绝经后2型糖尿病患者钙调激素、骨转换标志物与骨密度的相关性分析  

Correlation of calcium regulating hormone and parathyroid hormone with bone mineral density in female patients with type 2 diabetes mellitus

作　　者：杨霞[1] 张超 王桂荣 李宝玲[1] YANG Xia;ZHANG Chao;WANG Guiron;LI Baoling(Endocrinology Department,General Hospital of Ningxia Medical Univer-sity,Yinchuan 750004,China;Urinary Surgery,Ningxia People＇s Hospital,Yinchuan 750002,China;Chronic Disease Management Center,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院内分泌科,宁夏银川750004 [2]宁夏人民医院泌尿外科,宁夏银川750002 [3]宁夏医科大学总医院慢病管理中心-天盛卫生服务站,宁夏银川750004

出　　处：《宁夏医学杂志》2018年第9期772-775,共4页Ningxia Medical Journal

摘　　要：目的探讨绝经后老年女性2型糖尿病(T2DM)患者血清钙调激素,如甲状旁腺激素(PTH)、25-羟基维生素D[25(OH) D],骨转换标志物与骨密度的相关性。方法本研究为回顾性分析研究,共纳入绝经后老年女性T2DM患者100例,通过双能X线测定的骨密度值将其分为骨量正常组24例、低骨量组40例和骨质疏松组36例;收集3组患者的年龄、体重指数(BMI)、糖尿病病程,分别测定空腹血糖(FBG)、HbA1c、血钙(Ca)、血磷(P)、血清碱性磷酸酶(ALP)、血清PTH、25(OH) D、骨钙素N端中分子片段(N-MID)、总Ⅰ型胶原氨基端延长肽(T-P1NP)水平,分析各组糖代谢指标、25(OH) D、PTH及骨转换标志物与骨密度的相关性。结果比较2组患者的年龄、FBG、血钙(Ca)、血磷(P)、ALP、25(OH) D水平,差异均无统计学意义(P> 0. 05);比较3组患者的BMI、病程、HbA1c、PTH及骨转换标志物水平,差异有统计学意义(P <0. 05);低骨量组、骨质疏松组的T-P1NP和N-MID水平低于骨量正常组,HbA1c、PTH水平高于骨量正常组(P <0. 05);相关性分析提示25(OH) D、T-P1NP、N-MID水平与腰椎、全髋、股骨颈的骨密度呈正相关(P <0. 05),HbA1c、PTH与各部位骨密度呈负相关(P <0. 05)。本研究收集的100例绝经后T2DM患者中,维生素D缺乏者占67%,不足者占21%,充足者仅占12%; T2DM患者的25(OH) D与PTH、HbA1c均呈负相关(P <0. 05)。结论绝经后老年T2DM患者的骨密度均与25(OH) D、PTH、HbA1c及骨代谢指标存在相关性,且糖尿病患者中普遍存在维生素D缺乏,容易出现继发性甲旁亢,从而增加骨质疏松甚至脆性骨折的发生风险。老年T2DM患者应定期监测HbA1c、25(OH) D、PTH和骨转换标志物,积极控制血糖、纠正维生素D缺乏,对骨量减少和骨质疏松进行防治。Objective To investigate the correlation between bone density and parathyroid hormone（PTH）,25-hydroxyvitamin D 25（OH） D,the levels of bone metabolism markers in postmenopausal patients with type 2 diabetes mellitus（T2DM）.Methods Thestudy was a retrospective analysis,100 postmenopausal patients with T2DM were divided into normal bone mass group（n = 24）,osteopenia group（n = 40） and osteoporosis group（n = 36） based on the bone density. The age,height,weight,duration of diabetes,and the levels of fasting blood glucose（FBG）,Hb A1 C,serum calcium,serum phosphorus,serum PTH,25（OH） D,ALP,N-middle steocalcin（N-MID）,total procollagen type I amino-terminal peptide（T-P1 NP） of the patients in the three groups were determined,and the relationship of all indices with bone density was analyzed. Results There was no significant difference in age or FBG,serum calcium,serum phosphorus and 25（OH） D among the three groups（P 0. 05）,but there were significant differences in body mass index,duration of disease,HbA1c,N-MID,T-P1 NP and PTH among the three groups（P 0. 05）. Compared to the normal bone mass group,the osteopenia group and osteoporosis group had lower levels of N-MID and T-P1 NP,and higher levels of HbA1c and PTH（P 0. 05）. 25（OH） D,T-P1 NP and N-MID had a positive correlation with bone density（P 0. 05）; HbA1c,PTH had a significant negative correlation with bone density of the 2 nd to 4 th lumbar vertebrae,femoral neck and total hip（P 0. 05）. Among 100 patients,the cases of vitamin D sufficiency,insufficiency and deficiency accounted for 12%,21% and 67% respectively. Conclusion 25（OH）D,PTH,HbA1c and the bone metabolism markers have a certain correlation with bone density among postmenopausal patients with T2DM. Vitamin D deficiency is common in diabetes patients. It＇s easy to cause secondary hyperthyroidism,increasing the incidence of osteoporosis and even the risk of brittle fracture. The older patients with T2DM should regularly monitor Hb A1 C,25（OH

关 键 词：绝经后2型糖尿病 25-羟基维生素D 甲状旁腺激素 糖化血红蛋白 骨代谢标志物 骨密度 

分 类 号：R580[医药卫生—内分泌]