2型糖尿病患者骨质疏松发生率及骨代谢生化指标测定分析

摘要

目的 探讨2型糖尿病患者合并骨质疏松的发生率及骨代谢生化指标变化.方法 ①对142例2型糖尿病患者进行桡骨定量骨超声测定及骨钙素、尿1型胶原C端肽及血钙、磷、碱性磷酸酶等骨代谢生化指标检测,分别计算男、女2型糖尿病患者骨质疏松发生率并与非糖尿病对照人群进行比较;②分析糖尿病患者骨超声测定值(骨超声波波速,SOS,m/s)与其年龄、病程、代谢控制程度及体重指数等之间的关系;③根据骨超声测定结果将2型糖尿病患者分为合并骨质疏松组、骨量减少组与未合并骨质疏松组,比较组三间的骨代谢生化指标变化,并与健康对照组做比较.结果 ①糖尿病患者骨质疏松发生率明显高于非糖尿病人群,②糖尿病患者骨超声值与其年龄、病程、尿CTX及体重指数呈负相关,与骨钙素、糖化血红蛋白及空腹血糖未发现相关性;③糖尿病患者中合并骨质疏松组尿CTX测定明显高于骨量减少组及骨量正常组(P<0.05),血PTH在骨质疏松组明显高于骨量正常组,血钙、磷、碱性磷酸酶及血清骨钙素测定组间相比无显著性差异(P>0.05);总体糖尿病患者与非糖尿病对照人群相比血清骨钙素测定明显降低(P<0.05),尿CTX明显升高(P<0.05).结论 2型糖尿病患者较易患骨质疏松,其骨代谢改变特点是:骨形成下降、骨吸收增加,糖尿病骨代谢异常的发生与众多因素有关,在治疗糖尿病的同时,应注意骨质疏松的预防和治疗.%Objective To explore the incidence of osteoporosis and the change of bone metabolic and biochemical markers in patients with type-2 diabetes mellitus. Methods ① 142 type-2 diabetes mellitus patients were selected to measure the bone mass in the radius using quantitative ultrasound (QUS) and the biochemical markers of bone metabolism, including bone GLa protein (BGP), urine cross-linked C-telopeptide of type Ⅰ collagen ( CTX-1 ), serum calcium ( Ca ), serum phosphorus ( P ), and alkaline phosphatase (ALP). Incidence of osteoporosis was calculated in male and female diabetic patients,respectively. The results were compared with those in non-diabetic control subjects; ②The relationship between the speed of sound (SOS) in the radius in diabetic patients and the age, course of the disease,metabolic control level, and body mass index (BMI) was analyzed. ③The patients with type-2 diabetes were divided into following 3 groups according to the bone quantitative ultrasound results: osteoporosis group, low bone mass group, and normal bone mass group, Biochemical markers of bone metabolism among groups were compared. The results were also compared to those in control group. Results ① The incidence of osteoporosis in patients with type-2 diabetes mellitus was significantly higher than those in non-diabetic people. ②SOS in diabetic patients was negatively correlated with age, course of the disease, urine CTX,and BMI, and no correlations were found with BGP, HbA1C, and FBG. ③ Urine CTX of patients in osteoporosis group was significantly higher than that in low bone mass group and normal bone mass group (P ＜ 0. 05 ). Serum PTH of patients in osteoporosis group was significantly higher than that in normal bone mass group. Serum Ca, P, ALP, and BGP had not obvious difference among different groups ( P ＞ 0.05 ).BGP of diabetic patients was decreased significantly ( P ＜ 0. 05 ), and the level of urine CTX was increased significantly ( P ＜ 0. 05 ), compared to that of non-diabetic control subjects. Conclusion The patients with type-2 diabetes mellitus were vulnerable to osteoporosis. Their bone metabolism changes included decreased bone formation and increased bone absorption. The abnormal bone metabolism in type-2 diabetes mellitus was related to many factors. We should pay attention to the prevention and treatment of osteoporosis during the treatment of diabetes.