2型糖尿病患者冠状动脉钙化与骨代谢指标的相关性研究

Correlation between coronary artery calcification and bone metabolic markers in patients with type 2 diabetes

目的探讨2型糖尿病患者冠状动脉钙化(coronary arterial calcification,CAC)与骨质疏松症指标的相关性。方法根据冠脉钙化积分将200例2型糖尿病患者分成冠脉钙化组和对照组,分别记录一般资料,检测血糖、血脂、钙、磷、碱性磷酸酶(alkaline phosphatase,ALP)、N端中段骨钙素(molecular fragment of osteocalcin N terminal,N-MID)、I型胶原羧基端肽交联(β-cross-linked C-telopeptide of type I collagen,β-CTX)等生化指标,同时进行骨密度(bone mineral density,BMD)和冠脉增强CT等检查,探寻BMD、骨代谢指标与CAC等指标是否存在相关性。在此基础上,进一步对冠脉钙化组患者检测指标进行相关性分析。依据冠脉增强CT结果将受试者分为冠脉狭窄组和无冠脉狭窄组,进一步探讨2型糖尿病患者冠脉狭窄与骨质疏松症的关系。结果冠脉钙化组的年龄、ALP、腰围、体质量指数(body mass index,BMI)、空腹血糖(fasting blood glucose,FBG)高于对照组,差异有统计学意义(P<0.05)。BMD及骨代谢指标组间比较差异无统计学意义(P>0.05)。相关性分析表明,磷、25(OH)D 3、β-CTX、甲状旁腺素(parathyroid hormone,PTH)与腰椎、髋部BMD均为负相关(P<0.05);有无冠心病既往史与腰椎BMD为正相关(P<0.05),绝经年限与腰椎BMD为负相关(P<0.05);年龄、绝经年限、收缩压、HDL-C、HOMA-IS与髋部BMD均为负相关(P<0.05)。CAC与各指标的Logistic回归分析表明,冠脉是否钙化与有无冠脉狭窄、有无冠心病既往史、有无颈动脉粥样硬化显著相关(P<0.05)。冠脉狭窄与各指标的Logistic回归分析显示,冠脉是否狭窄与有无冠脉钙化、有无冠心病既往史之间显著相关(P<0.05)。结论冠脉狭窄与腰椎BMD相关,冠脉钙化与冠脉狭窄显著相关;冠脉狭窄、冠心病既往史、颈动脉粥样硬化是冠脉钙化的危险因素,冠脉钙化是冠心病的致病危险因素。2型糖尿病患者控制血糖、防治骨质疏松症的发生或可降低冠心病的发生风险。

Objective To investigate the correlation between coronary arterial calcification(CAC)and osteoporosis in patients with type 2 diabetes.Methods 200 patients with type 2 diabetes mellitus were divided into coronary artery calcification group and control group according to the coronary artery calcification score.General data were recorded,and detected blood glucose,blood lipids,calcium,phosphorus,ALP,N-MID,β-CTX and other biochemical indices.Meanwhile,bone mineral density(BMD)and Coronary artery enhanced CT,to explore whether there is correlation between BMD,bone metabolism indexes and CAC and other indexes,on this basis,correlation analysis of related indexes in patients with coronary artery calcification group was further conducted.According to the result of enhanced coronary CT,the patients were divided into coronary stenosis group and non-coronary stenosis group to further explore the relationship between coronary stenosis and osteoporosis in type 2 diabetes patients.Results Age,ALP,waist circumference,BMI and fasting blood glucose(FBG)in the coronary artery calcification group were higher than those in the control group,and there were statistical differences(P<0.05),but no statistically significant differences in bone mineral density and bone metabolism indexes between the two groups(P>0.05).Correlation analysis:P,25(OH)D 3,β-CTX,PTH were negatively associated with lumbar spine and hip BMD(P<0.05).Previous history of coronary heart disease were positively correlated with lumbar BMD(P<0.05)and menopause years were negatively associated lumbar BMD(P<0.05),while age,menopause years,systolic blood pressure,HDL-C and HOMA-IS were negatively associated with hip BMD(P<0.05).Logistic regression analysis of CAC and each index:Coronary artery calcification was correlated with coronary artery stenosis,history of coronary heart disease and carotid atherosclerosis(P<0.05).Logistic regression analysis of coronary artery stenosis and each index:There was significant correlation between coronary artery stenosis and coronary artery calcification and history of coronary heart disease(P<0.05).Conclusion This study confirmed that coronary artery stenosis is correlated with lumbar BMD,coronary artery calcification is significantly correlated with coronary artery stenosis;Coronary artery stenosis,previous history of coronary heart disease and carotid atherosclerosis were independent risk factors for coronary artery calcification and CAC was independent risk factors for coronary heart disease.Controlling blood glucose and osteoporosis in patients with type 2 diabetes may reduce the risk of coronary heart disease.