胰岛素抵抗与2型糖尿病合并骨质疏松发生骨折风险的相关性研究

Study on the correlation between insulin resistance and fracture risk in type 2 diabetes mellitus patients with osteoporosis

目的探讨2型糖尿病(type 2 diabetes mellitus,T2DM)合并骨质疏松患者发生骨折风险与胰岛素抵抗(insulin resistance,IR)之间的相关性。方法前瞻性纳入2015年6月至2017年6月在重庆市第九人民医院内分泌科就诊的T2DM患者,经骨密度测定诊断为骨质疏松症。根据随访结果,分为骨折组(A组)和无骨折对照组(B组)。收集患者一般信息,按照稳态模型评估公式计算胰岛素抵抗指数,根据IR指数进一步将IR患者分为高、中、低IR三个亚组。入院行骨代谢指标血清Ⅰ型前胶原N末端前肽(PINP)和Ⅰ型胶原羧基端β降解产物(β-CTX)检测,根据身高、体重计算体质量指数(bone mass index,BMI),同时记录随访期间再发骨折的不良事件。结果 A、B两组各纳入患者47例和110例,骨折发生率为29. 93%。A组患者血糖、IR的发病率和HOMA-IR值均显著高于B组(P<0. 05),且两组骨代谢指标PINP和β-CTX值存在明显差异(P<0. 05)。各IR亚组分析发现随着HOMA-IR值逐渐升高,血糖水平和骨折发生率也随之增高(P<0. 05);高HOMA-IR值患者PINP值明显降低(P <0. 05),但β-CTX值在各IR组中差异并不明显(P> 0. 05)。进一步相关性分析发现骨折发生率与HOMA-IR值呈正相关(r=0. 372,P=0. 009),与PINP值呈负相关(r=-0. 015,P<0. 001)。结论 IR是T2DM合并骨质疏松患者发生骨折的危险因素,这一结果为此类患者的临床治疗提供了新思路。

Objective To investigate the relationship between insulin resistance and fracture risk in type 2 diabetes mellitus(T2DM)patients with osteoporosis. Methods From June 2015 to June 2017,T2DM patients with osteoporosis detected by bone densitometry in the Department of Endocrinology of our hospital were prospectively enrolled. The patients were divided into fracture group(Group A)and non-fracture control group(Group B) according to follow-up result. The patients’ general information was collected. HOMA-IR index was calculated by adopting the homeostatic model assessment formula,and the patients with IR were further divided into three subgroups: the low IR group,middle IR group and high IR group. Serum PINP and β-CTX,which are bone metabolism index,were detected at admission. BMI value was calculated using weight and height. Simultaneously,adverse events of secondary fractures were recorded during follow-up. Results There were 47 and 110 patients included in Group A and Group B,respectively,of which the total fracture incidence was 29. 93%. Blood glucose level,IR morbidity and HOMA-IR value were significantly increased in Group A compared with those in Group B(P<0. 05). Furthermore,there were also significant differences in bone metabolism index,PINP andβ-CTX values between these two groups(P<0. 05). The IR subgroup analysis showed that with the increase of HOMA-IR value,blood glucose level and incidence rate of new fracture were increased(P< 0. 05). PINP value in patients with higher HOMA-IR decreased significantly(P<0. 05),but β-CTX value showed no statistically significant difference in all the IR subgroups(P > 0. 05). Further correlation analysis showed that fracture rate was positively correlated with HOMA-IR value(r = 0. 372,P = 0. 009),but negatively correlated with PINP value(r =-0. 015,P<0. 001). Conclusion IR could be considered as a risk factor for new fracture in T2DM patients with osteoporosis,which provides new ideas for the treatment of these patients.