绝经后2型糖尿病患者髋部骨几何结构参数及影响因素  

Geometry parameters of the hip in postmenopausal women with type 2 diabetes mellitus and the influential factors

作　　者：胡世弟[1] 李瑾[1] 刘璐[1] 李鑫[1] 戴如春[1] 伍贤平[1] 廖二元[1] 

机构地区：[1]中南大学代谢内分泌研究所湘雅二医院内分泌科国家代谢性疾病临床医学研究中心,长沙410011

出　　处：《中华骨质疏松和骨矿盐疾病杂志》2015年第1期13-20,共8页Chinese Journal Of Osteoporosis And Bone Mineral Research

基　　金：国家自然科学基金(81270960;81070695);教育部"新世纪优秀人才支持计划"(NCET-11-0507);中南大学中央高校基本科研业务费专项资金(2014ZZTS359);湖南省高层次卫生人才"225"工程;中南大学湘雅骨质疏松症临床大数据系统建设项目(33-86)

摘　　要：目的探讨绝经后2型糖尿病(T2DM)患者髋部骨几何结构参数的变化并分析主要影响因素。方法回顾性纳入在湘雅二医院内分泌科住院的绝经后T2DM患者(150例)及健康对照者(160名),采用双能X线骨密度仪及其配置的髋部骨强度分析(hip structural analysis,HAS)软件,检测腰椎(L1-4)总体、左侧股骨颈(FN)和髋部总体(TH)骨密度(BMD)以及髋部骨几何结构,采用多元逐步线性回归分析髋部骨几何参数影响因素。结果绝经后T2DM患者腰椎(L1-4)、FN及TH的BMD与健康对照组差异无统计学差异;绝经后T2DM组股骨颈干角(NSA)较健康对照组增加,股骨颈截面面积(FN-CSA)减少(P<0.05)。体重指数(BMI)、FN-BMD和TH-BMD与截面面积(CSA)、截面力矩(CSMI)、截面模量(Z)和皮质厚度(ACT)呈正相关(P<0.01),与屈曲应力比(BR)呈负相关(P<0.01)。校正空腹血糖(FBG)、糖化血红蛋白(Hb A1c)和病程影响因素后,年龄、绝经年限与FN、转子间(IT)2个部位骨结构指标CSA、CSMI、Z、ACT(FN-CSA、FN-CSMI、FN-Z、FN-ACT、IT-CSA、IT-CSMI、IT-Z、IT-ACT)及股骨干(FS)部位骨结构指标CSA、ACT(FS-CSA、FS-ACT)呈负相关(P<0.01),与FN、IT、FS 3个部位的BR(FN-BR、IT-BR、FS-BR)呈正相关(P<0.01),与FS部位的CSMI、Z(FS-CSMI、FS-Z)无明显相关。校正年龄和BMI影响因素后,除病程与FN-CSMI呈正相关(P<0.05)外,FBG、Hb A1c和病程与髋部骨几何结构参数之间均无相关性,同时股骨颈NSA与各影响因素间无相关性。校正BMD后,多元逐步回归分析发现髋部骨几何结构参数主要影响因素为BMI和绝经年限。结论绝经后T2DM患者表现为NSA增大和FNCSA降低的骨几何结构改变,可能与T2DM患者髋部高骨折风险相关。BMD、BMI和绝经年限为影响髋部骨几何结构参数的主要影响因素。Objective To investigate the variation of geometry parameters of the hip in postmenopausal women with type 2 diabetes mellitus （T2DM）, to explore the influential factors.Methods The medical records of 150 postm-enopausal women with T 2DM and 160 health controls in the Second Xiangya Hospital were included in this cross-sectional study.Bone mineral density （BMD） at lumbar spines （L1 -L4）, the left femoral neck and the total hip, was measured with dual energy X-ray absorptionmetry .Hip structural analyses were done using the validated Beck ’s method on hip scans from dual energy x-ray absorptiometry .Multiple regression method was used to analylse the influential factors .Results There was no statistical significance for the BMD at L 1 -L4 and proximal femur regions between the T 2DM and control group.Postmenopausal women with T2DM group had decreased femoral neck cross sectional area （FN-CSA） and upper neck shaft angle （NSA） vs controls （P〈0.05）.BMI, FN-BMD and TH-BMD all showed positive correlation with CSA , sectional modulus （ Z） , cross-sectional moment of inertia （ CSMI） and average cortical thickness （ ACT） , while negative correlation with bucking ratio （BR） （P〈0.01）.Adjusted for fasting blood-glucose （FBG）, HbA1c and course of dia-betes, ages and years since menopause （YSM） showed negative correlation with FN-CSA、 FN-CSMI、 FN-Z、 FN-ACT、IT-CSA、 IT-CSMI、 IT-Z、 IT-ACT、FS-CSA and FS-ACT （P〈0.01）, and positive correlation with FN-BR, IT-BR and FS-BR （P〈0.01）, but no correlation with FS-CSMI and FS-Z.FBG, HbA1c and course of diabetes showed no correla-tion with the variation of geometry parameters .However, adjusted for ages and body mass index （BMI）, course of diabe-tes, course of diabetes showed positive correlation with FN-CSMI （P〈0.05） and NSA showed no correlation with all the influential factors .Adjusted for TH-BMD, the stepwise multiple linear regression showed that the main influential factors geometry parame

关 键 词：2型糖尿病 绝经女性 骨密度 骨质疏松 髋部骨几何结构 

分 类 号：R681[医药卫生—骨科学]