group（OP）. The data of all cases were collected, including gender, age, duration of diabetes, height, weight and body mass index（BMI）. The biochemical indexes and bone metabolism markers were measured respectively, such as fasting blood glucose （FBG）, 2-hour postprandial blood glucose （PPG）, glycated hemoglobin （HbA1c）, blood calcium and phosphorus and so on. The blood samples to detect serum cor wered collected at 8 and 16, and collect 24-hour urine to observe 24-hour urinary free cortisol. The indexes of the two groups were compared respectively. Pearson or Spearman correlation analysis was used to analyze the correlation between the two variables, and multiple linear stepwise regression was used to analyze the influencing factors of bone mineral density.Results The duration of diabetes in group OP was longer than that in group NC, while BMI was lower and the level of PPG was higher, and the differences were statistical significance（all P 〈 0.05）. There were no statistical significant differences in gender, age, FBG, HbA1c, blood calcium and blood phosphorus between the two groups （all P 〉 0.05）. The level of N-MID in group OP was higher than that in group NC, and the difference was statistical significance （ P 〈 0.05）. There were no statistical significant differences in PTH, Total-PINP, 25- （OH） D 3 and CROSS between the two groups （all P 〉 0.05）. In group OP, the BMD of femoral neck, wards triangle, hip joint and L 1 to L 4 were lower than those in group NC, and the differences were statistical significance（all P 〈 0.05）. The level of 24 h UFC in group OP was higher than that in group NC, and the difference was statistically significant （ P 〈 0.05）. There was no statistical significant difference between the two groups in 8 and 16 Cor （ P 〉 0.05）. The BMD of femoral neck had positive correlation with BMI （ r =0.169, P =0.021）, which was negatively correlated with the course of diabetes, PPG, N-MID, and 24 h UFC（ r =-0.244、-0.161、-0.278、-0.204, P =0.001、0.028、0.000、0.005）. The BMD of total hip had positive correlation with BMI and 25- （OH）D 3 （ r =0.176, 0.156, P = 0.016, 0.033）,which was negatively correlated with the course of diabetes, PPG, Total-PINP, N-MID, CROSS, 24-hour UFC（ r =-0.231、-0.177、-0.159、-0.315、-0.155、-0.253, P =0.001、0.015、0.030、0.000、0.035、0.000）. The BMD of lumbar spine had positive correlation with BMI （ r =0.148, P =0.043）, which was negatively correlated with diabetic course and N-MID （ r =-0.175, -0.275, P =0.016, 0.000）.Multiplelinear stepwise regression analysis showed that the duration of diabetes, 25-（OH）D 3, N-MID and 24-hour UFC were the main influencing factors of total hip BMD.Conclusion BMD in T2DM patients is closely related to the level of 24 h UFC, but not to serum Cor. Patients with the higher level of 24 h UFC are more likely to develop osteoporosis.