基于HR-pQCT检测糖尿病与非糖尿病患者vBMD差异Meta分析  

Comparison of vBMD detected by HR-pQCT in patients with and without diabetes:a meta-analysis

作　　者：刘玉芳[1] 柴三葆[1] 孙健斌 赵心 袁宁[1] 辛思旭 张晓梅[1] 纪立农[2] LIU Yu-fang;CHAI San-bao;SUN Jian-bin;ZHAO Xin;YUAN Ning;XIN Si-xu;ZHANG Xiao-mei;JI Li-nong(Department of Endocrinology,Peking University International Hospital,Beijing 102206,China;Department of Endocrinology,Peking University People s Hospital,Beijing 100044,China)

机构地区：[1]北京大学国际医院内分泌科,北京102206 [2]北京大学人民医院内分泌科,北京100044

出　　处：《中华骨质疏松和骨矿盐疾病杂志》2018年第6期588-596,共9页Chinese Journal Of Osteoporosis And Bone Mineral Research

摘　　要：目的比较糖尿病患者与非糖尿病患者外周骨体积骨密度(volume bone mineral density,vBMD)的差异。方法 2017年12月对Medline (使用PubMed网站)、Embase、Cochrane数据库进行了检索。检索关键词为"diabetes"(糖尿病)、"bone microstructure"(骨微结构)、"volume bone mineral density"(vBMD)、"high resolution peripheral bone quantitative CT"(高分辨外周骨定量CT,HR-pQCT),检索时限为2000年1月1日至2017年11月30日,研究类型为横断面研究。通过HR-pQCT方法,比较糖尿病患者与非糖尿病患者vBMD的差异,评估部位包括桡骨远端和胫骨远端,评估指标包括皮质骨vBMD、骨小梁vBMD。采用Q统计量检验和I2检验进行异质性评估。采用RevM an 5. 1软件进行Meta分析。结果共纳入10项研究,总计糖尿病患者430例,非糖尿病对照1 313例。(1)在桡骨远端,糖尿病患者的骨小梁vBMD显著高于非糖尿患者[WMD=8. 99,95%CI (6. 33,11. 65)],去除1型糖尿病后,差异更加显著[WMD=9. 66,95%CI(6. 96,12. 36)];而皮质骨vBMD差异无统计学意义[WMD=-3. 79,95%CI (-13. 45,5. 87)]。(2)在胫骨远端,糖尿病患者的骨小梁vBMD显著高于非糖尿患者[WMD=5. 03,95%CI (2. 56,7. 50)],去除1型糖尿病后,差异更加显著[WMD=5. 43,95%CI (2. 93,7. 93)];而皮质骨vBMD差异无统计学意义[WMD=0. 89,95%CI (-11. 76,13. 54)]。敏感性分析示本次荟萃分析结果稳定性较好。结论糖尿病患者,尤其是2型糖尿病患者外周骨的骨小梁vBMD显著高于非糖尿病患者。Objective To compare the volume bone mineral density （vBMD） of peripheral bone in diabetes patients with those without diabetes. Methods We searched Medline, Web of Science and Cochrane databases for articles published before December 2017. Searching keywords were “diabetes”, “bone microarchitecture”, “volume bone mineral density” and “high resolution peripheral bone quantitative CT” （HR-pQCT）. Cross-sectional studies assessing bone microarchitecture of peripheral skeleton with HR-pQCT in diabetes patients were deemed eligible. The results were shown by the WMD and 95% confidence interval （ CI ）. Heterogeneity was tested using Q-Cochrane test and I 2 measure.Revman 5.1 was used to conduct meta-analysis. Results A total of 10 cross-sectional studies （430 diabetics and 1 313 controls）were included. （1）At the radius, trabecular vBMD of diabetes patients was higher than those without diabetes[WMD=8.99,95% CI （6.33,11.65）]. The difference was more significant when the study of type 1 diabetes were removed[WMD=9.66,95% CI （6.96,12.36）]. There was no significant difference in cortical vBMD between patients with and without diabetes[WMD=-3.79,95% CI （-13.45,5.87）. （2）At the tibia, trabecular vBMD of diabetes patients was higher than those without diabetes[WMD=5.03,95% CI （2.56,7.50）]. The difference was more significant when the study of type 1 diabetes were removed[WMD=5.43,95% CI （2.93,7.93）]. There was no significant difference in cortical vBMD between patients without diabetes[WMD=0.89,95% CI （-11.76,13.54）]. Sensitivity analysis showed that the results of this meta-analysis were stable. In regard to cortical vBMD, there was significant heterogeneity among studies, while no heterogeneity in regard to trabecular vBMD. Conclusion The results of this meta-analysis indicate diabetes, especially type 2 diabetes patients have higher trabecular vBMD at peripheral skeleton than those without diabetes.

关 键 词：糖尿病 体积骨密度 高分辨外周骨定量 

分 类 号：R681[医药卫生—骨科学]