2型糖尿病患者睡眠障碍与骨密度及骨折风险相关性的研究

The correlation between sleep disorder and bone mineral density and fracture risk in patients with type 2 diabetes mellitus

目的 探讨中老年T2DM患者睡眠障碍与骨密度(BMD)和骨折风险的相关性。方法 选取2022年9月至2023年4月于长沙市第一医院内分泌代谢科住院治疗的50岁以上T2DM患者150例,根据匹兹堡睡眠质量指数量表(PSQI)分为无睡眠障碍组(n=66)及睡眠障碍组(n=84),比较两组一般资料及生化指标,分析睡眠障碍与BMD和骨折风险的关系。结果 睡眠障碍组Hb A1c、FPG、女性占比、使用催眠药物比例及椎体骨折风险评分高于无睡眠障碍组,BMI和股骨颈、髋部BMD低于无睡眠障碍组(P<0.05)。Pearson相关分析显示,PSQI评分与股骨颈、髋部BMD呈负相关(P<0.05)。Pearson或Spearman相关分析显示,椎体骨折风险评分与年龄、DM病程、使用催眠药物、睡眠障碍呈正相关(P<0.05或P<0.01),与股骨颈BMD和髋部BMD呈负相关(P<0.01)。Logistic回归分析显示,FPG、使用催眠药物、髋部BMD是睡眠障碍的影响因素,睡眠障碍、PSQI评分是骨质疏松症的影响因素。结论 改善睡眠有助于减少中老年T2DM患者骨质疏松症的发生,降低骨折风险。

Objective To analyze the correlation between sleep disorder and bone mineral density(BMD)and fracture risk in middle-aged and elderly patients with type 2 diabetes mellitus(T2DM).Methods 150 T2DM patients over 50 years old who were hospitalized in the Endocrine Metabolism Department of Changsha First Hospital from September 2022 to April 2023 were selected.According to the Pittsburgh Sleep Quality Index(PSQI),they were divided into a non-sleep disorder group(66 cases)and a sleep disorder group(84 cases).The general data and biochemical indicators of the two groups were compared.The relationship between sleep disorder and BMD,fracture risk was analyzed.Results Compared with the non-sleep disorder group,HbAjc,FPG,female proportion,the proportion of hypnotics and risk scores of vertebral fracture in the sleep disorder group were higher,and BMI,BMD of femoral neck and hip were lower(P<0.05).Pearson correlation analysis showed a negative correlation between PSQI score and BMD of femoral neck and hip(P<.05).Pearson or Spearman correlation analysis showed that the risk scores of vertebral fracture was positively correlated with age,duration of DM,use of hypnotics and sleep disorder(P<0.05 or P<0.01),and negatively correlated with BMD of femoral neck and hip(P<0.01).Binary logistic regression analysis showed that FPG,use of hypnotics and hip BMD were influencing factors of sleep disorders,while sleep disorders and PSQI scores were influencing factors of osteoporosis.Conclusions For middle-aged and elderly T2DM patients,improving sleep may help reduce the occurrence of osteoporosis and reduce the risk of fractures.