【摘要】 目的:分析绝经后2型糖尿病患者瘦素水平与骨代谢变化的关系。方法:选取2004-01/2006-01上海市杨浦区中心医院收治的80例2型糖尿病住院患者,符合WHO1999年糖尿病诊断标准,均为绝经后女性,年龄60～80岁,对本实验知情同意。排除标准:雌激素替代治疗者、使用糖皮质激素及影响钙磷代谢药物者、有胃肠手术史者、其他内分泌疾病患者。记录患者年龄、糖尿病病程、绝经年限、体质量指数。氧化酶法测定空腹血糖,微柱亲和层析法测定糖化血红蛋白。ELISA法测定瘦素水平。采用法国UPIS3000型定量骨超声测定仪将专用探头置于被检者右足跟部,测定其跟骨超声传导速度、振幅衰减,计算骨硬度指数。骨硬度指数=0.67×振幅衰减+0.28×跟骨超声传导速度-383。对跟骨定量超声指标、一般指标、瘦素水平进行直线相关分析。结果:80例绝经后2型糖尿病患者全部进入结果分析。振幅衰减、跟骨超声传导速度、骨硬度指数与患者年龄(r=-0.342～-0.298,P均<0.01)、病程(r=-0.341～-0.309,P均<0.01)、绝经年限(r=-0.318～-0.289,P均<0.01)、糖化血红蛋白(r=-0.308～-0.273,P<0.05或0.01)呈显著负相关;与瘦素水平(r=0.336～0.528,P均<0.01)、体质量指数(r=0.302～0.353,P均<0.01)呈显著正相关。校正年龄、病程、绝经年限、体质量指数等影响因素后,振幅衰减、跟骨超声传导速度、骨硬度指数仍与瘦素水平呈显著正相关(R2=0.498～0.546,P均<0.01)。结论:2型糖尿病患者糖代谢异常与其骨质疏松发生有关,高瘦素水平和高体质指数对骨代谢有明显的保护作用。更多还原

【Abstract】 AIM: To investigate the relationship between bone metabolism and serum leptin in type 2 diabetes mellitus (T2DM) postmenopausal female patients. METHODS: Totally 80 postmenopausal female inpatients with T2DM (according to the diagnostic criteria of WHO1999) aged 60-80 years from Yangpu District Central Hospital who gave informed consent were enrolled in the present study from January 2004 to January 2006. Exclusive criteria: Subjects who taking medications such as estrogen, glucocorticoid, or calcium or phosphorus metabolism, having a history of gastrointestinal surgery and other endocrine diseases were excluded. Each subject’s age, duration, menopausal period, body mass index (BMI), fasting glucose (oxidation enzyme method), hemoglobin A1c (HbA1c) (microcolumn affinity chromatography) and leptin levels (ELISA) were measured. Ultrasound characteristics of the right heel bone were measured with ultrasound bone densitometer (French UPIS3000) to identify the speed of sound (SOS), broanband ultrasound attenuation (BUA) and stiffness (STI). STI was equal to 0.67×BUA+0.28×SOS-383. Linear correlation analysis was performed in ultrasound index, general index and leptin level. RESULTS: A total of 80 postmenopausal female inpatients with T2DM were involved in the result analysis. BUA, SOS and STI were negatively related with age (r =-0.342 to -0.298,P all < 0.01), duration(r =-0.341 to -0.309,P all < 0.01), menopausal period(r = -0.318 to -0.289,P all < 0.01), HbA1c (r =-0.308 to -0.273,P < 0.05 or 0.01), and were positively correlated with leptin(r =0.336-0.528,P all < 0.01) and BMI(r =0.302-0.353,P all <0.01). Significant positive correlation coefficients between BUA, SOS, STI were observed even after adjusting for the effect of age, duration, menopausal period and BMI (R 2=0.498-0.546, P all < 0.01). CONCLUSION: The abnormality of glucose metabolism in T2DM postmenopausal female patients is associated with osteoporosis. High levels of leptin and BMI may obviously protect the bone metabolism.更多还原