2型糖尿病患者糖脂代谢、血清钙磷、骨代谢与骨密度的相关性研究  

Correlation of glucolipid metabolism,serum calcium and phosphorus,bone metabolism and bone mineral density in type 2 diabetic patients

作　　者：安红红 徐静[3] 马迎惠 李翀 宋凯琳 彭巧君[4] AN Honghong;XU Jing;MA Yinghui;LI Chong;SONG Kailin;PENG Qiaojun(College of Nursing,Xinjiang Medical University,Urumqi 830001,China;The Fourth Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Department of Endocrinology,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830001,China;Inpatient Department,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830001,China)

机构地区：[1]新疆医科大学护理学院,新疆乌鲁木齐830001 [2]新疆医科大学第四附属医院,新疆乌鲁木齐830054 [3]新疆医科大学第一附属医院内分泌科,新疆乌鲁木齐830001 [4]新疆医科大学第一附属医院住院部,新疆乌鲁木齐830001

出　　处：《现代医学》2023年第3期318-323,共6页Modern Medical Journal

基　　金：新疆维吾尔自治区卫生健康青年医学科技人才专项科研资助项目(WJWY-202208)。

摘　　要：目的:探讨2型糖尿病(T2DM)患者糖脂代谢、血清钙磷及骨代谢与骨密度(BMD)的相关性。方法:选择2021年12月至2022年8月住院的178例T2DM患者,根据双能X线骨密度仪对患者腰椎L1~L4及股骨近端(股骨颈、大转子和全髋骨)BMD进行测定,并根据骨质疏松诊断标准将患者分为骨量正常组(T值≥-1.0,60例)、骨量减少组(-2.5<T值<-1.0,59例)、骨质疏松组(T值≤-2.5,59例)。分析3组患者的糖脂代谢指标、血清钙磷及骨代谢指标与骨密度间的关系,并进行有序Logistic回归分析。结果:3组患者的性别、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、血清C肽、钙、磷、25羟维生素D[25(OH)D]、甲状旁腺激素(PTH)、β胶原特殊序列(β-CTX)及骨钙素(OC)比较差异均有统计学意义(P<0.05)。经Pearson相关性分析结果显示,β-CTX、总Ⅰ型胶原氨基端延长肽(TP1NP)、OC、PTH、25(OH)D与糖尿病病程、性别、FBG、HbAlc、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、总胆固醇(TC)、血清C肽、钙、磷等指标均存在相关性(P<0.05)。有序Logistic回归分析显示,患者的病程、25(OH)D、PTH、OC、钙、β-CTX、PBG等指标与骨质疏松的发生密切关联,病程增加(OR=1.090,95%CI 1.012~1.174)、β-CTX(OR=112.435,95%CI 2.908~4346.825)和PTH(OR=2.536,95%CI 1.600~4.020)水平升高是引起T2DM患者发生骨质疏松的主要危险因素。结论:T2DM患者的病程、PBG、25(OH)D、PTH、钙、OC、β-CTX与骨密度之间存在一定的相关性,且病程增加、β-CTX和PTH水平升高与骨质疏松的发生密切相关,应结合各影响因素对T2DM患者的骨量异常情况进行防治。Objective:To explore the correlation between glucose and lipid metabolism,serum calcium,phosphorus and bone metabolism and bone mineral density(BMD)in type 2 diabetes(T2DM)patients.Methods:178 patients with T2DM who were hospitalized from December 2021 to August 2022 were selected,and BMD of the lumbar spine L1-L4 and proximal femur(femoral neck,greater trochanter and total hip)was measured according to dual-energy X-ray bone densitometry,and the patients were divided into normal bone mass group(T≥-1.0,n=60),reduced bone mass group(-2.5<T<-1.0,n=60)and osteoporosis group(T≤-2.5,n=60).The relationships between glucose and lipid metabolic indexes,serum calcium and phosphorus and bone metabolic indexes and bone mineral density wereanalyzed in the three groups,and ordered Logistic regression analysis was performed.Results:There were significant differences in gender,FBG,HbA1C,serum C peptide,calcium,phosphorus,25(OH)D,PTH,β-CTX and OC between the three groups(P<0.05).According to Pearson correlation analysis,β-CTX,TP1NP,OC,PTH,25(OH)D were significantly correlated with diabetes duration,gender,FBG,HbAlc,LDL-C,TG,TC,serum C-peptide,calcium,phosphorus and other indicators(P<0.05).Sequential Logistic regression analysis showed that the disease duration,25(OH)D,PTH,OC,calcium,β-CTX and PBG were related to the occurrence of osteoporosis,the increase of disease duration(OR=1.090,95%CI 1.012-1.174),β-CTX(OR=2.536,95%CI 1.600-4.020)and PTH(OR=2.536,95%CI 1.600-4.020)were the main risk factors of osteoporosis in T2DM patients.Conclusion:The course of T2DM patients,PBG,25(OH)D,PTH,calcium,OC,β-CTX have a certain correlation with bone mineral density,and the increase of disease duration,elevated levels ofβ-CTX and PTH are closely related to the occurrence of osteoporosis.It is necessary to combine various factors to prevent and treat the abnormal bone mass of T2DM patients.

关 键 词：2型糖尿病 维生素D 骨质疏松 骨代谢 

分 类 号：R587.1[医药卫生—内分泌]