老年2型糖尿病合并骨质疏松症患者血尿酸水平变化的临床分析

Clinical analysis of serum uric acid level in elder patients with type 2 diabetes mellitus and osteoporosis

目的探讨血尿酸(UA)在老年2型糖尿病(T2DM)合并骨质疏松症(OP)患者发生、发展中的变化情况。方法选择确诊为T2DM的老年患者76例,进行骨密度(BMD)测定,依据T值水平将T2DM患者分为骨量正常组(T值≥-1.0,26例)、骨量减少组(-2.50.05);四组年龄、病程、BMI、HbA1c、TG、Scr、25(OH)D、UA水平均存在统计学上的差异(P<0.05)。骨量减少组和骨质疏松组年龄均高于正常对照组和骨量正常组(P<0.05);正常对照组和骨量正常组,骨量减少组和骨质疏松组组间年龄差异无统计学意义(P>0.05)。骨量正常组、骨量减少组、骨质疏松组的糖尿病病程呈逐渐升高趋势,且两两间存在差异(P<0.05)。骨量正常组、骨量减少组、骨质疏松组的糖尿病肾病发生率比较差异无统计学意义(P>0.05)。正常对照组BMI低于骨量正常组,高于骨量减少组和骨质疏松组(P<0.05);骨量正常组、骨量减少组、骨质疏松组BMI逐渐降低(P<0.05),但骨量减少组和骨质疏松组组间BMI比较差异无统计学意义(P>0.05)。骨量正常组、骨量减少组、骨质疏松组HbA1c显著高于正常对照组,骨质疏松组显著高于骨量正常组和骨量减少组(P<0.05);骨量正常组和骨量减少组组间HbA1c差异不显著(P>0.05)。骨量正常组、骨量减少组、骨质疏松组TG及Scr均高于正常对照组,且三组间存在两两差异(P<0.05)。考虑到UA及25(OH)D水平存在性别差异,故将该指标进一步分为男性及女性受试组。男性:骨量正常组、骨量减少组、骨质疏松组25(OH)D水平均低于正常对照组,UA水平均显著高于正常对照组,且骨量正常组、骨量减少组、骨质疏松组25(OH)D水平两两组比较差异显著(P<0.05);骨质疏松组UA水平明显高于骨量正常组和骨量减少组(P<0.05)。女性:骨量正常组、骨量减少组、骨质疏松组25(OH)D水平均显著低于正常对照组,且骨质疏松组明显低于骨量正常组和骨量减少组(P<0.05);但骨量正常组和骨量减少组25(OH)D水平比较差异无统计学意义(P>0.05);骨量减少组和骨质疏松组UA水平均显著高于正常对照组,骨质疏松组UA水平均显著高于骨量正常组、骨量减少组(P<0.05);骨量正常组和正常对照组UA水平比较差异无统计学意义(P>0.05)。正常对照组的OP患病率为12.5%(5/40),T2DM患者的OP患病率为31.6%(24/76),T2DM患者的OP患病率高于正常对照组,差异具有统计学意义(χ^(2)=5.088,P=0.024<0.05)。Pearson分析表明,老年T2DM患者的UA水平与年龄、糖尿病病程、HbA1c、TG及Scr呈正相关(r=0.378、0.544、0.463、0.342、0.469,P<0.05),与25(OH)D呈负相关(r=-0.375,P<0.05),而与BMI、血钙、血磷无明显相关性(P>0.05)。结论老年T2DM患者OP患病率高于同龄健康人群,UA水平较后者升高,UA与高血糖、高血脂、骨代谢异常等相关。

Objective To explore the changes of serum uric acid(UA)in elderly patients with type 2 diabetes mellitus(T2DM)and osteoporosis(OP).Methods A total of 76 elderly patients diagnosed with T2DM were selected for bone mineral density(BMD)determination.According to T-value,T2DM patients were divided into normal bone mass group(T-value≥-1.0,26 cases),osteopenia group(-2.5<T-value<-1.0,26 cases)and osteoporosis group(T-value≤-2.5,24 cases).At the same time,40 healthy subjects matching age and sex were selected as the normal control group.The age,sex,duration of diabetes,incidence of diabetic nephropathy,body mass index(BMI),glycated hemoglobin(HbA1c),total cholesterol(TC),triglyceride(TG),serum calcium,serum phosphorus,serum creatinine(Scr),25-hydroxyvitamin D[25(OH)D],and UA levels of all subjects were recorded.Comparison was made on levels of UA,25(OH)D and the incidence of OP in subjects of different genders,as well as clinical indicators among the four groups.The correlation between UA level and other clinical indicators in elderly patients with T2DM was analyzed.Results The levels of UA and 25(OH)D in male patients were higher than those in female patients,and the prevalence of OP was lower than that in female patients,the differences were significant(P<0.05).The levels of TC,blood calcium,blood phosphorus and incidence of diabetic nephropathy were compared,and significant difference were found when suffered from pairwise comparison(P>0.05).There were significant differences in age,duration of diabetes,BMI,HbA1c,TG,Scr,25(OH)D and UA among the four groups(P<0.05).The age of osteopenia group and osteoporosis group was higher than that of normal control group and normal bone mass group(P<0.05).There was no significant difference in age between normal control group and normal bone mass group,osteopenia group and osteoporosis group(P>0.05).The course of diabetes in normal bone mass group,osteopenia group and osteoporosis group was gradually increased,and there was a difference between every two groups(P<0.05).There was no significant difference in the incidence of diabetic nephropathy in normal bone mass group,osteopenia group and osteoporosis group(P>0.05).BMI of normal control group was lower than that of normal bone mass group,but higher than that of osteopenia group and osteoporosis group(P<0.05).BMI of the normal bone mass group,the osteopenia group and the osteoporosis group was gradually decreased(P<0.05),but there was no statistical significance between the osteopenia group and the osteoporosis group(P>0.05).HbA1c in normal bone mass group,osteopenia group and osteoporosis group was significantly higher than that in normal bone mass group and osteopenia group(P<0.05).There was no significant difference in HbA1c between normal bone mass group and osteopenia group(P>0.05).TG and Scr in normal bone mass group,osteopenia group and osteoporosis group were higher than those in normal control group,and pairwise comparison showed significant difference(P<0.05).Considering the gender differences in UA and 25(OH)D levels,the indexes were further divided into male and female subject groups.In males,25(OH)D level of normal bone mass group,osteopenia group and osteoporosis group was lower than that of normal control group,and UA level was significantly higher than that of normal control group,and 25(OH)D level of normal bone mass group,osteopenia group and osteoporosis group was significantly different(P<0.05).UA level of osteoporosis group was significantly higher than that of normal bone mass group and osteopenia group(P<0.05).In females,25(OH)D level in normal bone mass group,osteopenia group and osteoporosis group was significantly lower than that in normal bone mass group,and the osteopenia group was obviously lower than normal bone mass group and osteopenia group(P<0.05).But there was no significant difference in 25(OH)D level between normal bone mass group and osteopenia group(P>0.05).UA level in osteopenia group and osteoporosis group was significantly higher than that in normal control group,and UA level in osteoporosis group was significantly higher than that in normal bone mass group and osteopenia group(P<0.05).There was no significant difference in UA level between normal bone mass group and normal control group(P>0.05).The prevalence of OP in normal control group was 12.5%(5/40),and 31.6%(24/76)in T2DM patients.The prevalence of OP in T2DM patients was higher than that in normal control group,and the difference was statistically significant(χ^(2)=5.088,P=0.024<0.05).Pearson analysis showed that UA level in elderly patients with T2DM was positively correlated with age,duration of diabetes,HbA1c,TG and Scr(r=0.378,0.544,0.463,0.342,0.469;P<0.05),and was negatively correlated with 25(OH)D(r=-0.375,P<0.05),but had no significant correlation with BMI,blood calcium and blood phosphorus(P>0.05).Conclusion Elderly patients with T2DM have a higher prevalence of OD and increased level of UA than the normal control population.There are certain correlation between UA and high blood glucose,high triglyceride,abnormal bone metabolism.