摘要：
目的 探讨2型糖尿病合并骨质疏松的相关因素.方法 用双能X线测量仪测定2型糖尿病患者骨矿密度,根据T值将187例患者分为骨量正常组(58例,男39例、女19例)、骨量减低组(103例,男74例、女29例)及骨质疏松组(26例,男11例,女15例),比较不同性别间骨量差异;记录吸烟、饮酒及运动史以及年龄和病程,测量身高、体质量、空腹血糖、餐后2h血糖(2 h PG)、多时点胰岛素、糖化血红蛋白(HbAlc)、三酰甘油、总胆固醇、肱踝动脉脉搏波传导速度(baPWV)及尿微量白蛋白/肌酐值(ACR),计算体重指数和胰岛素曲线下面积(AUC-INS),并进行统计分析及相关性研究.结果 女性患者中骨质疏松构成比明显高于男性[23.8％ (15/63)比8.9％ (11/124),P＜0.01].骨量正常组、骨量减低组、骨质疏松组男性患者2 hPG水平两两比较差异均有统计学意义[(14.3±2.6) mmol/L比(15.0±2.5) mmol/L比(16.6±2.3) mmol/L](P＜0.05或P＜0.01);女性患者3组间空腹血糖、2hPG水平差异无统计学意义(P＞0.05).骨质疏松组男性患者年龄、病程、空腹血糖、2 hPG、HbA1c大子女性患者[(73±10)岁比(66±6)岁、(13.7±3.8)年比(12.6±3.7)年、(8.8±0.6) mmol/L比(8.2±0.9) mmol/L、(16.6±2.3) mmol/L比(14.2±1.7) mmol/L、(8.9±0.7)％比(8.2±0.8)％](P＜0.05或P＜0.01),AUC-INS、总胆固醇、baPWV则低于女性患者[(657±148)min·pmol/L比(714±136) min·pmol/L、(5.2±0.8) mmol/L比(5.9±0.8) mmol/L、(1 767±227) cm/s比(1 873±165)cm/s](P＜0.05或P＜0.01).相关性分析显示,男性2型糖尿病患者骨矿密度与吸烟、饮酒、空腹血糖、HbA1c呈负相关(P＜0.05或P＜0.01);女性2型糖尿病患者骨矿密度与空腹血糖、HbA1c无相关性(P＞0.05);男、女性2型糖尿病患者骨矿密度与年龄、病程、baPWV、ACR呈负相关(P＜0.05或P＜0.01),与运动、AUC-INS及体重指数呈正相关(P＜0.05或P＜0.01),与2hPG、三酰甘油、总胆固醇无相关性(P＞0.05).结论 2型糖尿病患者骨矿密度受多种因素影响,与运动、年龄、病程、AUC-INS、体重指数、baPWV、ACR存在相关关系,其中男性患者骨矿密度还与吸烟、饮酒、空腹血糖、HbA1c相关.%Objective To explore the risk factors of osteoporosis (OP) in the patients with type 2 diabetes (T2DM).Methods Totally 187 patients with T2DM were enrolled and divided into normal bone mass group (58 cases,39 males,19 females),bone mass reduction group (103 cases,74 males,29 females) and OP group (26 cases,11 males,15 famles) according to the bone mineral density (BMD) detected by dual-emission X-ray absorptiometry.The history of smoking,drinking and exercise history,the age and the disease duration were recorded;the height,weight,fasting plasma glucose (FPG),2-hour postprandial plasma glucose (2 h PG),multi points insulin,glycosylated hemoglobin A1c (HbA1 c),triglyceride (TG),total cholesterol (TC),brachial-ankle pulse wave velocity (baPWV) and urinary albumin/creatinine ratio (ACR) were measured;the body mass index (BMI) and area under the curve of insulin (AUC-INS) were calculated.The correlations between BMD and main factors were analyzed.Results A higher proportion of OP was found in females compared with males [23.8％ (15/63) vs 8.9％ (11/124)] (P ＜0.01).The FPG and 2 h PG showed significant differences among the three groups in the males [(14.3 ± 2.6) mmol/L vs (15.0 ± 2.5) mmol/L vs (16.6 ± 2.3) mmol/L] (P ＜ 0.05 or 0.01),while showed no differences among the three groups in the females (all P ＞ 0.05).In OP group,the age,disease duration,FPG,2 h PG of the males were all significantly higher than those of the females [(73 ± 10) yearsvs (66±6) years,(13.7±3.8) years vs (12.6±3.7) years,(8.8±0.6) mmol/L vs (8.2±0.9) mmol/L,(16.6t2.3) mmol/L vs (14.2±1.7) mmol/L,(8.9±0.7)％ vs (8.2 ±0.8)％](P＜0.05 or 0.01),while the AUC-INS,TC and baPWV of the males were significantly lower than those of the females [(657 ± 148) min · pmol/L vs (714 ± 136) min · pmol/L,(5.2 ± 0.8) mmol/L vs (5.9 ± 0.8) mmol/L,(1 767 ± 227) cm/s vs (1 873 ± 165) cm/s] (P ＜ 0.05 or P ＜ 0.01).Correlation analysis revealed that BMD was negatively correlated with smoking,drinking,FPG and HbA1 c in the male patients (P ＜0.05 or 0.01),and was not correlated with FPG and HbAlc in the female patients (P ＞0.05);BMD was negatively correlated with age,disease duration,baPWV and ACR,positively correlated with exercise,AUC-INS and BMI (P ＜ O.05 or 0.01),not correlated with 2 h PG,TG and TC (P ＞ 0.05) in both the male and the female patients.Conclusions The BMD in patients with T2DM is affected by many factors,including exercise,age,disease duration,AUC-INS,BMI,baPWV,ACR in both male and female patents.Smoking,drinking,FPG and HbAlc is also correlated with BMD in male T2MD patients.
