老年糖尿病患者内脏脂肪面积、骨密度和骨代谢指标水平及意义

The level and significance of visceral fat area,bone mineral density,and bone metabolism in elderly patients with diabetes

目的探讨老年糖尿病患者内脏脂肪面积、骨密度和骨代谢指标水平及意义。方法选取2021年6月至2022年8月在四川大学华西医院就诊的老年糖尿病患者160例作为观察组,选取同期健康体检老年人160例作为对照组,检查两组内脏脂肪面积、骨密度、Ⅰ型胶原羧基端肽β特殊序列(β-CTX)、总Ⅰ型前胶原氨基端延长肽(TPⅠNP)和骨钙素(OC)水平。分析老年糖尿病患者内脏脂肪面积、骨密度和骨代谢指标水平与患者临床特征的关系,及内脏脂肪面积与骨密度、骨代谢指标间相关性。结果观察组内脏脂肪面积、β-CTX和TPⅠNP分别为(110.12±16.65)cm2、(389.94±55.51)ng/mL和(55.78±9.98)mg/L,明显高于对照组(P<0.05),而T值和OC分别为(-2.10±0.55)和(20.15±4.43)ng/mL,明显低于对照组(P<0.05)。观察组骨质疏松患者糖化血红蛋白(HbA1c)为(9.08±1.13)%,高于骨量减少组和骨量正常组(P<0.05);观察组骨质疏松患者内脏脂肪面积、β-CTX和TPⅠNP分别为(126.65±17.89)cm2、(410.03±48.87)ng/mL和(61.18±9.15)mg/L,明显高于骨量减少和骨量正常患者(P<0.05),而OC为(15.53±2.68)ng/mL,明显低于骨量减少和骨量正常患者(P<0.05)。观察组女性患者β-CTX和TPⅠNP分别为(415.12±49.50)ng/mL和(60.79±9.50)mg/L,明显高于男性患者(P<0.05),而T值和OC分别为(-2.34±0.48)和(18.73±2.30)ng/mL,明显低于男性患者(P<0.05);观察组年龄≥72岁患者β-CTX和TPⅠNP分别为(408.47±50.02)ng/mL和(60.81±9.11)mg/L,明显高于年龄<72岁患者(P<0.05),而T值和OC分别为(-2.28±0.32)和(19.02±2.09)ng/mL,明显低于年龄<72岁患者(P<0.05);观察组体质指数≥22 kg/m2患者内脏脂肪面积为(125.61±18.60)cm2,明显高于体质指数<22 kg/m2患者(P<0.05)。内脏脂肪面积与T值、OC呈负相关(P<0.05),而与β-CTX和TPⅠNP呈正相关(P<0.05)。结论老年糖尿病患者内脏脂肪面积、骨密度和骨代谢指标水平与患者年龄、性别及体质指数有一定关系,内脏脂肪面积与骨密度、骨代谢指标存在相关性。

Objective To investigate the level and significance of visceral fat area,bone mineral density and bone metabolism in elderly patients with diabetes.Methods 160 elderly patients with diabetes who visited our hospital from June 2021 to August 2022 were selected as the observation group,and 160 elderly patients who underwent physical examination were selected as the control group.The visceral fat area,bone density,βspecial sequence of C-terminal peptide of type I collagen(β-CTX),total amino terminal elongation peptide of type I procollagen(TPⅠNP)and osteocalcin(OC)levels were examined in the two groups.The relationship between visceral fat area,bone mineral density and bone metabolism index level and clinical characteristics of patients,and the correlation between visceral fat area and bone mineral density and bone metabolism index were analyzed in elderly diabetes.Results The visceral fat area,β-CTX,and TPⅠNP of the observation group were(110.12±16.65)cm~2,(389.94±55.51)ng/mL,and(55.78±9.98)mg/L,respectively,which was significantly higher than the control group(P<0.05),while the T value and OC were(-2.10±0.55)and(20.15±4.43)ng/mL,respectively,which was significantly lower than the control group(P<0.05).The glycated hemoglobin(HbA1c)of patients with osteoporosis in the observation group was(9.08±1.13)%,which was higher than that of the bone loss group and the normal bone mass group(P<0.05).The visceral fat area,β-CTX,and TPⅠNP of patients with osteoporosis in the observation group were(126.65±17.89)cm~2,(410.03±48.87)ng/mL,and(61.18±9.15)mg/L,respectively,which was significantly higher than those with decreased bone mass and normal bone mass(P<0.05),while the OC was(15.53±2.68)ng/mL,which was significantly lower than those with decreased bone mass and normal bone mass(P<0.05).Theβ-CTX and TPⅠNP of female patients in the observation group were(415.12±49.50)ng/mL and(60.79±9.50)mg/L,respectively,which was significantly higher than those of male patients(P<0.05),while the T value and OC were(-2.34±0.48)and(18.73±2.30)ng/mL,respectively,which was significantly lower than those of male patients(P<0.05).Theβ-CTX and TPⅠNP of patients aged≥72 years in the observation group were(408.47±50.02)ng/mL and(60.81±9.11)mg/L,respectively,which was significantly higher than those of patients aged<72 years(P<0.05),while the T value and OC were(-2.28±0.32)and(19.02±2.09)ng/mL,respectively,significantly lower than those of patients aged<72 years(P<0.05).The visceral fat area of patients with a body mass index≥22 kg/m~2 in the observation group was(125.61±18.60)cm~2,which was significantly higher than that of patients with a body mass index<22 kg/m~2(P<0.05).The visceral fat area was negatively correlated with T value and OC(P<0.05),but positively correlated withβ-CTX and TPⅠNP(P<0.05).Conclusion The visceral fat area,bone density and bone metabolism index levels in elderly patients with diabetes have a certain relationship with age,sex and body mass index.The visceral fat area has a correlation with bone density and bone metabolism index.