血脂测定在绝经后2型糖尿病妇女骨质疏松中的临床意义

摘要

目的 探讨血脂检测在绝经后2型糖尿病(type 2 diabetes mellitus,T2DM)妇女骨质疏松(osteoporosis,OP)中的临床意义.方法 选取2012年1月至2016年6月我院内分泌科收治的绝经后T2DM患者210例,并选取同期体检的60名无糖代谢异常的绝经后女性作为对照组.检测所有研究对象的血糖、血脂及相关生化指标,采用双能X线骨密度仪检测其腰椎1～4及左股骨颈的骨密度(bone mineral density,BMD).结果 (1)T2DM组的糖尿病病程、空腹血糖(fasting blood glucose,FBG)、餐后2 h血糖、糖化血红蛋白(glycosylated hemoglobin,HbA1c)、总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol ,LDL-C)高于对照组,而高密度脂蛋白胆固醇(high density lipoprotein cholesterol ,HDL-C)及左股骨颈BMD低于对照组(P＜0.05). T2DM组中骨量减少及OP组血清磷与BMD正常组相比显著降低,而LDL-C显著增高;OP组与骨量减少组相比LDL-C亦增高(P＜0.05). (2)T2DM组Pearson相关分析显示,FBG、血清磷、血尿酸均与腰椎1～4 BMD、左股骨颈BMD呈正相关,而碱性磷酸酶、LDL-C均与腰椎1～4 BMD、左股骨颈BMD呈负相关;TC与腰椎1～4 BMD呈负相关,HbA1c、甘油三酯与左股骨颈BMD呈正相关. (3)多因素Logistic分析显示,LDL-C是绝经后T2DM女性BMD降低的独立危险因素(β=1.522,P=0.000). (4)ROC曲线结果显示,LDL-C为2.09 mmol/L时预测绝经后T2DM女性BMD降低的敏感性为87.9%、特异性为64.3%,曲线下面积为0.69.结论 血清LDL-C水平与绝经后T2DM女性BMD降低密切相关,对临床上早期发现OP并采取有效措施具有指导意义.%Objective To investigate the clinical significance of serum lipids determination in osteoporosis in postmenopausal women with type 2 diabetes mellitus(T2DM).Methods A total of 210 postmenopausal women with type 2 diabetes who were in-patients of the Endocrinology Department of Wuxi People’s Hospital were selected from January 2012 to June 2016, while the control group consisted of 60 postmenopausal women without abnormal glucose metabolism.Serum lipid profiles, blood glucose and related blood biochemical parameters were determined in all participants.BMD of lumbar spine 1-4 and the left femoral neck was measured by dual-energy X-ray absorptiometry scanning.Results (1) Compared with the control group, the duration of diabetes, FPG, 2 h PBG, HbA1C, TC and LDL-C were higher, whereas HDL-C and BMD of the left femoral neck were lower in the T2DM group (P＜0.05).In T2DM participants, compared with the normal BMD group, serum phosphorus was significantly lower and LDL-C was significantly higher in the osteopenia and osteoporosis groups (P＜0.05).In addition, LDL-C was also higher in the osteoporosis group than in the osteopenia group (P＜0.05).(2) Pearson correlation analysis of the T2DM group showed that FBG, serum phosphorus and uric acid were positively correlated with BMD of the lumbar spine 1-4 and the left femoral neck, while AKP, LDL-C were negatively correlated with BMD of the lumbar spine 1-4 and the left femoral neck.TC was negatively correlated with BMD of the lumbar spine 1-4, and HbA1C and TG were positively correlated with BMD of the left femoral neck.(3) Multivariate logistic analysis showed that LDL-C was an independent risk factor for decreased BMD in postmenopausal women with T2DM (β=1.522, P =0.000).(4) ROC curve analysis revealed that the sensitivity of LDL-C 2.09 mmol/L was 87.9%, specificity 64.3%, and 0.69 under the curve when it was used to predict decreased BMD in postmenopausal women with T2DM. Conclusion Serum LDL-C level was closely related to the decrease of BMD in postmenopausal women with T2DM, and it is of guiding significance to find osteoporosis in the early stage and to take effective measures.