绝经期T2DM患者血糖变异、低密度脂蛋白与骨质疏松发病的关系

The Relationship between Blood Glucose Variability,Low-Density Lipoprotein,and the Onset of Osteoporosis in Postmenopausal Patients with Type 2 Diabetes Mellitus

目的探讨绝经期2型糖尿病(T2DM)患者血糖变异、低密度脂蛋白胆固醇(LDL-C)与骨质疏松(OP)发病的关系。方法选取汝州市第一人民医院2020年4月至2022年12月收治的226例绝经期T2DM患者为研究对象,收集患者一般资料,采集患者空腹静脉血检测血糖、血脂、甲状腺激素水平和骨代谢指标[血钙、血磷、碱性磷酸酶(ALP)、Ⅰ型胶原氨基端延长肽(P1NP)、β胶原降解产物(β-CTx)]并对患者进行持续性血糖监测,计算血糖变异参数[平均血糖波动幅度(MAGE)、血糖变异系数(CV)、24 h平均血糖水平(MBG)和血糖水平标准差(SDBG)],采用X线吸收法检测患者骨密度,根据检测结果将患者分为骨量正常组(n=73)、骨量减少组(n=86)和OP组(n=67),比较三组临床资料、骨代谢指标和血糖变异指标,采用Spearman相关系数分析血糖变异、LDL-C与绝经期T2DM患者发病的相关性。结果三组T2DM病程、血清总胆固醇(TC)、LDL-C、高密度脂蛋白胆固醇(HDL-C)、尿酸(UA)水平差异有统计学意义(P<0.05),年龄、体质量指数(BMI)、合并症、空腹血糖(FPG)、空腹C肽、血清三酰甘油(TG)、三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)水平比较,差异无统计学意义(P>0.05);OP组、骨量减少组血清血钙、血磷、ALP、P1NP水平均显著低于骨量正常组,β-CTx水平均显著高于骨量正常组,差异均有统计学意义(P<0.05),OP组血清ALP、P1NP水平均显著低于骨量减少组,β-CTx水平均显著高于骨量减少组,差异均有统计学意义(P<0.05);OP组、骨量减少组MAGE、CV、SDBG水平均显著高于骨量正常组,差异均有统计学意义(P<0.05),OP组MAGE、CV、SDBG水平均显著高于骨量减少组,差异均有统计学意义(P<0.05),三组MBG水平比较差异无统计学意义(P>0.05);Spearman相关系数分析显示,血糖变异参数(MAGE、CV、SDBG和)血清LDL-C水平与绝经期T2DM患者骨质疏松发病均存在显著正相关,具有统计学意义(P<0.05)。结论绝经期T2DM患者LDL-C以及血糖变异参数(MAGE、CV、SDBG)与骨质疏松发病有显著相关性,检测上述指标有利于绝经期T2DM患者OP的早期诊断。

Objective To investigate the relationship between blood glucose variability,low-density lipoprotein cholesterol(LDL-C),and the onset of osteoporosis(OP)in postmenopausal patients with type 2 diabetes mellitus(T2DM).Methods A total of 226 postmenopausal T2DM patients admitted to The First People’s Hospital of Ruzhou from April 2020 to December 2022 were selected as the research subjects.General information of the patients was collected,and fasting venous blood was collected to test blood glucose,blood lipids,thyroid hormone levels,and bone metabolism indicators[blood calcium,blood phosphorus,alkaline phosphatase(ALP),N-terminal propeptide of type 1 precollagen(P1NP),andβ-collagen degradation product(β-CTx)].Continuous blood glucose monitoring was performed on the patients,and blood glucose variability parameters[mean amplitude of glycemic excursions(MAGE),coefficient of variation of blood glucose(CV),24-hour mean blood glucose level(MBG),and standard deviation of blood glucose level(SDBG)]were calculated.The bone density of the patients was measured by X-ray absorption method.According to the test results,the patients were divided into normal bone mass group(n=73),reduced bone mass group(n=86),and OP group(n=67).The clinical data,bone metabolism indicators,and blood glucose variability indicators of the three groups were compared.The Spearman correlation coefficient was used to analyze the correlation between blood glucose variability,LDL-C,and the onset of disease in postmenopausal T2DM patients.Results There were statistically significant differences in the duration of T2DM,serum total cholesterol(TC),LDL-C,high-density lipoprotein cholesterol(HDL-C),and uric acid(UA)levels among the three groups(P<0.05).There were no statistically significant differences in age,body mass index(BMI),complications,fasting blood glucose(FPG),fasting C-peptide,serum triglyceride(TG),triiodothyronine(FT3),free thyroxine(FT4),and thyroid-stimulating hormone(TSH)levels(P>0.05).The serum levels of blood calcium,blood phosphorus,ALP,and P1NP in the OP group and the reduced bone mass group were significantly lower than those in the normal bone mass group,and theβ-CTx level was significantly higher than that in the normal bone mass group,with statistically significant differences(P<0.05).The serum levels of ALP and P1NP in the OP group were significantly lower than those in the reduced bone mass group,and theβ-CTx level was significantly higher than that in the reduced bone mass group,with statistically significant differences(P<0.05).The levels of MAGE,CV,and SDBG in the OP group and the reduced bone mass group were significantly higher than those in the normal bone mass group,with statistically significant differences(P<0.05).The levels of MAGE,CV,and SDBG in the OP group were significantly higher than those in the reduced bone mass group,with statistically significant differences(P<0.05).There was no statistically significant difference in the comparison of MBG levels among the three groups(P>0.05).Spearman correlation coefficient analysis showed that the blood glucose variability parameters(MAGE,CV,SDBG)and serum LDL-C level were significantly positively correlated with the onset of osteoporosis in postmenopausal T2DM patients,which was statistically significant(P<0.05).Conclusion LDL-C and blood glucose variability parameters(MAGE,CV,SDBG)in postmenopausal T2DM patients are significantly correlated with the onset of osteoporosis.Testing these indicators is beneficial for the early diagnosis of OP in postmenopausal T2DM patients.