2型糖尿病对绝经后骨质疏松患者发生骨折的影响及预测因素分析

Effect of Type 2 Diabetes on Fracture in Postmenopausal Patients with Osteoporosis and Analysis of Predictive Factors

目的评估2型糖尿病是否作为绝经后骨质疏松患者发生骨折的危险因素,探讨选取的预测2型糖尿病患者发生骨折的指标的应用价值。方法选取2015年1月—2016年1月于我院住院及门诊诊断绝经后骨折疏松的184名患者作为研究对象,将2型糖尿病合并绝经后骨质疏松患者92名作为研究组,将无合并2型糖尿病的绝经后骨质疏松患者92名作为对照组。随访2年后对两组患者进行骨质疏松性骨折发生率进行分析。比较两组骨转换率指标(N-MID、TRAP、P1NP)、骨密度的差异,通过COX回归分析比较两组人群的2年新发骨折风险,以新发骨折为因变量,新发骨折距离随访时间为时间变量,以糖尿病分组为自变量,对年龄、绝经年限、既往骨折史等可能危险因素进行COX回归分析。结果 (1)对研究组与对照组之间基线资料进行比较,两组在年龄、绝经年限、BMI、ALT、CRE、ALP、Ca、P、N-MID的比较上差异无统计学意义(P> 0. 05);研究组的TRAP、P1NP、BMD水平低于对照组且差异有统计学意义(P <0. 05)。(2)对研究组血糖水平与骨转换水平进行相关性分析,发现无论校正与否,均呈负相关关系。校正年龄、绝经年限后,血糖水平和骨密度呈显著性正相关。糖尿病病程与骨密度呈显著负相关,经年龄和绝经年限校正后显著性消失。(3)研究组在2年的观察期中发生新发骨折12例(13. 0%),高于对照组(4例,4. 3%),两组比较有统计学差异(P=0. 032)。COX回归分析显示研究组的总新发骨折风险高于对照组(HR=1. 786～2. 160,P=0. 034～0. 045)。以研究组新发骨折为因变量,以年龄、糖尿病病程、绝经年限、BMI、ALT、CRE、ALP、Ca、P、NMID、TRAP、P1NP、BMD为自变量,进行逐步Logistic回归分析,最后显示糖尿病病程、绝经年限、BMD三者的OR均大于1,P <0. 05,与新发骨折发生呈正相关,可作为危险因素。结论 2型糖尿病是绝经后骨质疏松骨折的高危因素之一,2型糖尿病的骨折高风险可能和骨转换水平受抑制有关,因此,可以通过测定2型糖尿病患者的骨转化指标,可能早期发现骨折的高危患者,并通过选择合适的抗骨质疏松药物及早实现骨折的防治。

Ojbective To evaluate whether type2diabetes is a risk factor for fracture in postmenopausal osteoporosis patients and to explore the application value of selected indicators to predict fracture in type2diabetes patients.Methods From January2015to January2016,184patients with postmenopausal fracture and osteoporosis diagnosed in our hospital and outpatient department were selected as the study subjects.92patients with type2diabetes mellitus with postmenopausal osteoporosis were selected as the study group.92postmenopausal osteoporosis patients without type2diabetes mellitus were selected as the control group.The incidence of osteoporotic fractures in the two groups was analyzed after2-year of follow-up.The difference of bone density and bone turnover rate(N-MID,TRAP,P1NP)were compared between the two groups.The2-year risk of new fractures was compared between the two groups by COX regression analysis.The new fracture was taken as the dependent variable,and the new fracture distance follow-up time was taken as the time variable.COX regression analysis was performed on age,menopause years,previous fracture history and other possible risk factors with diabetes as independent variables.Results①Baseline data were compared between the type2diabetes group and the non-diabetic group.There was no statistically significant difference between the two groups in age,menopause duration,BMI,ALT,CRE,ALP,Ca,P,n-mid(P>0.05).The TRAP,P1NP,BMD level of type2diabetes group is lower than that of non-diabetic group and statistically significant(P<0.05).②The correlation between blood glucose level and bone transformation level in type2diabetes group was analyzed.After adjusting for age and menopause,there was a significant positive correlation between blood glucose level and bone density.The course of diabetes mellitus was negatively correlated with bone density and after adjusting for age and menopause,significant disappeared.③12new fractures(13.0%)occurred in the type2diabetes group during the2year observation period,higher than4cases(4.3%)in the non-diabetic group,and there was a statistically significant difference between the two groups(P=0.032).COX regression analysis showed that the total risk of new fractures was higher in the type2diabetes group than in the non-diabetic group(HR=1.786-2.160,P=0.034-0.045).In type2diabetes mellitus group of new fractures as the dependent variable,with age,duration of diabetes,menopause age,BMI,ALT,CRE,ALP,Ca,P,N-MID,TRAP,P1NP,BMD as independent variables,stepwise Logistic regression analysis,the final showed that duration of diabetes duration of menopause and BMD of the OR were greater than1(P<0.05),and new bone fractures were positively correlated,can be used as a risk factor.Conclusion Type2diabetes is one of the high risk factors for postmenopausal osteoporosis fracture.The high risk of fracture in type2diabetes may be related to inhibition of bone turnover level.Therefore,by measuring bone turnover markers in type2diabetic patients,it is possible to identify high-risk patients with fractures at an early stage.And choose appropriate anti osteoporosis drugs to achieve early prevention and treatment of fractures.