不同体质量指数2型糖尿病患者骨转换指标、骨密度及骨折发生的关系

Bone turnover markers,bone mineral density,and fractures in type 2 diabetes mellitus patients with different body mass indexes

目的了解不同体质量指数(body mass index,BMI)2型糖尿病(type 2 diabetes mellitus,T2DM)患者的骨转换指标、骨密度及骨折情况。方法回顾2006-2018年在上海市第一人民医院骨质疏松专病门诊初次就诊且已确诊T2DM,同时资料齐全、符合纳入标准的患者,共1422例(其中男性199例,女性1223例)。据世界卫生组织(World Health Organization,WHO)推荐中国成年人肥胖诊断标准,根据BMI分为4组:BMI<18.5 kg/m2为消瘦组,18.5 kg/m2≤BMI<24 kg/m2为正常组,24 kg/m2≤BMI<28 kg/m2为超重组,BMI≥28 kg/m2为肥胖组。采用回顾性分析记录所有研究对象的一般资料、血清生化及骨转换指标(bone turnover marker,BTM)、骨密度(bone mineral density,BMD)、骨折史等临床资料。结果与正常组相比,消瘦组Ⅰ型胶原羧基端肽(type 1 collagen carboxy terminal peptide,β-CTX)增高,超重组及肥胖组均降低,差异有统计学意义(均P<0.05);消瘦组血清骨钙素(bone gla protein,BGP)增高,肥胖组降低(均P<0.05);消瘦组L1-4、股骨颈、全髋BMD降低(均P<0.05),而超重组和肥胖组增高(均P<0.05)。与消瘦组相比,正常组、超重组及肥胖组β-CTX、BGP明显降低,L1-4、股骨颈、全髋BMD显著增高,差异有统计学意义(均P<0.05)。BMI与β-CTX(r=-0.120,P=0.000)、BGP(r=-0.104,P=0.000)呈负相关,与P(r=0.061,P=0.023)呈正相关;与L1-4BMD(r=0.283,P=0.000)、股骨颈BMD(r=0.249,P=0.000)、全髋BMD(r=0.337,P=0.000)呈正相关。T2DM患者中女性(OR=1.869,P=0.009)、年龄(OR=1.018,P=0.014)、BMI(OR=1.084,P=0.000)均是骨折发生的危险因素,而L1-4 BMD(OR=0.361,P=0.027)及全髋BMD(OR=0.085,P=0.012)是骨折的保护性因素。结论在肥胖T2DM患者中BMD可能会低估其骨折风险,因此在预测T2DM患者骨折风险方面不仅要参考骨密度情况,还需全面考虑其他影响因素,如性别、年龄、BMI等,以便对患者进行综合的评估及管理。

Objective To investigate the bone turnover markers,bone mineral density(BMD),and fractures in type 2 diabete mellitus(T2DM)patients with different body mass indexes(BMI).Methods Totally 1422 patients(199 males and 1223 females)were selected according to the inclusion criteria who had been diagnosed with T2DM in Shanghai General Hospital between 2006 and 2018.According to the diagnostic criteria for obesity in Chinese adults recommended by World Health Organization(WHO),subjects were divided into four groups according to BMI:BMI<18.5 kg/m2 as emaciated group,18.5 kg/m2≤BMI<24 kg/m2 as normal group,24 kg/m2≤BMI<28 kg/m2 as overweight group,and BMI≥28 kg/m2 as obese group.Retrospective statistical analyses were performed for basic clinical characteristics,bone turnover markers,bone mineral density(BMD),and fractures data.Results(1)β-CTX was higher in the emaciated group and lower in the overweight group and the obese group than that of the normal group(all P<0.05).BGP was higher in the emaciated group and lower in obese group than that of the normal group(all P<0.05).BMD at lumbar spine,femoral neck,and hip were lower in the emaciated group,but higher in the overweight group and the obese group than that of the normal group(all P<0.05).Compared with the emaciated group,there were a significant decrease inβ-CTX and BGP and increase in BMD in the normal group,the overweight group and the obese group(all P<0.05).BMI was negatively correlated withβ-CTX(r=-0.120,P=0.000)and BGP(r=-0.104,P=0.000),and positively correlated with P(r=0.061,P=0.023).BMI was also positively correlated with the BMD of L1-4(r=0.283,P=0.000),femoral neck(r=0.249,P=0.000),and hip(r=0.337,P=0.000).In T2DM patients,female(OR=1.869,P=0.009),age(OR=1.018,P=0.014),BMI(OR=1.084,P=0.000)were risk factors for fracture,however,the BMD of L1-4(OR=0.361,P=0.027)and hip(OR=0.085,P=0.012)were protective factors for fracture.Conclusion BMD may underestimate the fracture risk in obese T2DM patients.Therefore,we should not only refer to BMD,but also consider other factors such as gender,age,and BMI in predicting the fracture risk,so as to conduct comprehensive evaluation and management of T2MD patients.