2型糖尿病绝经后女性患者经皮氧分压与骨密度的关系

The relationship between transcutaneous oxygen pressure and bone mineral density in postmenopausal women with type 2 diabetes mellitus

目的探讨2型糖尿病绝经后女性经皮氧分压水平与骨密度(bone mineral density,BMD)的关系,进一步了解微循环对糖尿病骨密度的影响。方法本横断面研究共纳入162例绝经后2型糖尿病患者。通过双能X射线吸收测定法评估其腰椎、髋部、右侧股骨颈、Ward’s三角区、股骨大转子及转子内骨密度。根据T-Score值分为3组:骨质疏松组(T≤-2.5)、骨量减低组(-2.5<T<-1.0)和骨量正常组(T≥-1.0)。Perimed PeriFlux System 5000检测双侧膝下及足背经皮氧分压水平,经皮氧分压是微血管病变的主要检测手段。比较3组间的一般特征,应用Pearson分析骨密度与经皮氧分压之间的关联,多元逐步回归分析骨密度的影响因素。结果骨质疏松组TcPO_(2)、ABI水平低于骨量正常组(40.09 vs.47.89,1.06 vs.1.17,P<0.05)。TcPO_(2)与腰1至腰4、股骨颈、股骨大转子、转子内、总髋及Ward’s三角区BMD呈正相关,r分别为0.259、0.215、0.226、0.217、0.213、0.226。校正年龄、病程、BMI、绝经年限后,TcPO_(2)与腰椎骨密度仍呈正相关。多元逐步回归分析,TcPO_(2)、BMI和年龄是腰椎骨密度的独立影响因素,TcPO_(2)、BMI、Ca和绝经年限是股骨颈的独立影响因素。结论2型糖尿病绝经后女性骨质疏松患者TcPO_(2)、ABI降低,TcPO_(2)下降可能是糖尿病骨密度降低的独立影响因素。

Objective To investigate the relationship between transcutaneous oxygen pressure and bone mineral density(BMD)in postmenopausal women with type 2 diabetes,and to further understand the influence of microcirculation in BMD.Methods A total of 162 postmenopausal patients with type 2 diabetes were included in this cross-sectional study.BMD of the lumbar spine,hip,right femoral neck,Ward’s triangle,femoral trochanter,and intertrochanter was evaluated with dual-energy X-ray absorptiometry.According to the T score values,the patients were divided into three groups:osteoporosis group(T≤-2.5),bone loss group(-2.5<T<-1.0),and normal bone mass group(T≥-1.0).Perimed PeriFlux System 5000 was used to detect the transcutaneous partial pressure of oxygen of the bilateral knee and the dorsum of the foot,respectively.Transcutaneous partial pressure of oxygen was the primary detection method for microvascular lesions.The general characteristics of the three groups were compared.The correlation between BMD and transcutaneous oxygen partial pressure was analyzed with Pearson correlation coefficient analysis.The influencing factors of BMD were analyzed with multiple stepwise regression.Results The levels of TcPO_(2) and ABI in postmenopausal women with osteoporosis were lower than those in the healthy BMD group(40.09 vs.47.89,1.06 vs.1.17,P<0.05).TcPO_(2) was positively correlated with BMD at the lumbar spine,femoral neck,femoral trochanter,intertrochanter,total hip,and Ward's triangle(r=0.259,0.215,0.226,0.217,0.213,0.226,respectively).After adjusting for age,course of the disease,BMI,and menopausal years,TcPO_(2) was still positively correlated with BMD of the lumbar spine.Multiple stepwise regression analysis showed that TcPO_(2),BMI,and age were independent influencing factors of lumbar BMD,while TcPO_(2),BMI,calcium,and menopausal years were independent influencing factors of the femoral neck BMD.Conclusion Levels of TcPO_(2) and ABI decrease in type 2 diabetic postmenopausal women with osteoporosis.The decline in TcPO_(2) may be an independent influencing factor affecting the reduction in BMD in these patients.