不同体重指数的社区男性2型糖尿病患者骨代谢与胰岛素抵抗的相关性研究

摘要

目的 探讨不同体重指数(BMI)的社区男性2型糖尿病(T2DM)患者骨代谢与胰岛素抵抗的相关性.方法 根据BMI值将82例北京朝阳社区男性T2DM患者分为肥胖组、超重组及正常组,分别进行生化及骨转换指标检测、胰岛素-C肽释放试验及骨密度(BMD)检查,采用胰岛素抵抗指数(HOMA-IR)、胰岛素作用指数(IAI)、胰岛素分泌指数(IS)评价其胰岛功能并进行比较分析.结果 3组患者年龄、腰围、WHR、总睾酮(TT)、TC、HDL-C、TG、FPG、腰椎及全髋BMD比较差异均有统计学意义(P<0.05).在肥胖组患者中,HOMA-IR与血清钙呈正相关(P=0.017),与骨钙素(BGP)呈负相关(P=0.020);IAI与腰椎BMD呈正相关(P=0.002);IS与血清钙呈正相关(P=0.021),与BGP、β-胶原降解产物(β-CTX)呈负相关(P=0.015、P=0.038);FINS与血清钙呈正相关(P=0.046);餐后2 h胰岛素与25(OH)D呈负相关(P=0.035);空腹C肽与I型胶原氨基末端肽(P1NP)呈正相关(P=0.035),与全髋及股骨颈BMD呈负相关(P<0.001、P=0.002);餐后2h C肽与P1NP呈正相关(P=0.002),与25(OH)D、全髋及股骨颈BMD均呈负相关(P=0.039、P<0.001、P=0.001);Hb1Ac与BGP呈负相关(P=0.042).Logistic回归分析结果显示,LDL-C升高是BMD减低的危险因素(OR=2.117,95%CI 1.106~4.050,P=0.024),而BMI增加为其保护因素(OR=0.810,95%CI 0.665~0.987,P=0.037).结论 不同BMI社区男性T2DM患者的BMD有明显差异,胰岛素抵抗及血糖控制情况可影响其骨代谢,而高BMI为其BMD减低的保护因素.%Objective To investigate the relationship between bone metabolism and insulin resistance in male T2DM patients from community with different BMI. Methods Eighty-two male patients with T2DM were divided into obesity group,overweight group and normal group based on their BMI. The biochemical indicators,bone turnover markers,insulin and C peptide releasing test and BMD were examined. HOMA-IR,IAI and IS were used to evaluate the islet function. Results Age,waist,WHR,TT,TC,HDL-C,TG,FPG and BMD of lumbar and total hip were significantly different among 3 groups (P <0. 05). In obesity group,positive correlations were found between HOMA-IR and serum Ca (P =0. 017),IAI and BMD of lumbar(P =0. 002),IS and serum Ca(P = 0. 021),FINS and serum Ca(P = 0. 046),fasting C-peptide and N-propeptide of type 1 collagen(P1NP,P =0. 035),postprandial C-peptide and P1NP(P = 0. 002).Negative correlations were found between HOMA-IR and BGP(P =0. 020),IS and BGP(P = 0. 015),IS and β-CTX(P =0. 038),postprandial insulin and 25(OH)D(P =0. 035),fasting C-peptide and BMD of total hip (P < 0. 001 ) and femoral neck (P = 0. 002 ),postprandial C-peptide and 25 (OH)D(P =0. 039),postprandial C-peptide and BMD of total hip(P < 0. 001)and femoral neck(P = 0. 001),HbA1c and BGP(P =0. 042). Logistic regression analysisshowed that,LDL-C increasing was a risk factor (OR =2. 117,95% CI 1. 106-4. 050,P = 0. 024)and BMI increasing was a protective factor(OR = 0. 810,95% CI 0. 665-0. 987,P =0. 037)of BMD decreasing. Conclusion In male T2DM patients with different BMI,BMD are significantly different. Insulin resistance and blood glucose control affect bone metabolism.High BMI is a protective factor for BMD decreasing.