2型糖尿病患者促甲状腺激素与骨质疏松关系的研究

The association between thyrotropin level and osteoporosis in patients with type 2 diabetes

目的研究2型糖尿病患者中骨密度(BMD)与促甲状腺激素水平的关系,探讨2型糖尿病中骨质疏松的可能危险因素。方法收集西安市中心医院内分泌科2017年1月至2018年5月住院的2型糖尿病患者151例,其中男性79例,女性72例。测定一般生化指标、甲状腺功能及骨代谢指标,双能X线骨密度仪测定BMD。对比不同性别之间非骨质疏松(non-OP)及骨质疏松(OP)患者上述指标的差异;Pearson相关分析法分析腰椎及股骨颈BMD与各临床指标之间的关系,多因素logistic回归分析方法探索不同性别组2型糖尿病患者骨质疏松的可能危险因素。结果 1.男性2型糖尿病患者中,non-OP组FT_3较OP组明显升高,女性2型糖尿病患者组OP患者TSH明显高于对照组,BMI明显低于对照组(P<0.05);2.女性腰椎及股骨颈BMD均与TSH负相关(r=-0.290及-0.239 P<0.05),男性BMD与TSH无相关性,无论男女,股骨颈BMD与年龄呈负相关(r=-0.242及-0.363 P<0.05)、与BMI呈正相关(r=0.263及0.469 P<0.05); 3.多因素logistic回归分析示,TSH是女性2型糖尿病患者骨质疏松的主要影响因素(OR=2.581, 95%CI 1.210-5.504,P=0.014。结论 2型糖尿病患者中,随着年龄的增大和BMI的降低骨质疏松发生的风险增高;女性2型糖尿病患者中TSH升高是OP发生的主要危险因素。

Objective To investigate the relationship between osteoporosis and thyrotropin level and the potential risk factors of osteoporosis in patients with type 2 diabetes mellitus(T2DM).Methods 151 patients(79 males and 72 females)with T2DM in our hospital were selected.BMD of the lumbar spine 1-4(L1-4)and the femoral neck of all the patients were detected using dualenergy X-ray absorptiometry.In different gender group according to the T score,patients were divided into OP group and non-OP group.The differences of general condition and biochemical parameters between the OP group and non-OP group were compared.Pearson correlation analysis was used to analyze the relationship between BMD and clinical indicators.Logistic regression analysis was used to explore the possible risk factors of osteoporosis.Results 1)In male group,FT3 of non-OP patients was higher than that of OP patients(P<0.05).In the female group there were significant differences in BMI and TSH between OP group and non-OP group(P<0.05).2)Pearson correlation analysis showed that in female group both lumbar spine and femoral neck BMD were negatively correlated with TSH.Both in men and women,femoral neck BMD was negatively correlated with age(r=-0.242 and-0.363,P<0.05),and positively correlated with BMI(r=0.263 and 0.469,P<0.05).3)Multivariate logistic regression analysis showed that TSH was the main influencing factor of osteoporosis in female patients with type 2 diabetes(OR=2.581,95%CI 1.210-5.504,P=0.014).Conclusion In patients with type 2 diabetic,with the increase of age and decrease of BMI,the risk of osteoporosis increases.In elderly females with type 2 diabetic patients,BMD is closely related to the level of TSH.The patients with higher TSH level are more likely to have low BMD.