外源性胰岛素与绝经后2型糖尿病患者腰椎骨密度的相关性研究

Relationship between exogenous insulin and bone mineral density of the lumbar spine in postmenopausal women with type 2 diabetes

目的探讨使用外源性胰岛素对绝经后2型糖尿病(T2DM)患者腰椎骨密度的影响。方法选取2018年3月至2019年8月在武汉科技大学附属孝感医院内分泌科住院的182例肝肾功能正常的绝经后T2DM患者为研究对象。收集患者的一般资料、标准OGTT、IRT及血常规结果。采用双能X线骨密度仪检测腰1-4椎体骨密度,根据T值水平将研究对象分为3组:骨量正常组(T≥-1,n=49)、骨量减少组(-2.5<T<-1,n=67)和骨质疏松组(T≤-2.5,n=66)。结果各组年龄、体质量指数(BMI)、外源性胰岛素使用率比较,差异有统计学意义(P<0.01)。其中骨质疏松组年龄大于骨量正常组和骨量减少组,骨质疏松组BMI小于骨量正常组和骨量减少组,骨质疏松组和骨量减少组外源性胰岛素使用率低于骨量正常组(P<0.05)。相关性分析显示,骨密度与年龄呈负相关,与BMI呈正相关(P<0.01)。有序Logistic回归分析显示,使用外源性胰岛素[OR=2.402,95%CI(1.305~4.419)]和高BMI[OR=1.171,95%CI(1.068~1.283)]是绝经后T2DM患者腰椎骨密度的保护因素,年龄[OR=0.910,95%CI(0.875~0.945)]是绝经后T2DM患者腰椎骨密度的危险因素(P<0.01)。结论绝经后T2DM患者腰椎骨密度与血糖水平、胰岛β细胞功能无显著相关性;外源性胰岛素对绝经后T2DM患者腰椎骨密度的增加有益,其对骨密度的保护作用机制可能与内源性胰岛素不同。

Objective To investigate the effect of exogenous insulin on bone mineral density(BMD)of the lumbar spine in postmenopausal patients with type 2 diabetes mellitus(T2DM).Methods From March 2018 to August 2019 in the endocrinology department of Xiaogan Hospital affiliated to Wuhan University of Science and Technology,182 postmenopausal T2DM patients with normal liver and kidney functions were enrolled.General information of the patients,the result of standard OGTT,IRT,and blood routine test were collected.Dual energy X-ray absorptiometry was used to detect the BMD of lumbar vertebra 1-4.According to the T values,the subjects were divided into three groups:normal bone mass group(T≥-1,n=49),decreased bone mass group(-2.5<T<-1,n=67),and osteoporosis group(T≤-2.5,n=66).Results Age,body mass index(BMI),and utilization rate of exogenous insulin were significantly different between each group(P<0.01).The age in the osteoporosis group was higher than that in the normal bone mass group and the decreased bone mass group,BMI in the osteoporosis group was lower than that in the normal bone mass group and the decreased bone mass group,and the utilization rate of exogenous insulin in the osteoporosis group and the decreased bone mass group was lower than that in the normal bone mass group(P<0.05).Correlation analysis showed that BMD was negatively correlated with age but positively correlated with BMI(P<0.01).Sequential logistic regression analysis showed that exogenous insulin use[OR=2.402,95%CI(1.305,4.419)]and high BMI[OR=1.171,95%CI(1.068,1.283)]were protective factors for BMD of the lumbar spine in postmenopausal T2DM patients.Age[OR=0.910,95%CI(0.875,0.945)]was a risk factor for BMD of the lumbar spine in postmenopausal T2DM patients(P<0.01).Conclusion There is no significant correlation between BMD of the lumbar spine and blood glucose level,islet β-cell function in postmenopausal T2DM patients.Exogenous insulin is beneficial to the increase of BMD of the lumbar spine in postmenopausal T2DM patients,and its protective mechanism of BMD may be different from that of endogenous insulin.