2型糖尿病患者骨密度变化及其相关影响因素

Analysis of Bone Mineral Density and Its Related Factors in Patients with Type 2 Diabetes Mellitus

目的:探讨2型糖尿病(T2DM)患者骨密度(BMD)变化以及其相关影响因素。方法:487例T2DM患者为T2DM组、138例健康体检者为对照组,采用双能X线骨密度仪测定所有受试者第1-4腰椎、左侧股骨颈及全髋关节骨密度值,记录骨量及骨质疏松发病率;并按照骨密度检查结果将T2DM组患者分为骨质疏松组、骨量减少组及骨量正常组,比较不同骨密度水平患者一般资料、糖化血红蛋白(HbA1c)、空腹血清C肽、空腹胰岛素、空腹血糖(FBG)、血钙(Ca)、碱性磷酸酶(ALP)、抗酒石酸酸性磷酸酶(TRACP)、肌酐(SCr)、尿素氮(BUN)及胱抑素C(Cys C),对有差异指标采用Pearson相关分析骨密度水平与这些指标的相关性。结果:与对照组相比,T2DM组L1-4、股骨颈及全髋关节的骨密度均显著降低,骨量减少发生率及骨质疏松发病率均增高(P <0. 05); T2DM骨质疏松组及骨量减少组患者的年龄、病程、FBG、TRACP、Cys C均高于骨量正常组,BMI、HbA1c、空腹胰岛素、Ca均低于骨量正常组(P <0. 05);血Scr、BUN值比较,差异无统计学意义(P> 0. 05); Pearson相关性分析显示,T2DM组患者骨密度水平与年龄、病程、HbA1c、血TRACP、Cys C呈负相关,与胰岛功能、血Ca呈正相关(P <0. 05);与BMI、FBG、血ALP、Scr、BUN无明显相关性(P> 0. 05)。结论:T2DM患者较正常人更容易发生骨质疏松,年龄、病程、HbA1c、胰岛功能、TRACP、Ca、Cys C可能是影响其骨密度变化的相关因素。

Objective：To explore the bone mineral density （BMD） and its related factors in patients with Type 2 diabetes mellitus （T2DM）. Methods： 487 patients with T2DM and 138 healthy people during medical examination were respectively devided as the experimental group （T2DM group） and the control group. The bone mineral densities of all subjects were measured by dual-energy X-ray absorptiometry, and their bone density level and the incidence of osteoporosis were recorded. According to the results of bone mineral density examination, patients in T2DM group were divided into the osteoporosis group, the reduction group and the normal group. The correlation between bone density and clinical data of T2DM group was analyzed. Results： Compared with the control group, the BMD of L1-4, femoral neck and total hip in the T2DM group decreased significantly, while the incidence of bone mass reduction and osteoporosis increased （ P〈 0.05）. Among the T2DM group, the age, the course of disease, FBG, TRACP and Cys C of the osteoporosis and reduction groups were all higher than those of the normal group; BMI, HbA1c, fasting insulin and Ca were lower than those of the normal group （ P〈 0.05）; and there was no significant difference in Scr and BUN （ P 〉0.05）. Pearson correlation analysis showed that the bone density level of patients with T2DM was negatively correlated with age, course of disease, while HbA1c, TRACP and Cys C were positively correlated with islet function, serum Ca （ P 〈0.05）. But there was no significant correlation with BMI, FBG, ALP, Scr and BUN （ P 〉0.05）. Conclusion： Patients with T2DM are more likely to develop osteoporosis than normal people. Age, the course of disease, serum HbA1c, pancreatic islet function, TRACP, Ca and Cys C may be the relative factors influencing bone density changes.