老年2型糖尿病代谢综合征患者骨质疏松危险因素研究

Risk factors for osteoporosis in patients with metabolic syndrome in old people with type 2 diabetes mellitus

目的探索老年2型糖尿病(type 2 diabetes mellitus,T2DM)代谢综合征患者骨质疏松的危险因素。方法纳入首都医科大学宣武医院内分泌科≥60岁的2型糖尿病代谢综合征患者301例,测定糖化血红蛋白(hemoglobin A1c,HbA1c)、空腹胰岛素(fasting insulin,FINS),维生素D、血脂、C反应蛋白(C-reactive protein,CRP)、白细胞介素-6(interleukin-6,IL-6),计算体质量指数(body mass index,BMI)。并进行骨密度(bone mineral density,BMD)、四肢骨骼肌肌肉质量(appendicular skeletal muscle mass,ASM)及握力测定,分析骨质疏松的危险因素。结果老年2型糖尿病代谢综合征患者骨质疏松组BMI、维生素D、骨骼肌肌肉质量指数(appendicular skeletal muscle mass index,ASMI),握力显著低于骨质疏松组(P<0.05)。多元Logistic回归分析显示,女性、低握力显著增加骨质疏松的风险(分别为OR=2.85,P<0.001;OR=2.34,P=0.034),高BMI显著降低骨质疏松风险(OR=0.84,P<0.001)。结论女性、低握力是老年2型糖尿病代谢综合征患者骨质疏松独立的危险因素,BMI为其保护因素。

Objective To explore the risk factors for osteoporosis in patients with metabolic syndrome in old people with type 2 diabetes mellitus.Methods A total of 301 old people with metabolic syndrome and type 2 diabetes aged more than 60 years-old were included in the study.Levels of hemoglobin A1c(HbA1c),fasting insulin(FINS),vitamin D,blood lipid,serum C-reactive protein(CRP)and interleukin-6(IL-6)were measured.Body mass index(BMI)was calculated.Furthermore,bone mineral density(BMD),skeletal muscle mass and grip strength were assessed.The risk factors for osteoporosis were evaluated.Results Compared with people without osteoporosis,people with osteoporosis had lower levels of BMI,vitamin D,skeletal muscle mass index and grip strength(P<0.05).In a multiple stepwise Logistic analysis,being female and lower grip strength were associated increased risk of osteoporosis(OR=2.85,P<0.001;OR=2.34,P<0.001,respectively),while higher BMI was associated with decreased risk of osteoporosis(OR=0.84,P<0.001).Conclusion Being female and lower grip strength were independent risk factors for osteoporosis in patients with metabolic syndrome in old people with type 2 diabetes mellitus,while higher BMI was a protective factor.