2型糖尿病合并骨质疏松的危险因素分析

Risk Factors for Osteoporosis in Patients with Type 2 Diabetes Mellitus

【目的】探讨2型糖尿病(type 2 diabetesmellitus,T2DM)合并骨质疏松(osteoporosis,OP)的危险因素。【方法】选取T2DM患者417例,采用双能X线骨密度仪测量患者股骨颈和L1-4,椎体的骨密度(BMD),根据其T值分为T2DM合并OP组(T值≤—2.5,207例)和单纯T2DM组(T值>—2.5,210例),同时收集同期健康体检者200例作为正常对照组。比较三组体质量指数(BMI)、糖化血红蛋白(HbAlc)、空腹胰岛素(FINS)、血脂、BMD等指标,分析T2DM合并OP的危险因素。【结果】T2DM合并OP组患者的年龄、糖尿病病程、HbAlc、总胆固醇(TC)高于单纯T2DM组(P<0.05);T2DM合并OP组的高密度脂蛋白胆固醇(HDL-C)、BMD低于单纯T2DM组(P<0.05)。相关性分析显示,HbAlc、TC与股骨颈及L1-4,椎体BMD呈负相关,HDL-C与L1-4,椎体BMD呈正相关(P<0.05)。Logistic回归分析显示:糖尿病病程、HbAlc、TC、HDL-C是T2DM合并OP的独立相关因素(P<0.05)。受试者工作特征曲线结果显示:糖尿病病程>14.51年、HbAlc> 9.32%、HDL-C<1.12mmol/L、TC>5.67mmol/L为预测T2DM患者发生OP的危险因素。曲线下面积均大于0.6。【结论】糖尿病病程延长、高血糖、血脂代谢紊乱是T2DM患者发生OP的独立危险因素。

【Objective】To investigate the risk factors for osteoporosis(OP)in patients with type 2 diabetes mellitus(T2DM).【Methods】A total of 417 patients with T2I)M were selected,and l)one mineral density(BMD)of femoral neck and lumbar s[)ine 14 were measured by dual-energy X ray absorptiometry.According to the T value of BMD,207 patients were divided into T2DM combined with OP group(T valued-2.5,207 cases)and 210 patienls were divided into simple T2DM group(T valued﹥-2.5.210 cases).Meanwhile,200 healthy subjects were enrolled as normal control group.7'hen,the age.course of diabetes mellitus,body mass index(BMI),HbAlc,fasting insulin(FINS),lipid and BMD were compared and analyzed among the three groups.The risk factors for OP in patients with T2DM were evaluated.【Results】Compared to simple T2DM group,the age*course of diabetes mellitus,HbAlc and total cholesterol(TC)were significantly higher(P<0.05).whereas high density lipoprotein cholesterol(HDL-C),BMD were significantly lower in the T2DM combined with OP group(P<0.05).Correlation analysis showed lhat HbAlc and TC were negatively related with BMD of femoral neck and lumbar spine while HDL-C was positively related with BMD of lumbar spine 1-4(P<0.05).In multiple stepwise Logistic regression showed that course of diabetes mellitus,HbAlc,HDL C and TC were independent factors for T2DM combined with OP(P<0.05).The receiver operating characteristic curve showed that the course of diabetes mellitu.s>14.51 years.HbAlc<9.32%,HDL<1.12mmol/L and TC>5.67mmol/L in patients with T2DM increased the risk of OP.The area under curve were more than 0.6.【Conclusion】The extended course of diabetes mellitus,hyperglycemia and abnormal lipid metabolism are independent risk factor for OP in patients with T2DM.