绝经后女性2型糖尿病患者血尿酸水平与骨密度的相关性研究  

Correlation between blood uric acid levels and bone mineral density in postmenopausal women with type 2 diabetes mellitus

作　　者：刘倩[1] 张捷[2] 张景云[1] 张秋梅[1] 王宝利[1] 潘从清[3] Liu Qian;Zhang Jie;Zhang Jingyun;Zhang Qiumei;Wang Baoli;Pan Congqing(Department of Endocrinology,Tianjin Medical University Chu Hsien-I Memorial Hospital,National Health Comission Key Laboratory of Hormones and Development(Tianjin Medical University),Tianjin Key Laboratory of Metabolic Diseases,Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology,Tianjin Medical University,Tianjin 300134,China;Department of Radiology,Tianjin Medical University Chu Hsien-I Memorial Hospital,National Health Comission Key Laboratory of Hormones and Development(Tianjin Medical University),Tianjin Key Laboratory of Metabolic Diseases,Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology,Tianjin Medical University,Tianjin 300134,China;Department of Integrated Traditional Chinese Medicine and Western Medicine,Tianjin Medical University Chu Hsien-I Memorial Hospital,National Health Comission Key Laboratory of Hormones and Development(Tianjin Medical University),Tianjin Key Laboratory of Metabolic Diseases,Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology,Tianjin Medical University,Tianjin 300134,China)

机构地区：[1]天津医科大学朱宪彝纪念医院内分泌科、天津市内分泌研究所、国家卫生健康委员会激素与发育重点实验室、天津市代谢性疾病重点实验室,天津300134 [2]天津医科大学朱宪彝纪念医院放射科、天津市内分泌研究所、国家卫生健康委员会激素与发育重点实验室、天津市代谢性疾病重点实验室,天津300134 [3]天津医科大学朱宪彝纪念医院中西医结合科、天津市内分泌研究所、国家卫生健康委员会激素与发育重点实验室、天津市代谢性疾病重点实验室,天津300134

出　　处：《中华糖尿病杂志》2024年第10期1118-1124,共7页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：天津市教委科研计划项目(2021KJ240)。

摘　　要：目的探讨绝经后女性2型糖尿病(T2DM)患者血尿酸水平与骨密度(BMD)的相关性。方法采用横断面研究方法,回顾性选取2019年9月至2022年12月在天津医科大学朱宪彝纪念医院住院的绝经后女性T2DM患者为研究对象。收集研究对象血尿酸以及腰椎、全髋和股骨颈的BMD。按照血尿酸水平将研究对象分为4组,分别为T_(1)组(血尿酸≤242.3μmol/L)、T_(2)组(242.3<血尿酸≤288.2μmol/L)、T_(3)组(288.2<血尿酸≤336.8μmol/L)和T_(4)组(血尿酸>336.8μmol/L)。按照BMD结果将研究对象分为骨量正常组(T值≥-1)、骨量减少组(-2.5<T值<-1)和骨质疏松组(T值≤-2.5)。组间比较采用方差分析、Kruskal-Wallis H检验或χ^(2)检验,采用多元线性回归模型分析血尿酸与BMD的相关性,应用限制性立方样条分析血尿酸水平与骨量减少和骨质疏松发生的相关性。结果共纳入2027例绝经后女性T2DM患者。其中,T_(1)组507例,T_(2)组507例,T_(3)组508例,T_(4)组505例。骨量正常组430例,骨量减少组1117例,骨质疏松组480例。T_(1)、T_(2)、T_(3)、T_(4)组间的血尿酸(H=1899.375,P<0.001),以及腰椎BMD(F=5.979,P<0.001)、全髋BMD(F=6.156,P<0.001)、股骨颈BMD(F=2.669,P=0.046)差异均有统计学意义。多元线性回归分析结果显示,调整了多个混杂因素后,血尿酸仍然与腰椎BMD(r=0.432,P=0.022)、全髋部位BMD(r=0.432,P=0.012)存在相关性。骨量正常组、骨量减少组、骨质疏松组间血尿酸差异有统计学意义(F=6.647,P=0.001)。限制性立方样条分析结果显示,血尿酸与绝经后女性T2DM患者骨量异常的发生呈负向剂量-反应关系(P整体=0.0128,P非线性=0.8991),当血清尿酸浓度低于288.0717μmol/L时,骨量异常的发生率增加(OR=1.0003,95%CI 1.0001~1.0006,P非线性=0.8991)。结论在绝经后女性T2DM患者中,血尿酸与BMD呈正相关,血尿酸水平降低与这类患者骨量减少、骨质疏松的发生相关。Objective To investigate the correlation between serum uric acid levels and bone mineral density(BMD)in postmenopausal women with type 2 diabetes mellitus(T2DM).Methods Using a cross-sectional study design,a retrospective analysis was conducted on postmenopausal female patients with T2DM who were hospitalized at Chu Hsien-I Memorial Hospital of Tianjin Medical University from September 2019 to December 2022.Serum uric acid levels and BMD of the lumbar spine,total hip,and femoral neck were collected.The patients were divided into four groups based on blood uric acid levels:T_(1)group(uric acid≤242.3μmol/L),T_(2)group(242.3<uric acid≤288.2μmol/L),T_(3)group(288.2<uric acid≤336.8μmol/L),and T_(4)group(uric acid>336.8μmol/L).According to the BMD results,the subjects were divided into normal bone mass group(T value≥-1),osteopenia group(-2.5<T value<-1)and osteoporosis group(T value≤-2.5).Comparisons between groups were conducted using analysis of variance(ANOVA),Kruskal-Wallis H test,orχ^(2)test.The correlation between blood uric acid and BMD was analyzed using a multiple linear regression model.Restricted cubic spline analysis was used to examine the relationship between blood uric acid levels and the occurrence of osteopenia/osteoporosis.Results A total of 2027 postmenopausal women with T2DM were included in the study.There were 507 cases in T_(1)group,507 cases in T_(2)group,508 cases in T_(3)group,and 505 cases in T_(4)group.There were 430 cases in the normal bone mass group,1117 cases in the osteopenia group,and 480 cases in the osteoporosis group.There were statistically significant differences in blood uric acid levels(H=1899.375,P<0.001),as well as in lumbar spine BMD(F=5.979,P<0.001),total hip BMD(F=6.156,P<0.001),and femoral neck BMD(F=2.669,P=0.046)among the groups.The results of multiple linear regression analysis showed that after adjusting for multiple confounding factors,blood uric acid was still significantly correlated with lumbar spine(r=0.432,P=0.022)and total hip BMD(r=0.432,P=0.012)

关 键 词：糖尿病 2型 绝经后女性 血尿酸 骨量减少 骨质疏松 

分 类 号：R587.1[医药卫生—内分泌]