2型糖尿病患者骨密度与腹部脂肪及代谢指标的相关性分析  

Bone Mineral Density,Abdominal Adipose and Metabolic Indexes in Type 2 Diabetes Mellitus Patients:a Correlation Analysis

作　　者：殷丽琴 许文琼[2] YIN Li-qin;XU Wen-qiong(Department of Endocrinology,the First Hospital of Nanchang City,Nanchang 330008;Department of Endocrinology,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌市第一医院内分泌科,南昌330008 [2]南昌大学第一附属医院内分泌科,南昌330006

出　　处：《实用临床医学（江西）》2024年第5期1-7,28,共8页Practical Clinical Medicine

基　　金：江西省卫健委科技计划项目(202130159)。

摘　　要：目的 探讨2型糖尿病(T2DM)患者骨密度(BMD)与腹部脂肪及代谢指标的相关性。方法 选取2020年7-12月南昌大学第一附属医院收治的40岁以上T2DM患者236例,应用定量计算机体层摄影(QCT)测定L1-3BMD、腹部内脏脂肪(AVF)及皮下脂肪(SAF)面积。按BMD值分为骨量正常组84例、低骨量组109例和骨质疏松(OP)组43例,比较3组患者的一般资料、生化指标、骨代谢指标、腹部脂肪及脂肪细胞因子并分析其与BMD的关系。同时以体重指数(BMI)及女性年龄分组,比较各组BMI、腰臀比(WHR)、BMD、AVF及SAF的差异。结果 236例T2DM患者骨量正常者、低骨量者和骨质疏松者分别占35.59%、46.19%和18.22%,女性OP发生率显著高于男性(P <0.05)。低骨量组年龄明显大于骨量正常组和骨质疏松组(P <0.05),骨质疏松组病程明显大于骨量正常组(P <0.05),骨质疏松组甘油三酯(TG)水平明显小于骨量正常组与低骨量组(P <0.05),骨质疏松组β-胶原特殊系列(β-CTX)、总Ⅰ型胶原氨基端延长肽(TP1NP)均明显大于骨量正常组(P <0.05),低骨量组25-羟基维生素D[25(OH)D]明显大于骨量正常组及低骨量组(P <0.05),低骨量组肿瘤坏死因子-α(TNF-α)明显大于骨量正常组(P <0.05),3组间其他指标比较差异均无统计学意义(P>0.05)。体重正常组126例患者AVF <80cm^(2)14例,≥80cm^(2)112例;肥胖组BMI、WHR、AVF、SAF值均显著大于超重组与体重正常组(P <0.05);3组BMD比较差异无统计学意义(P> 0.05)。相关性分析示,BMD与年龄、病程、β-CTX、TP1NP、白介素1β(IL-1β)、白介素6(IL-6)、TNF-α呈负相关(P <0.05);AVF与年龄、BMI、WHR、空腹C肽(FCP)、TG、C反应蛋白(CRP)、IL-1β、IL-6、TNF-α、SAF呈正相关(P <0.05),与高密度脂蛋白胆固醇(HDL-C)呈负相关(P <0.05)。SAF与BMI、WHR、TG、CRP、TNF-α、AVF、血磷(P)呈正相关(P <0.05)。多元有序Logistic回归分析示,女性、年龄、病程、β-CTX是T2DM患者发生OP的危险因素,�Objective To investigate the correlation between bone mineral density(BMD)and abdominal adipose as well as metabolic indexes in patients with type 2 diabetes mellitus(T2DM).Methods A total of 236 patients with T2DM aged over 40 years who were admitted to the First Affiliated Hospital of Nanchang University from July to December 2020 were selected.Quantitative CT(QCT)was used to measure L1-3 BMD,abdominal visceral fat(AVF),and subcutaneous adipose tissue(SAF)area.Based on BMD values,the patients were divided into 3 groups:the normal bone mass group with 84 cases,the low bone mass group with 109 cases,and the osteoporosis(OP)group with 43 cases.The general information,biochemical indicators,bone metabolism indexes,abdominal fat,and adipocytokines of the 3 groups were compared,and their relationships with BMD were analyzed.Meanwhile,patients were grouped based on body mass index(BMI)and female age to compare differences in BMI,waist-hip ratio(WHR),BMD,AVF,and SAF among all groups.Results Among the 236 T2DM patients,those with normal bone mass,low bone mass,and osteoporosis accounted for 35.59%,46.19%,and 18.22%,respectively;the incidence of OP in women was significantly higher than that in men(P<0.05).The ages of patients in the low bone mass group were significantly older than those in the normal bone mass group and the OP group(P<0.05);the disease duration in the OP group was significantly longer than that in the normal bone mass group(P<0.05);the triglyceride(TG)level in the OP group was significantly lower than that in the normal bone mass group and the low bone mass group(P<0.05);the levels ofβ-C-terminal telopeptide of type I collagen(β-CTX)and total procollagen type 1 N-terminal propeptide(TP1NP)in the OP group were significantly higher than those in the normal bone mass group(P<0.05);the level of 25-hydroxyvitamin D[25(OH)D]in the low bone mass group was significantly higher than that in the normal bone mass group and the OP group(P<0.05);the level of tumor necrosis factor-α(TNF-α)in the low bone mass gr

关 键 词：2型糖尿病 骨密度 骨代谢 腹部脂肪 脂肪细胞因子 

分 类 号：R587.1[医药卫生—内分泌]