中老年2型糖尿病患者骨代谢特点及骨量丢失危险因素分析  

Analysis of bone metabolism characteristics and risk factors of bone loss in middle aged and elderly patients with type 2 diabetes mellitus

作　　者：李霞 赵同峰[1] 雷涛 LI Xia;ZHAO Tongfeng;LEI Tao(Department of Endocrinology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655;Department of Endocrinology, Putuo District Center Hospital, Shanghai 200062, China)

机构地区：[1]中山大学附属第六医院内分泌科,广东广州510655 [2]普陀区中心医院内分泌科,上海200062

出　　处：《中国骨质疏松杂志》2021年第1期105-109,共5页Chinese Journal of Osteoporosis

基　　金：上海市医学重点专科建设项目(ZK2019B16)。

摘　　要：目的探讨中老年2型糖尿病(type 2 diabetes mellitus,T2DM)患者骨代谢特点及骨量丢失危险因素。方法选择中老年T2DM患者612例(男296例,女316例),根据骨密度(bone mineral density,BMD)水平分为骨量正常组(108例)、骨量减少组(281例)、骨质疏松组(223例),分析各组差异及其相关性。结果女性患者中,骨质疏松组的年龄、甲状旁腺激素(parathyroid hormone,PTH)、I型前胶原N-末端肽(procollagen type I N propeptide,PINP)、I型胶原交联C-末端肽(collagen type I cross-linked C-telopeptide,CTX)显著增高,体质量指数(body mass index,BMI)、尿酸(uric acid,UA)、25-羟基维生素D[25-hydroxy vitamin D,25(OH)D]显著降低;腰椎L1~4 BMD与BMI、UA、25(OH)D正相关,与年龄、PTH、PINP、CTX负相关。男性患者中,骨质疏松组PTH显著增高,BMI显著降低;腰椎L1~4 BMD与BMI、UA正相关,与PTH负相关。Logistic回归分析显示高龄、高PTH、高PINP、低BMI、低UA、低25(OH)D是女性T2DM患者骨量丢失的危险因素,高PTH、低BMI是男性骨量丢失的危险因素。结论中老年女性T2DM合并骨质疏松患者骨转换水平增高,而男性骨转换水平无显著变化,但两者骨质疏松的发病可能均与低BMI、高PTH水平有关。Objective To analyze bone metabolism characteristics and risk factors of bone loss in middle aged and elderly patients with type 2 diabetes mellitus(T2DM).Methods Six hundred and twelve T2DM patients were divided into 3 groups according to bone mineral density(BMD)level,normal group(108 cases),osteopenia group(281 cases),and osteoporosis group(223 cases).The differences among the groups were analyzed.Results In females,age and the levels of parathyroid hormone(PTH),procollagen type I N-propeptide(PINP),and collagen type I cross-linked C-telopeptide(CTX)were significantly higher,but body mass index(BMI),uric acid(UA),and 25-hydroxy vitamin D[25(OH)D]were significantly lower in osteoporosis group.BMD of the lumbar spine1-4 was positively correlated to BMI,UA,and 25(OH)D,but negatively correlated to age,PTH,PINP and CTX.In males,PTH was significantly higher but BMI was significantly lower in osteoporosis group.BMD of the lumbar spine1-4 was positively correlated to BMI and UA but negatively correlated to PTH.Ordinal logistic regression result showed that age,high level of PTH or PINP,low levels of BMI,UA,or 25(OH)D were risk factors of osteoporosis in females.High level of PTH and low level of BMI were risk factors of osteoporosis in males.Conclusion Bone turnover level increases in female osteoporosis patients with type 2 diabetics but it has no significant change in males.However,low BMI and high PTH level are associated with the development of osteoporosis in both female and male patients.

关 键 词：2型糖尿病 骨代谢 生化指标 骨量丢失 骨质疏松 

分 类 号：R587.1[医药卫生—内分泌]