2型糖尿病患者周围神经病变与骨密度的关系  

Relationship between peripheral neuropathy and bone mineral density in patients with type 2 diabetes mellitus

作　　者：杜娟 陆轶群[2] 孙晔子[1] DU Juan;LU Yiqun;SUN Yezi(Department of Endocrinology,First People's Hospital of Zhangjiagang,Zhangjiagang 215699,CHINA)

机构地区：[1]张家港市第一人民医院内分泌科,江苏215699 [2]苏州大学附属第一医院内分泌科

出　　处：《江苏医药》2023年第2期172-176,共5页Jiangsu Medical Journal

摘　　要：目的探讨2型糖尿病(T2DM)患者周围神经病变与骨密度的关系。方法按照2011年中国骨质疏松诊断标准,300例T2DM患者分为骨量正常组(A组,113例)、骨量减少组(B组,102例)和骨质疏松组(C组,85例)。收集患者相关临床资料,计算肾小球滤过率(GFR)和胰岛素抵抗指数,测定双足震动感觉阈值,并分析T2DM患者发生骨质疏松的影响因素以及震动感觉阈值与临床指标的相关性。结果与A组相比,B组和C组年龄、颈动脉粥样硬化发生率、双足震动感觉阈值增加,男性患者比例、体重、GFR减少(P<0.05);C组男性患者比例低于B组,双足震动感觉阈值高于B组(P<0.05);C组ALP和餐后2-h胰岛素水平高于A组和B组(P<0.05)。多因素logistic回归分析发现,高右足震动感觉阈值和高水平ALP是T2DM患者发生骨质疏松的独立危险因素(P<0.01),而男性是T2DM患者发生骨质疏松的独立保护因素(P<0.01)。右足震动感觉阈值与患者年龄、ALP水平、颈动脉粥样硬化呈正相关(P<0.05或P<0.01),与GFR呈负相关(P<0.01)。结论T2DM患者骨密度与周围神经病变密切相关,周围神经病变的发生常伴随骨量减少,从而易导致骨质疏松。Objective To investigate the relationship between the peripheral neuropathy and bone mineral density in the patients with type 2 diabetes mellitus(T2DM).Methods According to the Chinese diagnostic criteria of osteoporosis 2011,a total of 300 T2DM patients were divided into three groups of A(with normal bone mass,113 cases),B(with osteopenia,102 cases)and C(with osteoporosis,85 cases).The relevant clinical data were collected.The glomerular filtration rate(GFR)and homeostasis model assessment-insulin resistance(HOMA-IR)were calculated,and the vibration perception threshold of the feet was measured.The factors influencing the incidence of osteoporosis in T2DM patients and the correlation between the vibration perception threshold and clinical indexes were analyzed.Results Compared with group A,the age,incidence of carotid atherosclerosis and vibration perception threshold of the feet were increased,while the percentage of male,body weight and GFR were decreased in groups of B and C(P<0.05).The percentage of male was lower,while the vibration perception threshold of the feet was higher in group C than those in group B(P<0.05).The levels of ALP and postprandial 2-hour insulin in group C were higher than those in groups of A and B(P<0.05).The multivariate logistic regression analysis showed that higher vibration perception threshold of right foot and level of ALP were the independent risk factors(P<0.01),while the male was the independent protective factor for the osteoporosis in T2DM patients(P<0.01).The vibration perception threshold of right foot was positively correlated with age,level of ALP and carotid atherosclerosis(P<0.05 or P<0.01),and was negatively correlated with GFR(P<0.01).Conclusion The bone mineral density is closely related to the peripheral neuropathy in T2DM patients.The development of peripheral neuropathy is often accompanied by the decrease of bone mass,which is likely to lead to osteoporosis.

关 键 词：2型糖尿病 周围神经病变 骨密度 骨质疏松 

分 类 号：R587[医药卫生—内分泌]