210例绝经后2型糖尿病发生骨质疏松的相关因素

Related factors of osteoporosis in 210 postmenopausal women with type 2 diabetes mellitus

目的探讨绝经后2型糖尿病(T2DM)女性发生骨质疏松(OP)的相关因素,并进一步分析相关因素对OP的预测价值。方法选取绝经后女性T2DM患者337例,根据骨密度结果将患者分为OP组(n=210)和正常骨量组(NBM组,n=127),记录患者的一般资料,检测糖化血红蛋白、肝功、肾功、血脂等指标,应用双能X线骨密度仪测定骨密度。采用SPSS 22.0软件对数据进行统计学分析,对两组一般资料进行比较,采用二分类Logistics回归进行多因素分析,采用Pearson相关分析对绝经时间、初潮年龄和绝经年龄与其他指标的相关性,绘制受试者工作特征曲线(ROC)并计算曲线下面积(AUC),评价多因素回归模型对绝经后T2DM女性患者发生OP诊断预测价值。结果OP组患者的年龄(P<0.001)、糖尿病病程(P<0.001)、初潮年龄(P=0.001)以及患者绝经时间(P<0.001)均高于NBM组,而OP组患者的体质量指数(BMI)低于NBM组(P=0.006),且差异具有统计学意义。二分类Logistics回归结果显示,患者年龄(OR=1.10,95%CI=1.01~1.21,P=0.031)、绝经时间(OR=1.17,95%CI=1.07~1.28,P<0.001)、合并肾病(OR=3.52,95%CI=1.42~8.75,P=0.007)及有钙摄取(OR=11.41,95%CI=4.94~26.34,P<0.001)为患者发生OP的危险因素,而BMI(OR=0.86,95%CI=0.78~0.95,P=0.002)和有习惯性锻炼(OR=0.28,95%CI=0.13~0.60,P<0.001)为保护性因素。以这些变量构建的预测概率分值经ROC曲线分析显示,AUC为0.919,最佳诊断临界值为0.665,诊断效能敏感度为81.3%,特异度为89.8%。结论年龄大、绝经时间长、合并肾病、低BMI及缺乏习惯性锻炼为绝经后T2DM患者发生OP的危险因素。钙摄取与OP风险增加的相关性可能与有OP倾向的女性有意增加钙摄取有关。

Objective To investigate the related factors of osteoporosis(OP)in postmenopausal women with type 2 diabetes mellitus(T2 DM)and to analyze their predictive value.Methods A total of 337 postmenopausal women with T2 DM were selected.According to the results of bone mineral density,the patients were divided into the OP group(n=210)and normal bone mass group(NBM group,n=127).The general data of the subjects were recorded,and indexes such as HbA1 c,liver function,kidney function and blood lipid were detected.The bone mineral density was measured with dual-energy X-ray absorptiometry.SPSS 22.0 software was used for statistical analysis.The general data of the two groups were statistically analyzed.Logistics regression was used for multivariate analysis.Pearson correlation analysis was used to analyze the correlation among menopausal duration,age of menarche,age of menopause and other indicators.Receiver operating characteristic(ROC)curve was drawn and the area under the curve(AUC)was calculated to evaluate the value of multivariate regression model in the diagnosis and prediction of OP.Results The age(P<0.001),duration of diabetes(P<0.001),age of menarche(P=0.001)and menopausal duration(P<0.001)in the OP group were higher or longer than those in NBM group,while the body mass index(BMI)in OP group was lower than that in NBM group(P=0.006).Binary Logistic regression results showed that age(OR=1.10,95%CI=1.01-1.21,P=0.031),menopausal duration(OR=1.17,95%CI=1.07-1.28,P<0.001),complicated nephropathy(OR=3.52,95%CI=1.42-8.75,P=0.007)and calcium intake(OR=11.41,95%CI=4.94-26.34,P<0.001)were risk factors for OP,while BMI(OR=0.86,95%CI=0.78-0.95,P=0.002)and habitual exercise(OR=0.28,95%CI=0.13-0.60,P<0.001)were protective factors.The AUC was 0.919;the optimal diagnostic cut-off value was 0.665;the sensitivity and specificity of diagnostic efficacy were 81.3%and 89.8%,respectively.Conclusion Old age,long menopausal duration,complicated nephropathy,low BMI and lack of habitual exercise are the risk factors for OP in postmenopausal women with T2 DM.The association between calcium intake and increased risk of OP may be related to the intentional increase in calcium intake.