糖尿病微血管病变程度与骨质疏松症的相关性研究  

Study on the Correlation between the Degree of Diabetic Microangiopathy and Osteoporosis

作　　者：谭晓霞 曾庆祥 洪丽荣 连晓芬[1] 黄政杰 张帆[1] TAN Xiaoxia;ZENG Qingxiang;HONG Lirong;LIAN Xiaofen;HUANG Zhengjie;ZHANG Fan(Perking University Shenzhen Hospital,Shenzhen 518000,China;不详)

机构地区：[1]北京大学深圳医院,广东深圳518000 [2]汕头大学医学院临床医学系

出　　处：《中国医学创新》2021年第31期15-19,共5页Medical Innovation of China

基　　金：重大慢性非传染性疾病防控研究项目(2017YFC1310704);广东省高水平医院重点建设医院专项项目(粤办函[2019]260号);深圳市科创委知识创新计划基础研究项目专项课题(深发改[2017]1447)。

摘　　要：目的:探讨糖尿病微血管病变程度与骨质疏松症(osteoporosis,OP)的相关性,为糖尿病患者并发OP的早期诊断提供科学依据。方法:选取2018年12月-2019年12月北京大学深圳医院内分泌科收治的且年龄≥50岁的2型糖尿病(type 2 diabetes mellitus,T2DM)患者404例,按糖尿病微血管病变程度分为0级(n=236)、1级(n=64)、2级(n=53)、3级(n=51),比较不同微血管病变程度患者的骨密度(bone mineral density,BMD)及T值;分析T2DM患者并发OP的影响因素。结果:不同微血管病变程度患者性别、年龄、DM病程、Cr比较,差异均有统计学意义(P<0.05)。不同微血管病变程度患者腰椎L_(1)、L_(2)、L_(3)、L_(4)、L_(1)~L_(4)、股骨颈及股骨BMD、T值比较,差异均有统计学意义(P<0.05),且随着糖尿病微血管病变程度分级升高BMD、T值逐渐降低;与0级比较,1、2和3级腰椎L_(1)、L_(2)、L_(3)、L_(4)、L_(1)~L_(4)、股骨颈及股骨BMD、T值均偏低,差异均有统计学意义(P<0.05)。随着糖尿病微血管病变程度分级升高,OP发生率逐渐升高(χ^(2)=61.60,P=0.000)。经二分类多元logistic回归分析显示,绝经后女性[OR=7.811,95%CI(3.837,15.900),P<0.05]、年龄≥65岁[OR=3.937,95%CI(2.111,7.343),P<0.05]、糖尿病微血管病变程度[OR=2.382,95%CI(1.810,3.134),P<0.05]是并发OP的危险因素,体重指数(BMI)是并发OP的保护因素[OR=0.360,95%CI(0.187,0.691),P<0.05]。结论:随着糖尿病微血管病变程度的进展,骨密度逐渐下降,OP患病率逐渐升高,且绝经后女性、年龄≥65岁、糖尿病微血管病变程度为T2DM患者并发OP的独立危险因素,而BMI≥24 kg/m~2为其保护因素。Objective:To investigate the correlation between the degree of diabetic microangiopathy and osteoporosis(OP)and provide scientific evidence for early diagnosis of OP for T2DM patients.Method:A total of 404 patients with type 2 diabetes mellitus(T2DM)who were admitted to the Department of Endocrinology of Peking University Shenzhen Hospital from December 2018 to December 2019 were selected.According to the degree of diabetic microangiopathy,the patients were divided into grade 0(n=236),grade 1(n=64),grade 2(n=53),grade 3(n=51).Bone mineral density(BMD)and T value of patients with different degrees of diabetic microangiopathy were compared.The influencing factors of OP in T2DM patients were analyzed.Result:There were statistically significant differences in gender,age,DM course and Cr among patients with different degrees of microangiopathy(P<0.05).There were statistically significant differences in BMD and T values of lumbar L_(1),L_(2),L_(3),L_(4),L_(1)-L_(4),femoral neck and femur in patients with different degrees of microangiopathy(P<0.05),and BMD and T values gradually decreased with the increase of the degree of diabetic microangiopathy.Compared with grade 0,BMD and T of lumbar L_(1),L_(2),L_(3),L_(4),L_(1)-L_(4),femoral neck and femur were lower in grade 1,2 and 3,and the differences were statistically significant(P<0.05).The incidence of OP increased with the increase of the grade of diabetic microangiopathy(χ^(2)=61.60,P=0.000).Multivariate analysis of two logistic regression showed that postmenopausal women[OR=7.811,95%CI(3.837,15.900),P<0.05],age≥65 years[OR=3.937,95%CI(2.111,7.343),P<0.05],the degree of diabetic microangiopathy[OR=2.382,95%CI(1.810,3.134),P<0.05]were risk factors for concurrent OP,and BMI≥24 kg/m^(2) was a protective factor for concurrent OP[OR=0.360,95%CI(0.187,0.691),P<0.05].Conclusion:With the development of diabetes microangiopathy,the BMD decreased while the prevalence of OP increased.Postmenopausal women,age≥65 years,the degree of diabetic microangiopathy were the independ

关 键 词：糖尿病微血管病变程度 骨密度 骨质疏松症 

分 类 号：R587.2[医药卫生—内分泌] R580[医药卫生—内科学]