2型糖尿病患者葡萄糖目标范围内时间与骨量异常的相关性  

Correlation between Time in Range and Abnormal Bone Mass in Patients with Type 2 Diabetes Mellitus

作　　者：龚怡然 赖若男 黄林晶[4,5] 陈秀清[4,5] 吴佩文[4,5] GONG Yiran;LAI Ruonan;HUANG Linjing;CHEN Xiuqing;WU Peiwen(Department of General Medicine,The First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China;Department of General Medicine,National Regional Medical Center,Binhai Campus of the First Affiliated Hospital,Fujian Medical University,Fuzhou 350212,China;The School of Basic Medical Sciences,Putian University,Putian 351100,China;Department of Endocrinology,The First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China;Department of Endocrinology,National Regional Medical Center,Binhai Campus of the First Affiliated Hospital,Fujian Medical University,Fuzhou 350212,China)

机构地区：[1]福建医科大学附属第一医院全科医学科,福州350005 [2]福建医科大学附属第一医院滨海院区国家区域医疗中心全科医学科,福州350212 [3]莆田学院基础医学院,莆田351100 [4]福建医科大学附属第一医院内分泌科,福州350005 [5]福建医科大学附属第一医院滨海院区国家区域医疗中心内分泌科,福州350212

出　　处：《福建医科大学学报》2024年第6期377-385,共9页Journal of Fujian Medical University

基　　金：福建省中青年教师教育科研项目(JAT220105)。

摘　　要：目的探讨2型糖尿病(T2DM)患者葡萄糖目标范围内时间(TIR)与骨量异常的相关性。方法回顾性收集2020年9月-2023年12月住院诊治并接受瞬感扫描式葡萄糖监测(FGM)的T2DM患者420例,分为骨量正常组237例、骨量减少组131例和骨质疏松组52例,比较3组的基线资料。再以TIR四分位间距进行分组,比较不同TIR区间骨量情况及临床指标。采用Pearson相关或Spearman秩相关分析评价TIR与各临床生化指标及骨密度的相关性。采用多因素logistic回归分析评估TIR与骨量减少和骨质疏松发生风险的相关性,并绘制受试者工作特征(ROC)曲线分析其预测价值。结果3组在年龄、性别、体质量指数(BMI)、糖尿病病程、TIR等方面比较,差别有统计学意义(P<0.05)。随着TIR百分位数升高,骨量减少、骨质疏松的发生率呈现下降趋势。相关性分析表明,TIR与BMI、空腹C肽、尿酸、肌酐、25\|羟基维生素D、骨密度呈正相关,与糖尿病病程、空腹血糖、糖化血红蛋白、高密度脂蛋白胆固醇、尿白蛋白/肌酐比值呈负相关(P<0.05)。logistic回归分析显示,在校正混杂影响因素后,TIR与骨量减少及骨质疏松的发生呈负相关。绘制ROC曲线,可见T2DM患者的TIR预测骨量减少发生的曲线下面积(AUC)为0.660,最佳临界值为69.65%;预测骨质疏松发生的AUC为0.680,最佳临界值为69.47%。结论T2DM患者TIR与骨量异常(包括骨量减少和骨质疏松)发生独立相关,TIR水平增加能有效降低骨量异常发生风险,其预测价值具有临床应用潜力,可为T2DM性骨质疏松的预防提供相关依据。Objective To investigate the correlation between time in range(TIR)and abnormal bone mass in patients with type 2 diabetes mellitus.Methods A total of 420 patients with T2DM hospitalized from September 2020 to December 2023 and receiving flash glucose monitoring(FGM)were retrospectively collected.They were divided into normal bone mass group(n=237),osteopenia group(n=131)and osteoporosis group(n=52).Baseline data were compared among the three groups.Patients were grouped by TIR interquartile range,then the bone mass and clinical indicators in different TIR intervals were compared.Pearson correlation or Spearman rank correlation analysis was used to evaluate the correlation between TIR and clinical biochemical indexes and bone mineral density.Multivariate logistic regression analysis was used to assess the association of TIR with the risk of osteopenia and osteoporosis,and receiver operating characteristic(ROC)curves were drawn to analyze the predictive value.Results There were significant differences in age,sex,body mass index(BMI),diabetes duration and TIR among the three groups(P<0.05).With the increase of TIR percentile,the incidence of osteopenia and osteoporosis showed a decreasing trend.Correlation analysis showed that TIR was positively correlated with BMI,fasting C-peptide,uric acid,creatinine,25-hydroxyvitamin D and bone mineral density,however,there was a negative correlation with the duration of diabetes,fasting blood glucose,glycated hemoglobin A1c,high-density lipoprotein-cholesterol and urinary albumin-to-creatinine ratio(P<0.05).Logistic regression analysis showed that TIR was negatively correlated with osteopenia and osteoporosis after adjusting for confounding factors.The ROC curve results showed that the area under curve(AUC)of TIR for predicting osteopenia in T2DM was 0.660,with the best cut-off value being 69.65%.And the AUC of TIR for predicting osteoporosis was 0.680,with the best cut-off value being 69.47%.Conclusion In patients with T2DM,TIR is independently associated with abnormal bone m

关 键 词：2型糖尿病 目标范围内时间 骨量异常 相关性 

分 类 号：R58[医药卫生—内分泌]