绝经后2型糖尿病患者腰椎体积骨密度和骨转换标志物的变化及其相关因素分析  

Changes of Lumbar Spine Volume Bone Mineral Density and Bone Turnover Markers and Their Correlative Factors in Postmenopausal Patients with Type 2 Diabetes

作　　者：赵梦宇 郭文雨 曹欢 阚全娥 ZHAO Mengyu;GUO Wenyu;CAO Huan;KAN Quan’e(Department of Endocrinology,People’s Hospital of Henan University/Henan Provincial People’s Hospital/People’s Hospital of Zhengzhou University,Zhengzhou 450003,China)

机构地区：[1]河南大学人民医院/河南省人民医院/郑州大学人民医院内分泌科,河南郑州450003

出　　处：《河南医学研究》2022年第22期4105-4109,共5页Henan Medical Research

摘　　要：目的探讨绝经后2型糖尿病(T2DM)患者腰椎体积骨密度(vBMD)和骨转换标志物(BTMs)的变化及其相关因素分析。方法选取2020年12月至2021年12月在河南省人民医院内分泌科住院的170例绝经后2型糖尿病患者。根据定量CT(QCT)骨质疏松(OP)诊断标准将研究对象分为3组:骨量正常组62例、骨量减少组58例、骨质疏松组50例。记录所有研究对象的一般资料。空腹抽血检测空腹血糖(FPG)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C),采用电化学发光法检测雌二醇(E_(2))、25羟维生素D[25(OH)D]、Ⅰ型胶原氨基端肽(PⅠNP)及Ⅰ型胶原羧基端肽β特殊序列(β-CTX)水平。结果骨质疏松组年龄、绝经年限、糖尿病病程、β-CTX均高于骨量减少组和骨量正常组(P<0.05),骨量减少组高于骨量正常组(P<0.05)。骨质疏松组E_(2)、vBMD、25(OH)D、PⅠNP均低于骨量减少组和骨量正常组(P<0.05),骨量减少组低于骨量正常组(P<0.05)。单因素相关性分析显示,腰椎vBMD与PⅠNP、BMI、E_(2)、25(OH)D均呈正相关,与β-CTX、年龄、绝经年限、糖尿病病程、FPG、HbA1c、LDL-C均呈负相关(P<0.05);PⅠNP与BMI、E_(2)、25(OH)D均呈正相关(P<0.05),与年龄、绝经年限、糖尿病病程、TC、LDL-C均呈负相关(P<0.05);β-CTX与年龄、绝经年限、糖尿病病程、FPG、HbA1c、LDL-C均呈正相关(P<0.05),与E_(2)、25(OH)D均呈负相关(P<0.05)。多元逐步线性回归分析显示,年龄、绝经年限、糖尿病病程、25(OH)D、E_(2)、PⅠNP、β-CTX是vBMD的独立影响因素(P<0.05);年龄、E_(2)是PⅠNP的独立影响因素(P<0.05);年龄、绝经年限、E_(2)是β-CTX的独立影响因素。结论绝经后T2DM患者腰椎vBMD和BTMs随着绝经年限、糖尿病病程的延长而发生明显变化,BTMs可预测OP发生风险。多种因素可能共同参与了绝经后T2DM合并OP患者的骨代谢。Objective To investigate the changes of lumbar spine volume bone mineral density(vBMD)and bone turnover markers(BTMs)and analysis of correlative factors in postmenopausal patients with type 2 diabetes.Methods A total of 170 cases of postmenopausal patients with type 2 diabetes were selected in the Department of Endocrinology of Henan Provincial People’s Hospital from December 2020 to December 2021.According to quantitative CT(QCT)osteoporosis(OP)diagnosis criteria guideline,the subjects of study were divided into three groups:62 cases normal bone mass group,58 cases osteopenia group and 50 cases osteoporosis group.The general information of all subjects was recorded.Fasting plasma glucose(FPG),hemoglobin A1c(HbA1c),total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C)were determined.Estradiol(E_(2)),25 hydroxyvitamin D[25(OH)D],procollageⅠN-terminal peptide(PⅠNP),β-isomer of C-terminal telopeptide of typeⅠcollagen(β-CTX)were determined by electrochemil uminescence method.Results Age,menopausal years,diabetic duration,β-CTX of osteoporosis group were higher than those of osteopenia group and normal bone mass group(P<0.05),and those of osteopenia group were higher than those of normal bone mass group(P<0.05).E_(2),vBMD,25(OH)D and PⅠNP of osteoporosis group were lower than those of osteopenia group and normal bone mass group(P<0.05),and those of osteopenia group were lower than those of normal bone mass group(P<0.05).Univariate correlation analysis showed that vBMD and PⅠNP,BMI,E_(2),25(OH)D were positively correlated,vBMD andβ-CTX,age,menopausal years,diabetic duration,FPG,HbA1c,LDL-C were negatively correlated(P<0.05).PⅠNP and BMI,E_(2),25(OH)D were positively correlated,PⅠNP and age,menopausal years,diabetic duration,TC,LDL-C were negatively correlated(P<0.05).β-CTX and age,menopausal years,diabetic duration,FPG,HbA1c,LDL-C were positively correlated,andβ-CTX and E_(2),25(OH)D were negatively correlated(P<0.05).Multiple

关 键 词：绝经 2型糖尿病 体积骨密度 骨质疏松 骨转换标志物 

分 类 号：R587.1[医药卫生—内分泌]