老年2型糖尿病患者血尿酸水平与骨密度的关系

Relationship Between Serum Uric Acid Level and Bone Mineral Density in Elderly Patients With Type 2 Diabetes Mellitus

目的探讨老年2型糖尿病(type 2 diabetes mellitus,T2DM)患者血尿酸(uric acid,UA)水平与骨密度(bone mineral density,BMD)的关系。方法回顾性分析2020年1月—2021年12月福建医科大学附属龙岩第一医院内分泌科收治的522例年龄60岁以上的T2DM患者,根据BMD检测的T值分为骨量正常组(T值≥-1.0)43例、骨量减少组(-2.5<T值<-1.0)209例和骨质疏松组(T值≤-2.5)270例。比较三组一般资料、UA水平及生化指标的差异。采用Pearson和Spearman相关分析UA与股骨颈、全髋、腰椎BMD的关系。采用多因素Logistic回归分析老年T2DM患者发生骨质疏松的影响因素。结果522例患者中男性264例,女性258例,年龄60~92岁。骨质疏松的发生率为51.7%。骨质疏松组UA低于骨量减少组和骨量正常组(P<0.05)。UA与股骨颈、全髋、腰椎BMD呈正相关(r=0.178、0.192、0.212,P<0.05)。以是否合并骨量异常(骨量减少及骨质疏松)为因变量,单因素Logistic回归分析显示,UA、白蛋白、碱性磷酸酶(alkaline phosphatase,ALP)、总胆红素(total bilirubin,TBIL)与老年T2DM患者发生骨质疏松有关(P<0.05),多因素Logistic回归分析显示,UA是老年T2DM患者骨质疏松的保护因素(OR=0.997,95%CI:0.994~1.000,P=0.026),TBIL也是保护因素(P<0.05),而ALP是其危险因素(P<0.05)。结论老年T2DM患者血UA水平与股骨颈、全髋及腰椎的BMD呈正相关,正常高UA水平是老年T2DM患者骨质疏松的保护因素。

Objective To investigate the relationship between serum uric acid(UA)level and bone mineral density(BMD)in elderly patients with type 2 diabetes mellitus(T2DM).Methods A retrospective analysis was performed on 522 patients with T2DM over 60 years of age admitted to the department of endocrinology,Longyan First Hospital Affiliated to Fujian Medical University from January 2020 to December 2021.According to the T value of BMD,43 cases were divided into normal bone mass group(T value≥-1.0),209 cases of bone loss group(-2.5<T value<-1.0)and 270 cases of osteoporosis group(T value≤-2.5).The differences of general data,UA levels and biochemical indexes among the three groups were compared.The relationship between UA and BMD of femoral neck,total hip and lumbar spine was analyzed by Pearson and Spearman correlation.Multivariate Logistic regression was used to analyze the influencing factors of osteoporosis in elderly patients with T2DM.Results Among the 522 patients,264 were males and 258 were females,aged 60-92 years.The incidence of osteoporosis was 51.7%.The UA of osteoporosis group was lower than that of osteopenia group and normal bone mass group(P<0.05).UA was positively correlated with BMD of femoral neck,total hip and lumbar spine(r=0.178,0.192,0.212,P<0.05).With or without bone mass abnormalities(bone mass loss and osteoporosis)as dependent variable,univariate Logistic regression analysis showed that UA,albumin,alkaline phosphatase(ALP)and total bilirubin(TBIL)were associated with osteoporosis in elderly patients with T2DM(P<0.05).Multivariate Logistic regression analysis showed that UA was a protective factor for osteoporosis in elderly patients with T2DM(OR=0.997,95%CI:0.994 to 1.000,P=0.026).TBIL was also a protective factor(P<0.05),while ALP was a risk factor(P<0.05).Conclusion Serum UA level is positively correlated with BMD of femoral neck,hip and lumbar spine in elderly patients with T2DM.Normal high serum UA level is a protective factor for osteoporosis in elderly patients with T2DM.