骨小梁评分在2型糖尿病患者中评价骨质量的应用

Trabecular bone score as an indicator for bone quality assessment in patients with type 2 diabetes mellitus

目的探讨骨小梁评分(trabecular bone score,TBS)在评价2型糖尿病患者骨质量中的应用。方法回顾性分析128例2型糖尿病患者和64例非糖尿病患者的腰椎骨密度(bone mineral density,BMD)图像,通过骨小梁评分软件(TBS i Nsight software)计算得出骨小梁评分,分析两组患者的骨密度、骨小梁评分差异,并分析骨小梁评分和骨密度、年龄、体重的关系。结果和非糖尿病组相比,2型糖尿病患者组腰椎BMD升高(0.9103±0.1742 vs 0.8382±0.1422,P=0.005),TBS降低(1.2787±0.122 vs 1.3166±0.1016,P=0.033),在排除年龄、体重、骨密度的干扰后差异依然有统计学意义(P=0.008);相关性分析方面发现TBS和年龄呈负相关(r=-0.395,P<0.001),和体质量指数呈负相关(r=-0.270,P<0.001);TBS和腰椎BMD呈正相关,非糖尿病患者比糖尿病患者的相关性更强(r=0.563,P<0.001 vs r=0.766,P<0.001)。结论在2型糖尿病患者中骨小梁评分降低,这和2型糖尿病患者骨折风险增高的事实相符合,骨小梁评分可能成为评估2型糖尿病患者骨质量的指标。

Objective This study aimed to evaluate the ability of lumbar spine trabecular bone score(TBS)to assess bone quality in T2DM patients.Methods In this retrospective cross-sectional study,bone mineral density(BMD)of the lumbar spine was measured in 128 T2DM patients and 64 non-T2DM patients using DXA.TBS was calculated by examining pixel variations within the DXA images using TBS iNsight software.The differences of BMD and TBS between the two groups were analyzed.The correlation between TBS and BMD,age,and body weight was also analyzed.Results Compared with that in patients without T2DM,lumbar spine BMD increased(0.9103±0.1742 vs 0.8382±0.1422,P=0.005),and lumbar spine TBS decreased(1.2787±0.122 vs 1.3166±0.1016,P=0.033)in patients with T2DM.After adjusting data for BMI,age,and BMD,a significant difference was also observed in lumbar spine TBS(P<0.001).The correlation analyses showed that TBS was negatively correlated with age(r=-0.395,P<0.001)and BMI(r=-0.270,P<0.001),but was positively correlated with BMD.The association was weaker in T2DM patients than in non-T2DM patients(r=0.563,P<0.001 vs r=0.766,P<0.001).Conclusion The decreased lumbar spine TBS in T2DM patients is consistent with the high fracture risk in these patients.TBS may assist the assessment of the bone quality in T2DM patients.