维生素D缺乏与老年2型糖尿病患者发生骨质疏松、骨骼肌质量减少的相关性研究  

Clinical research of the relationship between vitamin D deficiency and osteoporosis and skeletal muscle mass reduction in elderly patients with T2DM

作　　者：张恬 吕珊[1] 殷泉忠[2] 丁国宪[1] ZHANG Tian;LYU(吕)Shan;YIN Quanzhong;DING Guoxian(Department of Gerontology,the First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China;Department of Gerontology,Jiangyin People’s Hospital,the Affiliated Hospital of Dongnan University Medical College,Jiangyin214400,China)

机构地区：[1]南京医科大学附属江苏省人民医院,江苏南京210029 [2]东南大学医学院附属江阴医院老年医学科,江苏江阴214400

出　　处：《中国骨质疏松杂志》2019年第8期1110-1115,共6页Chinese Journal of Osteoporosis

摘　　要：目的研究血清25( OH) D 缺乏对老年2 型糖尿病( type 2 diabetes mellitus,T2DM)患者骨质疏松( osteoporosis,OP)、骨骼肌质量减少( skeletal muscle mass reduction)发生的影响。方法入组了280 例老年T2DM 患者和135 例正常老年人作对照研究。对两组人员均详细采集一般情况,检测ASMI、各部位骨密度( BMD)及血清25( OH) D 水平等实验室指标。利用t 检验、卡方检验比较组间的差异,采用相关分析、回归分析探讨老年T2DM 合并骨质疏松及骨骼肌质量减少的影响因素。结果①观察组的骨质疏松发生率、骨骼肌质量减少发生率以及骨质疏松合并骨骼肌量减少发生率均明显高于对照组(均P<0. 05);老年T2DM 患者血清25( OH) D 水平较对照组显著下降( P<0. 05);②在老年T2DM 患者中,无骨质疏松无肌少患者平均25( OH) D 水平最高,合并骨质疏松及肌少的糖尿病患者平均25( OH) D 水平最低,差异有统计学意义( P<0. 05);25( OH) D 水平越低,老年T2DM 患者骨质疏松、骨骼肌质量减少越严重( P<0. 05)。③Pearson 相关分析发现,老年T2DM 患者血清25( OH) D 水平与BMD( r = 0. 703,P<0. 05)、ASMI( r = 0. 536,P<0. 05)均呈显著正相关关系,BMD 与ASMI ( r = 0. 381,P<0. 05)也呈显著正相关关系。④Logistic 回归分析发现, 25( OH) D 缺乏( OR= 14. 47,P = 0. 005)是发生骨质疏松的危险因素;25( OH) D 缺乏( OR= 11. 59,P= 0. 015)是发生肌少症的危险因素。结论维生素D 缺乏、骨质疏松、骨骼肌质量减少在老年T2DM 患者中的发病率均高于正常老年人群。维生素D 缺乏是老年T2DM 患者发生骨质疏松与骨骼肌质量减少共同的危险因素,维生素D 越低,老年T2DM 患者骨质疏松、骨骼肌质量减少越严重。Objective To study the effect of 25( OH) D deficiency on osteoporosis and muscle mass decline in elderly patients with type 2 diabetes mellitus( T2 DM). Methods We recruited 280 elderly T2 DM patients and 135 matched controls. The general situation and laboratory features such as ASMI,BMD,and serum 25( OH) D level of all subjects were collected. The differences between the two groups were analyzed using t test or χ~2 test. The impact factors of elderly T2 DM with osteoporosis were analyzed using correlation analysis or regression analysis. Results The incidences of osteoporosis,skeletal muscle mass decline,and osteoporosis combined with skeletal muscle mass decline in the observation group were significantly higher than those in the control group. Compared with control,the serum 25( OH) D level was significantly lower in elderly T2 DM patients. In the elderly T2 DM patients,the average level of 25( OH) D was the highest in patients with diabetes alone and was the lowest in patients combined with osteoporosis and muscle mass decline. The lower the 25( OH) D lever was,the more severe osteoporosis and skeletal muscle mass decline were in elderly T2 DM patients( P< 0. 05). Pearson correlation analysis showed that serum 25( OH) D level in elderly T2 DM patients was positively correlated with BMD( r = 0. 703,P < 0. 05) and ASMI( r = 0. 536,P < 0. 05),and BMD was positively correlated with ASMI( r = 0. 381,P<0. 05). Logistical analysis revealed that serum 25( OH) D deficiency( OR= 14. 47,P= 0. 005) was the risk factor for the occurrence of osteoporosis in elderly T2 DM patients. Serum 25( OH) D deficiency( OR =11. 59,P= 0. 015) was the risk factors for the occurrence of skeletal muscle mass decline in elderly T2 DM patients. Conclusion Osteoporosis and skeletal muscle mass reduction are common in elderly patients with T2 DM,and they are closely related. Vitamin D deficiency may be involved in the development of both osteoporosis and skeletal muscle mass reduction.

关 键 词：2型糖尿病 25(OH)D 骨骼肌质量 骨质疏松 老年 

分 类 号：R592[医药卫生—老年医学]