微血管病变对2型糖尿病患者骨代谢影响的研究

Effect of microangiopathy on bone metabolism in patients with type Ⅱ diabetes mellitus

目的:分析探讨微血管病变对于2型糖尿病患者骨代谢的影响。方法:将就诊的150例2型糖尿病患者作为研究对象,根据患者是否出现糖尿病微血管病变(神经病变、眼病及肾病)将其分成合并糖尿病微血管病变的研究组(78例)和不合并糖尿病微血管病变的对照组(72例)。采用生化检验方法对两组患者的空腹血糖(FBG)、血清总碱性磷酸酶(TALP)、果糖胺(GSP)及血钙(Ca^(2+))指标进行测定;采用RIA法对两组患者的骨钙素(BGP)进行测定;采用DEXA法对两组患者的腰椎和髋部骨密度进行测定;结合两组患者身高和体重情况,计算其体重指数(BMI)。结果:研究组和对照组患者的GSP、BMI、TALP、FBG和Ca^(2+)指标水平对比均未见显著差别;研究组患者的血清BGP水平(3. 03±1. 43) ng/ml显著低于对照组(5. 67±2. 21) ng/ml,差异具有统计学意义(P <0. 05);研究组患的第2～4腰椎以及股骨颈、股骨大转子以及Ward's三角区的骨密度均低于对照组,差异均具有统计学意义(P <0. 05)。结论:2型糖尿病微血管病变可严重影响患者骨代谢情况,显著降低患者骨形成,加速骨质疏松进程,并可显著降低患者的髋部以及腰椎BMD情况。

Objective To investigate the effect of microangiopathy on bone metabolism in patients with type Ⅱ diabetes mellitus. Method 150 patients with type 2 diabetes mellitus were selected as the research object and divided into study group with diabetic microangiopathy( 78 cases) and control group without diabetic microangiopathy( 72 cases) according to whether the patient has diabetic microangiopathy( neuropathy,ophthalmopathy and nephropathy). The fasting blood glucose( FBG),serum total alkaline phosphatase( TALP),fructosamine( GSP) and serum calcium( Ca^2+) were measured by biochemical test,the osteocalcin( BGP) was measured by RIA,and the bone mineral density( BMD) of lumbar vertebrae and hip was measured by DEXA. Height and weight were calculated,and body mass index( BMI) was calculated. Results There was no significant difference in the levels of GSP,BMI,TALP,FBG and Ca2+between the study group and the control group,and the levels of BGP( 3. 03 ± 1. 43) ng/ml in the study group were significantly lower than those in the control group( 5. 67 ± 2. 21) ng/ml( P <0. 05). The BMD of sub and Ward’s triangle were lower than that of the control group( P < 0. 05). Conclusion Diabetic microangiopathy Ⅱ can severely affect bone metabolism,significantly reduce bone formation,accelerate osteoporosis,and significantly reduce BMD in the hip and lumbar spine.