绝经后2型糖尿病患者骨代谢变化  

Bone metabolism in postmenopausal patients with type 2 diabetes mellitus

作　　者：李俊岩[1] 李剑波 董进[3] 牛晓红[1] LI Jun-yan;LI Jian-bo;DONG Jin;NIU Xiao-hong(Department of Endocrinology,Changzhi Medical College Affiliated Heji Hospital, Changzhi 046000, Shanxi,China;Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University,Nanjing 210000, China;Department of Endocrinology and Metabolism, The First Affiliated Hospital ofShanxi Medical University, Taiyuan 030001, China)

机构地区：[1]长治医学院附属和济医院内分泌科,山西长治046000 [2]南京医科大学第一附属医院内分泌及代谢科,南京210000 [3]山西医科大学第一附属医院内分泌及代谢科,太原030001

出　　处：《中华骨质疏松和骨矿盐疾病杂志》2020年第3期216-221,共6页Chinese Journal Of Osteoporosis And Bone Mineral Research

摘　　要：目的分析绝经后2型糖尿病患者骨密度、骨转换标志物及骨折变化,探讨糖尿病性骨代谢特点。方法纳入2016年4月至2017年12月于长治医学院附属和济医院内分泌科住院的绝经后2型糖尿病患者164例作为研究对象,选取同期体检的年龄相匹配的非糖尿病绝经后女性178名作为健康对照组。对所有对象行骨密度,骨转换标志物及常规生化指标检测,并进行详细问卷调查。结果糖尿病组各个部位骨密度均较健康对照组略升高,但差异均无统计学意义(P>0.05)。糖尿病组骨转换标志物Ⅰ型胶原羧基末端肽交联(β-cross-linked c-terminal telopeptide of type 1 collagen,CTX)较健康对照组升高糖尿病组(0.49±0.26)μg/L vs.对照组(0.44±0.15)μg/L,P=0.047],骨钙素(osteocalcin,OC)及Ⅰ型原胶原氨基末端前肽(total procollagen type 1 N-propeptide,P1NP)较健康对照组降低OC糖尿病组(15.50±5.50)vs.对照组(19.69±5.41)μg/L,P=0.000],P1NP糖尿病组(44.63±19.64)vs.对照组(53.37±14.26)μg/L,P=0.000]。糖尿病组与健康对照组相比骨折发生例数明显增高(P=0.034)。结论绝经后2型糖尿病患者与健康对照相比,各个部位骨密度略升高,但骨形成下降,骨吸收增快,整体骨丢失加快,骨折发生率增高。推测糖尿病可能导致骨丢失加快,尤以皮质骨丢失明显,糖尿病性骨代谢特点仍需要大样本研究证实。Objective To analyze bone mineral density(BMD),bone turnover markers,and osteoporotic fracture in postmenopausal women with type 2 diabetes mellitus(DM),further to investigate the bone metabolic feature of diabetes.Methods This study was a cross-sectional study,which included 164 postmenopausal type 2 diabetes patients who were hospitalized in the Department of Endocrinology and 178 age-matched non-diabetic postmenopausal women who were selected as the healthy control from the Medical Examination Center,in Heji Hospital of Changzhi Medical College from April 2016 to December 2017.BMD and bone turnover markers was measured.The clinical data of all subjects were collected.Results The BMD of the DM group was slightly,but not significantly higher than that of the normal control group(P>0.05).In DM group,β-cross-linked c-terminal telopeptide of type 1 collagen(β-CTX),a bone turnover marker,was higher than that of the control group[(0.49±0.26)μg/L vs.(0.44±0.15)μg/L,P=0.047],osteocalcin(OC)and total procollagen typeⅠN-propeptide(P1NP)was lower than the control group:OC(15.50±5.50)μg/L vs.(19.69±5.41)μg/L,P=0.000,P1NP(44.63±19.64)μg/L vs.(53.37±14.26)μg/L,P=0.000.The fracture rate was significantly higher in DM group than that of the control group(P=0.034).Conclusions Compared with healthy controls,postmenopausal women with type 2 DM have less bone formation,but accelerated bone loss and higher fracture rate.Type 2 DM may contribute to bone loss,especially in cortical bones.A further investigation on a larger scale is needed to clarify the characteristic of DM related bone disease.

关 键 词：骨质疏松 骨密度 绝经后女性 2型糖尿病 

分 类 号：R681[医药卫生—骨科学]