老年男性2型糖尿病患者胰岛素抵抗与骨质疏松关系的研究

摘要

目的 探讨老年男性2型糖尿病(T2DM)患者骨代谢指标及骨密度(BMD)的临床特点,2型糖尿病危险因素与骨密度之间的关系.方法 入选老年男性T2DM患者116例,其中糖尿病肾病(DN)50例,分为T2DM组和DN组,另设老年男性健康对照组50例,记录年龄、体重指数(BMI)、DM病程,均行双能X线骨密度测定检查,并抽血检测空腹血糖(FPG)、糖化血红蛋白(HbA1C)、空腹胰岛素(Fins)、骨代谢、生化等指标的变化,计算稳态胰岛素评估模型胰岛素抵抗(HOMA-IR)指数.结果 (1)T2DM组、DN组年龄和BMI匹配的对照组比较无显著差异(P＞0.05)；DN组病程长于T2DM组,两组比较有统计学意义,(P＜0.05)；(2)T2DM组、DN组的BMD和骨矿含量(BMC)、25-羟基维生素D、睾酮(T)和骨钙素(BGP)水平较对照组降低,差异有统计学意义(P＜0.001与P＜0.05)；DN组较T2DM组更低,两组比较差异有统计学意义(P＜0.05)；(3) T2DM组和DN组的甲状旁腺激素(PTH)、B-胶原系列(B-CL)水平高于对照组,差异有统计学意义(P＜0.001与P＜0.05)；然而DN组又高于T2DM组,差异显著(P＜0.05)；(4)T2DM组、DN组存在胰岛素抵抗(IR),DN组IR尤其显著.HOMA-IR指数与BMD水平呈负相关(P＜0.05).结论 老年男性糖尿病患者DM病程及IR程度均与骨质疏松程度牟正相关,改善老年男性2型糖尿病患者IR对预防其OP的发生和发展有重大意义.%Objective To investigate the clinical characteristics of bone metabolism and bone mineral density (BMD) in elderly males with type 2 diabetes mellitus (T2DM) and to explore the relationship between diabetic risk factors and BMD in these patients. Methods One hundred and sixteen elderly male patients with T2DM were enrolled. The groups were formed as follows, Group T2DM (66 cases) , Group diabetic nephropathy ( DN ) (50 cases) , and control group (50 cases). The data of 116 cases were collected, including age, body mass index ( BMT) , DM duration. BMD was tested using dual energy X-ray absorptiometry and blood samples were tested including fasting plasma glucose ( FPG) , hemoglobin A1C ( HbA1C) , fasting insulin ( Fins) and 4 markers of bone metabolism. Insulin resistance was evaluated by calculating homeostasis model assessment-insulin resistance ( HOMA-IR) index. Results 1) There were no statistical difference in age among the 3 groups ( P > 0. 05). DM duration in DN group was longer than in DM group (P<0.05). 2) The levels of BMD, bone mineral content (BMC), 25-hydroxy vitamin D, testosterone (T), and bone glutamate protein (BCP) in group T2DM and in group DN were statistically lower than those in control group (P <0.001), while the level of these components were the lowest in DN group (P<0.05). 3) The level of parathyroid hormone (PTH), β-collagen series (β-CL) in group T2 DM and group DN were statistically higher than those in control group (P < 0.05), while the level of PTH, β-CL in group DN was the lowest (P < 0. 05). 4) Insulin resistance was more severe in group DN than in group T2DM (P <0. 05), and HOMA-IR was negatively correlated with BMD (P <0.05). Conclusion Both DM duration and insulin resistance (1R) predict the severity of OP, while releasing IR may contribute to the progression of OP in elderly male patients with T2DM.