甲状腺功能正常的2型糖尿病患者促甲状腺激素水平与骨密度的相关性

Association between thyroid stimulating hormone and bone mineral density in type 2 diabetes patients with normal thyroid function

目的探讨甲状腺功能正常的2型糖尿病(T2DM)患者促甲状腺激素(TSH)与骨密度(BMD)的相关性。方法选取男性T2DM患者400例,根据双能X线骨吸收(DXA)测定的BMD结果,将T2DM患者分为3组:骨量正常组136例,骨量减少组157例,骨质疏松组107例。收集其空腹血样本用于血糖、血脂、肾功能、Hb A1c、TSH等检测结果。结果与骨量正常组相比,骨量减少组和骨质疏松组患者血清TSH水平、L1~L4 BMD和全髋BMD均降低,且骨质疏松组低于骨量减少组,差异均有统计学意义(P <0. 05);Pearson相关分析提示L1~L4 BMD和全髋BMD与血清TSH水平呈正相关;Logistic回归分析提示,血清TSH水平是骨量异常的独立影响因素(P <0. 05)。结论在甲状腺功能正常的T2DM患者中,血清TSH水平与BMD密切相关,TSH可能参与骨质疏松的发生发展。

Objective To explore the relationship between thyroid stimulating hormone( TSH) and bone mineral density( BMD)in type 2 diabetes( T2 DM) patients with normal thyroid function. Methods 400 patients with T2 DM were divided in three groups according to the results of dual energy X-ray absorptiometry: the normal group( n = 136),the osteopenia group( n =157) and the osteoporosis group( n = 107). Glucose,lipid profile,renal function,Hb A1 c,and TSH were determined in all patients. Results Compared with the normal group,patients in osteopenia group and the osteoporosis group had lower BMI,serum TSH level,BMD of L1-L4 and BMD of total hip,with the difference statistically significant( P < 0. 05). Patients in the osteoporosis group had lower serum TSH level,BMD of L1-L4 and BMD of total hip than the osteopenia group( P < 0. 05). Pearson correlation analysis showed that BMD of L1-L4 and BMD of total hip were positively correlated with serum TSH level. Logistic analysis showed that serum TSH level was an independent factor for osteopenia or osteoporosis( P < 0. 05). Conclusion Serum TSH level is significantly correlated with BMD,and TSH may participate in the pathology and development of osteoporosis.