男性2型糖尿病患者骨密度与性激素指标的关系

Relationship Between Bone Mineral Density and Sex Hormones in Male Patients with Type 2 Diabetes

目的探讨男性2型糖尿病患者骨密度(bone mineral density,BMD)与性激素水平的关系。方法本研究回顾性分析89例男性2型糖尿病患者临床资料。采用双能X线骨密度仪检测腰椎、股骨颈BMD,根据BMD分为骨量正常组(n=54)和骨量异常组(n=35)(包括骨量减少及骨质疏松)。使用酶联免疫吸附法(enzyme-linked immunosorbent assay, ELISA)测定两组患者的血清雌二醇(estradiol, E_(2))、睾酮(testosterone, T)、游离睾酮(free testosterone, FT)、黄体生成素(luteinizing hormone, LH)、卵泡刺激素(follicle stimulating hormone, FSH)水平,测定糖化血红蛋白(glycosylated hemoglobin, HbA1c)、空腹血糖(fasting blood glucose, FBG)、餐后2h血糖(postprandial blood glucose, PBG)、甘油三酯(triglycerides, TG)、总胆固醇(total cholesterol, TC)、低密度脂蛋白(low density lipoprotein, LDL)、高密度脂蛋白(high density lipoprotein, HDL)、体质量指数(body mass index, BMI)并进行比较。结果与骨量正常组相比,骨量异常组BMI更低,E_(2)、T、FT,股骨颈及腰椎BMD水平显著降低(P<0.05)。Pearson相关分析显示FSH水平与股骨颈及腰椎BMD呈负相关(P<0.01),E_(2)、T及FT与股骨颈及腰椎BMD呈正相关(P<0.01)。多元线性回归分析显示E2、T及FT是腰椎及股骨颈BMD的保护因素。结论 E_(2)、T、FT、BMI等指标与男性2型糖尿病患者BMD相关,在男性2型糖尿病患者中性激素水平异常者更易发生骨质疏松。

Objective To explore the correlations between bone mineral density(BMD) and sex hormones in male patients with type 2 diabetes mellitus. Methods A total of 89 male patients with type 2 diabetes mellitus were retrospectively analyzed. The BMD of lumbar spine and femoral neck were measured by dual energy X-ray absorptiometry. The patients were divided into normal bone mass group(n=54) and abnormal bone mass group(n=35,including bone mass loss and osteporosis) according to BMD results. Serum levels of estradiol(E2), testosterone(T), free testosterone(FT), luteinizing hormone(LH) and follicle stimulating hormone(FSH) of patients in two groups were measured by enzyme-linked immunosorbent assay(ELISA). The glycosylated hemoglobin(HbA1c),fasting blood glucose(FBG), postprandial blood glucose(PBG), triglycerides(TG),total cholesterol(TC),low density lipoprotein(LDL),high density lipoprotein(HDL) and body mass index(BMI) of patients in two groups were measured and cmopared. Results Compared with the normal bone mass group, the BMI, serum levels of E_(2),T,FT and the BMD levels of lumbar spine and femoral neck of the abnormal bone mass group were significantly declined(P<0.01). Pearson correlation analysis revealed that FSH was negatively correlated with the BMD of lumbar spine and femoral neck(P<0.01), E_(2), T and FT were positive correlation with BMD of lumbar spine and femoral neck(P<0.01). Multiple stepwise regression analysis revealed that E_(2), T and FT were the main protective factors of BMD of lumbar spine and femoral neck. Conclusion E_(2), T, FT and BMI are correlate with BMD of male patients with type 2 diabetes mellitus, and those patients with abnormal sex hormone levels are more likely to have osteoporosis.