2型糖尿病患者下肢动脉疾病与体脂及骨密度的相关性分析

摘要

目的 探讨2型糖尿病(T2DM)患者下肢动脉疾病程度与体脂含量及骨密度(BMD)的相关性.方法 319例T2DM患者根据双下肢各动脉最大狭窄值,将其分为无狭窄组、轻度狭窄组、中度狭窄组及重度狭窄组4组,检测并比较各组不同部位体脂百分比、腰椎(L2～4)和左股骨BMD及相关代谢指标,分析其与下肢动脉疾病的相关性.结果 随着狭窄严重程度增加,脊柱脂肪百分比(SF％)升高,左股骨BMD下降；中、重度狭窄组全身体脂百分比(BF％)高于轻度狭窄组、无狭窄组,重度狭窄组左侧股骨脂肪百分比(LF％)高于无狭窄组,中、重度狭窄组L2～4BMD低于轻度狭窄组、无狭窄组.中、重度狭窄组病程、体质指数(BMI)、三酰甘油(TG)、糖化血红蛋白(HbA1c)、收缩压(SBP)高于轻度狭窄组、无狭窄组,中、重度狭窄组总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)高于无狭窄组,重度狭窄组血钙高于轻度狭窄组、无狭窄组,中、重度狭窄组高密度脂蛋白胆固醇(HDL-C)低于轻度狭窄组.下肢动脉疾病与SF％、HbA1c、TC、病程、BF％、SBP呈正相关,与左股骨BMD、L2～4BMD呈负相关(P＜0.05).且SF％、HbA1c、TC升高,左股骨BMD下降为患者发生糖尿病下肢病变的危险因素.结论 腹型肥胖及下肢BMD降低与T2DM患者合并下肢动脉疾病密切相关.%Objective To investigate the correlation between the severity of lower extremity arterial disease and the body fat percentage and bone mineral density (BMD) in patients with type 2 diabetes mellitus (T2DM).Methods According to the maximum stenosis value of the lower extremity artery, three hundred and nineteen hospitalized T2DM patients were divided into four groups, including non-stenosis group, mild stenosis group, moderate stenosis group and severe stenosis group.The values of body fat percentage in different parts of body, BMD of the second to fourth lumber vertebrate (L2-4BMD), BMD of the left femoral bone and relevant metabolic characteristics were measured and compared between four groups.The relationship of these indexes and the lower extremity arterial disease was analyzed.Results With the increase in the severity, the spine fat percentage (SF%) was gradually increased and the left femoral BMD decreased.In moderate and severe groups, the level of body fat percentage (BF%) was higher and that of L2-4BMD was lower than those of other groups.And there was a higher value of left femur body fat percentage (LF%) in severe group than that of non-stenosis group.In moderate and severe groups, the level of body mass index (BMI), triglyceride(TG), glycosylated hemoglobin(HbA1c) and systolic blood pressure (SBP) were higher than those of other groups.The levels of total cholesterol (TC), low-density lipoprotein (LDL-C) were higher in moderate and severe groups than those of non-stenosis group.In addition, there were higher value of blood calcium in severe group than that of non-stenosis and mild groups, and lower value of high-density lipoprotein (HDL-C) in moderate and severe groups than that of mild group.There was a positive correlation between the lower extremity arterial diseases and SF%, HbA1c, TC, course of disease, BF% and SBP, but a negative correlation between lower extremity arterial diseases and the left femoral BMD and the L2-4BMD (P < 0.05).Moreover, the increased levels of SF%, HbA1c and TC, and the decreased level of the left femoral BMD were risk factors for the severity of angiographic peripheral arterial disease in T2DM patients.Conclusion The abdominal obesity and the decrease of the lower extremity BMD were closely related to the lower extremity arterial disease in patients with T2DM.