糖尿病患者胰岛功能与低血钙诱发骨质疏松症关系的临床研究

摘要

目的：探讨糖尿病患者的胰岛功能与低血钙引起骨质疏松病变的关系。方法：采用双能 X 线骨密度测定仪测定50例2型糖尿病患者（DM 组）及42例对照组（NC 组）正位腰椎（L2～L4），双侧股骨的骨密度，并对比两项测定的临床指标。结果：患有骨质疏松的糖尿病患者较未患骨质疏松的糖尿病患者病程明显延长，空腹血清胰岛素（Fins）、C 肽以及餐后2h 血清胰岛素、C 肽明显降低（P＜0．05）。糖尿病患者双侧股骨 BMD 水平相比正常对照组下降，第3～4腰椎的 BMD 水平以及血钙水平则显著低于正常对照组（P＜0．05）。多元回归分析显示：糖尿病患者空腹血糖以及HbA1c 、病程与 BMD 负相关（P ＝0．014、0．018、0．003），体重指数、空腹血清胰岛素、餐后2h 血清胰岛素与 BMD 呈正相关（ P ＝0．012、0．021、0．006）、餐后2hC 肽和 BMD 有呈现正相关的关系。除餐后2hC 肽之外，其他的临床检验信息和 BMD 无明显关系。结论：2型糖尿病患者较正常人容易发生骨质疏松，且骨密度降低可能是由于胰岛素缺乏所导致。%Objective :To study the relationship of sslet function of diabetes patients and low blood calci‐um induced osteoporosis .Methods :Select 50 cases of type 2 diabetes mellitus patients (DM group) and 42 cases of control group (NC group) ,using dual‐energy X‐ray absorptiometry (dxa) for determination of bone mineral density of the lumbar (L2 ~ L4 ) ,bilateral femur (femoral neck ,big rotor ,intertrochanteric) ,and clinical indicators were measured .Results :Diabetic osteoporosis patients compared with non diabetic osteoporosis patients ,duration was obviously extended ,fasting serum insulin (Fins) ,c‐peptide and postprandial 2 h level were significantly lower ,the differences between groups were statistically significant , P < 0 .05) .Bilateral femur BMD level of diabetes patients had a different degree of decline compare with normal control group ,3 ~ 4 lumbar BMD level and blood calcium lev‐els were significantly lower than normal control group , P< 0 .05) .Multiple regression analysis showed that fasting blood glucose (FBG) in diabetic patients was negatively correlated with BMD (P = 0 .014) ,HbA1c was negatively correlated with BMD (P = 0 .018) ,the clinical course of diabetes was negatively correlated with BMD ( P = 0 . 003) ,body mass index and BMD was positively correlated (P = 0 .012) ,fasting serum insulin and BMD was posi‐tively correlated (P = 0 .021) ,postprandial 2 h serum insulin and BMD was positively correlated (P = 0 .014) , fasting C peptide was positively correlated with BMD (P = 0 .006) ,postprandial 2 hc peptide was positively correla‐ted with BMD (P = 0 .010) .The rest clinical data had no significant correlation with BMD .Conclusion :Type 2 di‐abetes patients are prone to osteoporosis than normal people ,bone mineral density decrease may be due to a lack of insulin .