绝经后2型糖尿病患者新骨骼肌肉减少指数与骨密度的关系

Correlation between new sarcopenia index and bone mineral density in postmenopausal patients with type 2 diabetes mellitus

背景:2型糖尿病合并骨质疏松的患病率逐年增加,骨质疏松的早期预防、早期发现及早期治疗被认为在绝经后2型糖尿病患者中至关重要。目的:探讨绝经后2型糖尿病患者新骨骼肌肉减少指数与骨密度及骨质疏松的相关性。方法:选择2021年1月至2022年3月广州中医药大学第一附属医院收治的绝经后2型糖尿病住院患者,根据是否合并骨质疏松分为骨质疏松组(93例)和非骨质疏松组(121例)。收集患者一般资料及骨密度信息、血常规、糖代谢、脂代谢、肾功能指标等,计算得到新骨骼肌肉减少指数。多因素线性回归分析各临床指标和腰椎、左侧股骨颈和左侧髋部骨密度的相关性,多因素logistic回归分析绝经后2型糖尿病患者骨质疏松的危险因素,受试者工作特征曲线分析新骨骼肌肉减少指数、胱抑素C、肌酐/胱抑素C对绝经后2型糖尿病患者合并骨质疏松的预测效能。结果与结论:①骨质疏松组患者新骨骼肌肉减少指数、胱抑素C、肌酐/胱抑素C均低于非骨质疏松组(P<0.05);②调整协变量后的多因素线性回归显示,肌酐/胱抑素C、新骨骼肌肉减少指数与腰椎、股骨颈及髋部骨密度呈显著正相关(β肌酐/胱抑素C=0.003,0.001,0.002,P<0.05;β新骨骼肌肉减少指数=0.002,0.001,0.002,P<0.05),胱抑素C与腰椎骨密度存在正相关(β胱抑素C=0.09,P<0.05);③调整协变量后的多因素logistics回归显示胱抑素C、肌酐/胱抑素C、新骨骼肌肉减少指数是绝经后糖尿病患者患骨质疏松的保护因素(OR=0.149,0.957,0.941,P<0.05);④新骨骼肌肉减少指数预测绝经后2型糖尿病患者出现骨质疏松的受试者工作特征曲线下面积最大(曲线下面积=0.756),灵敏度为67.8%,特异性为72.0%;⑤提示肾功能和骨骼健康存在内在联系,新骨骼肌肉减少指数升高与绝经后2型糖尿病患者骨密度升高存在相关性,绝经后2型糖尿病患者通过新骨骼肌肉减少指数可及时预测骨质疏松的发生风险。

BACKGROUND:The prevalence of type 2 diabetes mellitus complicated with osteoporosis is increasing yearly.Early prevention,detection,and treatment of osteoporosis are considered essential in postmenopausal patients with type 2 diabetes mellitus.OBJECTIVE:To investigate the correlation of new sarcopenia index(SI)with bone mineral density and osteoporosis in patients with type 2 diabetes mellitus complicated with osteoporosis.METHODS:Postmenopausal patients with type 2 diabetes mellitus hospitalized in the First Affiliated Hospital,Guangzhou University of Chinese Medicine from January 2021 to March 2022 were selected and divided into osteoporosis group(n=93)and non-osteoporosis group(n=121)according to whether type 2 diabetes mellitus is combined with osteoporosis.The demographic data,bone mineral density,blood routine,glucose metabolism,lipid metabolism,and renal function indexes were collected and the SI was calculated.The correlation between clinical indexes and bone mineral density of the lumbar spine,left femoral neck and left hip was analyzed by multivariate linear regression,and the risk factors of osteoporosis in postmenopausal patients with type 2 diabetes mellitus were analyzed by multivariate logistic regression.The predictive values of new SI,serum cystatin C level,and creatinine/serum cystatin C ratio(CCR)in predicting osteoporosis in postmenopausal patients with type 2 diabetes mellitus were analyzed by the receiver operating characteristic curve.RESULTS AND CONCLUSION:(1)The new SI,serum cystatin C level,and CCR value in the osteoporosis group were lower than those in the non-osteoporosis group(P<0.05).(2)Multivariate linear regression analysis with adjusted covariates showed that the new SI and CCR were significantly positively correlated with bone mineral density of the lumbar spine,left femoral neck and left hip(βCCR=0.003,0.001,0.002,P<0.05;βSI=0.002,0.001,0.002,P<0.05).The cystatin C level was significantly correlated with bone mineral density of the lumbar spine(βcystatin C=0.09,P<0.05).(3)Multivariate Logistic regression analysis with adjusted covariates showed that serum cystatin C level,CCR,and new SI were protective factors for osteoporosis in postmenopausal patients with type 2 diabetes mellitus(odds ratio=0.149,0.957,0.941;P<0.05).(4)The area under the receiver operating characteristic curve of the new SI for predicting osteoporosis in such patients was the largest(the area under the curve=0.756),with a sensitivity of 67.8%and a specificity of 72.0%.(5)To conclude,renal function is intrinsically related to bone health.An increased new SI is related to the increase of bone mineral density in postmenopausal patients with type 2 diabetes mellitus,and the risk of osteoporosis can be predicted by the new SI in such patients.