2型糖尿病患者不同骨量状态与代谢指标及并发症的相关性

Correlation analysis of different bone mass status with metabolic indexes and complications in patients with type 2 diabetes

目的分析2型糖尿病(type 2 diabetes,T2DM)患者不同骨量状态与代谢指标及并发症的相关性。方法选取2020年1月至2021年11月赣州市人民医院收治的390例T2DM患者为研究对象,根据世界卫生组织(World Health Organization,WHO)推荐标准评估T2DM患者的骨量状态,分为骨量正常组、骨量减少组、骨质疏松组;测量患者的血糖、血脂、骨代谢标志物等生化代谢指标,重点观察不同骨量状态与β胶原降解产物(β-crossLaps,β-CTX)、总Ⅰ型前胶原氨基端延长肽(N-terminal propeptide of typeⅠprocollagen,PⅠNP)等代谢指标的相关性;记录T2DM患者的并发症发生情况,并分为发生组与未发生组,分析骨量状态与并发症的相关性。结果390例T2DM患者经评估,158例患者骨量正常,144例骨量减少,88例骨质疏松;骨质疏松组患者的高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)、血肌酐(serum creatinine,Scr)、碱性磷酸酶(alkaline phosphatase,ALP)、糖化血红蛋白(glycosylated hemoglobin,HbA1c)、骨钙素(osteocalcin,OC)、甲状旁腺激素(parathyroid hormone,PTH)、β-CTX、PⅠNP水平均高于骨量减少组和骨量正常组,尿酸(uric acid,UA)水平低于骨量减少组和骨量正常组(P<0.05);T2DM患者的骨量状态与HDL-C、ALP、HbA1c、OC、PTH、β-CTX、PⅠNP指标均呈负相关(r<0,P<0.05),与UA呈正相关(r=0.405,P<0.05);有135例患者发生并发症;发生组患者的骨质疏松、骨量减少比例高于未发生组,骨量正常比例低于未发生组(P<0.05);经Logistic回归分析结果显示,T2DM患者骨量状态与并发症发生有关(P<0.05)。结论T2DM患者不同骨量状态与代谢指标及糖尿病大血管、微血管并发症有关,且患者骨量越少,微血管与大血管并发症发生率越高。

Objective To analyze the correlation between different bone mass status and metabolic indexes and complications in patients with type 2 diabetes mellitus(T2DM).Methods 390 patients with T2DM who were admitted to Ganzhou People’s Hospital from January 2020 to November 2021 were selected as the study subjects.The bone mass status of T2DM patients was evaluated according to the standards recommended by the World Health Organization(WHO),and they were divided into normal bone mass group,osteopenia group and osteoporosis group;The blood glucose,blood lipid,bone metabolism markers and other biochemical metabolic indicators of all patients were measured,and the relationship between different bone mass status andβ-crossLaps(β-CTX),N-terminal propeptide of typeⅠprocollagen(PⅠNP)and other metabolic indicators;The complications of T2DM patients were recorded and the correlation between bone mass and complications was analyzed.Results According to the evaluation of 390 patients with T2DM,158 patients had normal bone mass,144 patients had osteopenia,and 88 patients had osteoporosis;The levels of high-density lipoprotein cholesterol(HDL-C),serum creatinine(Scr),alkaline phosphatase(ALP),glycosylated hemoglobin(HbA1c),osteocalcin(OC),parathyroid hormone(PTH),β-CTX and PⅠNP of osteoporosis group were higher than those of osteopenia group and normal bone mass group,and uric acid(UA)was lower than those of osteopenia group and normal bone mass group(P<0.05);Bone mass status of T2DM patients and HDL-C,ALP,HbA1c,OC,PTHβ-CTX and PⅠNP were negatively correlated(r<0,P<0.05),and positively correlated with UA(r=0.405,P<0.05);According to the evaluation of 390 patients with T2DM,135 patients had complications;The proportion of patients with osteoporosis and osteopenia in complication group was higher than that in non-complication group,and the proportion of normal bone mass was lower than that in non-complication group(P<0.05);Logistic regression analysis showed that the bone mass status of T2DM patients was related to complications(P<0.05).Conclusion The different bone mass status of T2DM patients is related to metabolic indicators and macrovascular and microvascular complications of diabetes,and the smaller the bone mass,the higher the incidence of microvascular and macrovascular complications.