【摘要】 目的探讨中老年2型糖尿病(type 2 diabetic mellitus,T2DM)患者腰椎骨密度(bone mineral density,BMD)与代谢指标及糖尿病并发症的关系。方法回顾性分析228例中老年T2DM患者的住院资料,按腰椎1～4(L1-L4)BMD的水平分为骨量正常组(T>-1.0SD)、骨量减少组(-2.5 SD<T≤-1.0 SD)及骨质疏松组(T≤-2.5 SD),比较各组临床资料、血糖控制、代谢指标、糖尿病并发症情况,并分析腰椎BMD与各指标的相关性。结果 (1)随骨密度下降,体质量指数(body mass index,BMI)下降,女性比例、感觉阈值(vibration perception threshold,VPT)增加,差异有统计学意义(P<0.01);骨质疏松组年龄、糖化血清白蛋白(glycated albumin,GA)大于骨量正常及骨量减少组(P<0.01),且发生糖尿病足病明显增加(P<0.05);骨质疏松组病程、空腹及餐后2 h血糖大于骨量减少组(P<0.05),腰围、尿酸、甘油三酯低于骨量正常组(P<0.01),高密度脂蛋白胆固醇(HDL-C)、血镁高于骨量正常组(P<0.05);骨量减少组碱性磷酸酶高于骨量正常组(P<0.05),腰围(P<0.05)、尿酸(P<0.01)、总胆固醇(P<0.05)低于骨量正常组。(2)相关分析提示,腰椎BMD与年龄、性别(女)、GA、HDL-C、血镁、VPT(异常)呈负相关(P<0.05);与腰围、BMI、尿酸、甘油三酯呈正相关(P<0.01)。(3)以腰椎骨密度为因变量,进一步行多重线性回归分析,结果显示BMI、性别(女)、VPT(异常)、尿酸差异有统计学意义。结论女性患者和感觉阈值异常是T2DM患者骨密度降低的独立危险因素,而适当高BMI及高尿酸则是骨密度降低的保护因素。更多还原

【Abstract】 Objective To explore the relationship between bone mineral density(BMD) of lumbar vertebrae, metabolic index and diabetic complications in middle-aged and older patients with type 2 diabetes mellitus(T2 DM). Methods 228 middle-aged and older T2 DM patients were enrolled in this retrospective study and were divided into 3 groups according to BMD of lumbar vertebrae 1-4(L1-L4): normal BMD group(T>-1.0 SD), osteopenia group(-2.5 SD<T≤-1.0 SD) and osteoporosis group(T≤-2.5 SD). Differences in basic clinical data, glucose control, metabolic data and diabetic complications among 3 groups were compared. Relationship between lumbar BMD and all the index above were also analyzed. Results(1) Body mass index(BMI) decreased, whereas proportion of female patients and vibration perception threshold(VPT) increased as BMD decreased among all the groups(P<0.01). Osteoporosis group had older age(P<0.01), higher levels of glycated albumin(GA)(P<0.01) and higher incidence of diabetic foot problems(P<0.05) than osteopenia group and normal BMD group. Compared with osteopenia group, osteoporosis group had longer duration of T2 DM and higher fasting and postprandial glucose level(P<0.05). Compared with normal BMD group, osteoporosis group had lower waist circumference, uric acid and triglyceride(P<0.01), and higher serum magnesium and high density lipoprotein cholesterol(HDL-C)(P<0.05). Osteopenia group had higher level of alkaline phosphatase(P<0.05), and lower waist circumference(P<0.05), uric acid(P<0.01) and total cholesterol(P<0.05) than normal BMD group.(2) Correlation analysis showed that lumbar BMD was negatively correlated with age, gender(female), GA, HDL-C, magnesium and abnormal VPT(P<0.05), but positively correlated with waist circumference, BMI, uric acid and triglyceride(P<0.01).(3) Multiple linear regression analysis(with lumbar BMD as dependent variable) showed that BMI, gender(female), abnormal VPT and uric acid had statistical significance. Conclusion Female and abnormal VPT were independent factors associated with decreased BMD in T2 DM patients. On the other hand, appropriate high BMI and UA could be protective factors.更多还原