老年男性2型糖尿病患者正常范围内甲状腺功能与骨密度的相关性研究

Correlation between normal thyroid function and bone mineral density in elderly male patients with type 2 diabetes mellitus

目的探讨老年男性2型糖尿病(type 2 diabetes mellitus,T2DM)患者正常范围内的甲状腺功能与骨密度(bone mineral density,BMD)及BMD绝对值T值的关系。方法回顾性分析2020年8月—2022年3月于淮安市第一人民医院住院甲状腺功能正常的老年男性T2DM患者226例(设为T2DM组)的临床资料,同期年龄匹配的体检健康男性49例设为对照组。记录并比较2组DXA测得的脊柱L 1-4、左侧股骨颈、全髋BMD以及BMD绝对值T值,分析各部位BMD、绝对值T值与促甲状腺激素(TSH)及其他临床指标的关系。结果T2DM组全髋BMD与BMI、血清TSH水平正相关(P<0.05),全髋BMD绝对值T值与年龄、HDL负相关,与TSH、BMI正相关(P<0.05),股骨颈BMD绝对值T值与BMI、TSH水平成正性相关(P<0.05)。对照组各部位骨密度仅与BMI呈正性相关(P<0.05)。正常范围内的TSH是老年男性T2DM患者全髋BMD的独立保护因素(B=0.146,P=0.034),FT4、FT3、CHOL、HDL等因素与骨密度无独立相关性。结论老年男性T2DM患者TSH水平(正常范围内)与髋部整体BMD及股骨颈、髋部BMD绝对值T值呈正相关性;在此类患者群体中,TSH指标在正常范围内可能成为髋部BMD的独立保护因素。

Objective To investigate the relationship between normal thyroid function and bone mineral density(BMD),as well as BMD absolute T-value,in male patients with type 2 diabetes mellitus(T2DM).Methods The clinical data of 226 elderly male T2DM patients with normal thyroid function admitted to First People s Hospital of Huai an City from August 2020 to March 2022(T2DM group)were retrospectively analyzed.Additionally,49 age-matched healthy male subjects who underwent physical examination at the same period were set as the control group.The BMD and absolute BMD T-values of lumbar spine L 1-4,left femoral neck,and total hip measured by dual-energy X-ray absorptiometry(DXA)were recorded and compared between the two groups.The relationship between BMD and absolute T value and thyroid stimulating hormone(TSH)and other clinical indexes were analyzed.Results In T2DM group,BMD of total hip was positively correlated with body mass index(BMI)and serum TSH level(P<0.05);BMD absolute T-value of total hip was negatively correlated with age and high-density lipoprotein(HDL),and positively correlated with TSH and BMI(P<0.05);BMD absolute T-value of femoral neck was positively correlated with BMI and TSH level(P<0.05).In the control group,BMD of each part was only positively correlated with BMI(P<0.05).TSH within the normal range was an independent protective factor for total hip BMD in elderly male T2DM patients(B=0.146,P=0.034),while FT4,FT3,cholesterol(CHOL),HDL and other factors were not independently correlated with BMD.Conclusion There is a positive correlation between TSH level(within the normal range)and overall hip BMD,as well as absolute T-values of femoral neck and hip BMD in elderly male T2DM patients.In this patient population,TSH within the normal range may be an independent protective factor for hip BMD.