目的 探讨男性2型糖尿病(type 2 diabetes mellitus,T2DM)患者骨密度(bone mineral density,BMD)的变化与C肽水平关系.方法 采用双能X线骨密度仪对143例糖尿病患者和63例非糖尿病者(对照组)进行腰椎L1-4骨密度测量,记录年龄、体重指数(body mass index,BMI)、糖尿病病程.检测糖化血红蛋白(HbAle)、骨代谢指标及空腹、餐后2h血糖、C肽.采用C肽改良HOMA公式计算胰岛β细胞功能指数(HOMA-β)和胰岛素抵抗指数(HOMA-CR).糖尿病患者根据BMD水平分为2组:骨量正常组(DM-A组)和骨量减少/骨质疏松组(DM-B组).结果 糖尿病患者骨密度、空腹及餐后2hC肽均低于对照组(P＜0.05).与DM-A组相比,DM-B组HOMA-CR、Ⅰ型胶原羧基末端肽β特殊序列(βCTX)水平升高(P＜0.05),Ⅰ型前胶原羧基末端肽(PICP)水平降低(P＜0.05).多元逐步回归结果提示,BMI和空腹C肽是腰椎骨密度的主要影响因素.结论 男性2型糖尿病患者骨密度与空腹C肽水平密切相关,C肽水平偏低的男性2型糖尿病患者更容易发生骨密度降低.%Objective To explore the correlations between bone mineral density (BMD) and C peptide level in male type 2 diabetes patients.Methods BMDs of lumbar spine 1-4 (L1-4) were measured using dual energy X-ray absorptiometry (DXA) in 143 patients with T2DM and 63 normal controls.The data collected in all cases include age, body mass index (BMI) and DM duration.The level of serum glycosylated hemoglobin (HbAlc), bone metabolic markers, fasting and postprandial glucose and C peptide were measured.C peptide was used in modified homeostasis model to evaluate islet β cell function (HOMA-β) and insulin resistance (HOMA-CR).According to the level of BMD, patients were divided into two groups:normal BMD group (DM-A) and osteopenia/osteoporosis group (DM-B).Results BMD, FCP and 2 h CP were significantly reduced in T2DM patients compared with the control group (P ＜ 0.05).Compared with the DM-A group, the levels of HOMA-CR and βCTX were higher, and of PICP were lower in the DM-B group (P ＜ 0.05).Multiple stepwise regression analysis revealed that BMI and FCP were the main factors that influenced BMD of lumbar spine.Conclusion BMD was closely related to the level of FCP in male type 2 diabetes patients,and subjects with lower FCP were more likely to have low BMD.
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