老年2型糖尿病患者血糖波动与骨质疏松症

Glucose variability and osteoporosis in elderly type 2 diabetes mellitus patients

目的探讨老年2型糖尿病(T2DM)患者中血糖波动(GV)与骨质疏松症(OP)的相关性。方法 选择首都医科大学宣武医院综合科2019年1月~12月就诊的老年2型糖尿病患者141例,测量患者骨密度(BMD),空腹糖化血红蛋白(HbA1c)及糖化白蛋白(GA),计算糖化白蛋白与糖化血红蛋白比值(GA/HbA1c)。根据BMD将患者分为骨量正常组、骨量减少组及骨质疏松组。比较3组间一般资料以及实验室测定结果,计算年龄、BMI、GA、GA/HbA1c、OC、CTX、P1NP与骨密度的相关性,进行logistic回归分析骨质疏松的独立影响因素。计算GA、GA/HbA1c筛查骨质疏松的诊断价值。结果 骨质疏松组男性比例显著低于骨量正常组及骨量减低组,BMI显著低于骨量正常组,差异有统计学意义(P <0.05)。骨量正常组GA、GA/HbA1c显著低于骨量减少组及骨质疏松组,OC、CTX、P1NP显著低于骨质疏松组,差异有统计学意义(P <0.05)。股骨颈骨密度与年龄表现出明显的负相关(P <0.05)。BMD与BMI表现出明显的正相关(P <0.05)。BMD与GA、GA/HbA1c、OC、CTX、P1NP间表现出明显的负相关(P <0.05)。GA/HbA1c是骨质疏松的独立危险因素(P <0.05)。受试者工作曲线(ROC)曲线分析显示GA/HbA1c的曲线下面积(AUC)为0.777(P <0.05)。结论 老年2型糖尿病患者骨质疏松的发生率较高,GA/HbA1c与老年2型糖尿病患者骨质疏松密切相关,是骨密度降低的重要危险因素,控制血糖波动对防治骨质疏松有积极作用。

Objective To explore the relationship between glycemic variability(GV)and osteoporosis(OP)in elderly type 2 diabetes mellitus patients.Methods A total of 141 elderly type 2 diabetes mellitus patients treated in Department of Geriatric Comprehensive in Xuanwu Hospital Capital Medical University from January 2019 to December 2019 were selected.Measure bone mineral density(BMD),fasting Glycated hemoglobin(HbA1c),fasting Glycated Albumin(GA),the ratio value of Glycated Albumin and Glycated hemoglobin(GA/HbA1c)were calculated.Divided type 2 diabetes mellitus patients into normal group、osteopenia group and osteoporosis group according to BMD.Compare general data,laboratory measurements between three groups,and calculate the correlation between age、BMI、GA、GA/HbA1c、OC、CTX、P1NP and BMD.Logistic regression were used to analyse independent factors influecing osteoporosis.The diagnostic value of GA and GA/HbA1c screening for osteoporosis was calculated.Results Proportion of male in osteoporosis group was significant lower than normal and osteopenia group and BMI was significant lower than normal group.GA、GA/HbA1c in normal group was significant lower than osteopenia and osteoporosis group and OC、CTX、P1NP was significant lower than osteoporosis group(P<0.05)A significant negative correlation appeared between femoral neck BMD and age(P<0.05).A significant positive correlation appeared between BMD and BMI(P<0.05).A significant negative correlation appeared between BMD and GA、GA/HbA1c、OC、CTX、P1NP(P<0.05).Logistic regression analysis showed that GA/HbA1c was an independent risk factor of osteoporosis(P<0.05).Receiver operating characteristic curve(ROC)analysis showed that Area Under the Curve(AUC)was 0.777(P<0.05).Conclusion Elderly type 2 diabetes mellitus patients had high incidence of osteoporosis.GA/HbA1c are closely related to osteoporosist and independently associated with BMD.Controlling blood glucose fluctuations provide positive effects on prevention and treatment of osteoporosis in elderly type 2 diabetes mellitus patients.