2型糖尿病患者糖脂代谢、血清钙磷、骨代谢与骨密度的相关性研究-现代医学

2型糖尿病患者糖脂代谢、血清钙磷、骨代谢与骨密度的相关性研究

单位：1. 新疆医科大学护理学院, 新疆乌鲁木齐 830001;
2. 新疆医科大学第四附属医院, 新疆乌鲁木齐 830054;
3. 新疆医科大学第一附属医院内分泌科, 新疆乌鲁木齐 830001;
4. 新疆医科大学第一附属医院住院部, 新疆乌鲁木齐 830001

关键词：2型糖尿病维生素D 骨质疏松骨代谢

分类号：R587.1

出版年·卷·期（页码）：2023·51·第三期（318-323）

摘要：

目的：探讨2型糖尿病(T2DM)患者糖脂代谢、血清钙磷及骨代谢与骨密度(BMD)的相关性。方法：选择2021年12月至2022年8月住院的178例T2DM患者,根据双能X线骨密度仪对患者腰椎L₁～L₄及股骨近端(股骨颈、大转子和全髋骨)BMD进行测定,并根据骨质疏松诊断标准将患者分为骨量正常组(T值≥-1.0，60例)、骨量减少组(-2.5＜T值＜-1.0，59例)、骨质疏松组(T值≤-2.5，59例)。分析3组患者的糖脂代谢指标、血清钙磷及骨代谢指标与骨密度间的关系,并进行有序Logistic回归分析。结果：3组患者的性别、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、血清C肽、钙、磷、25羟维生素D[25(OH)D]、甲状旁腺激素(PTH)、β胶原特殊序列(β-CTX)及骨钙素(OC)比较差异均有统计学意义(P＜0.05)。经Pearson相关性分析结果显示，β-CTX、总Ⅰ型胶原氨基端延长肽(TP1NP)、OC、PTH、25(OH)D与糖尿病病程、性别、FBG、HbAlc、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、总胆固醇(TC)、血清C肽、钙、磷等指标均存在相关性(P＜0.05)。有序Logistic回归分析显示,患者的病程、25(OH)D、PTH、OC、钙、β-CTX、PBG等指标与骨质疏松的发生密切关联，病程增加(OR=1.090,95%CI 1.012~1.174)、β-CTX(OR=112.435, 95%CI 2.908~4 346.825)和PTH(OR=2.536,95%CI 1.600~4.020)水平升高是引起T2DM患者发生骨质疏松的主要危险因素。结论：T2DM患者的病程、PBG、25(OH)D、PTH、钙、OC、β-CTX与骨密度之间存在一定的相关性,且病程增加、β-CTX和PTH水平升高与骨质疏松的发生密切相关,应结合各影响因素对T2DM患者的骨量异常情况进行防治。

Objective： To explore the correlation between glucose and lipid metabolism, serum calcium, phosphorus and bone metabolism and bone mineral density(BMD) in type 2 diabetes(T2DM)patients. Methods： 178 patients with T2DM who were hospitalized from December 2021 to August 2022 were selected, and BMD of the lumbar spine L₁-L₄ and proximal femur (femoral neck, greater trochanter and total hip) was measured according to dual-energy X-ray bone densitometry, and the patients were divided into normal bone mass group (T≥-1.0,n=60), reduced bone mass group (-2.5＜T＜-1.0,n=60) and osteoporosis group (T≤-2.5,n=60). The relationships between glucose and lipid metabolic indexes, serum calcium and phosphorus and bone metabolic indexes and bone mineral density wereanalyzed in the three groups, and ordered Logistic regression analysis was performed. Results： There were significant differences in gender, FBG, HbA1C, serum C peptide, calcium, phosphorus,25(OH)D, PTH, β-CTX and OC between the three groups (P<0.05).According to Pearson correlation analysis,β-CTX, TP1NP, OC, PTH, 25(OH)D were significantly correlated with diabetes duration, gender, FBG, HbAlc, LDL-C, TG, TC, serum C-peptide, calcium, phosphorus and other indicators (P<0.05).Sequential Logistic regression analysis showed that the disease duration, 25(OH)D, PTH, OC, calcium,β-CTX and PBG were related to the occurrence of osteoporosis, the increaseof disease duration(OR=1.090, 95%CI 1.012-1.174),β-CTX(OR=2.536,95%CI 1.600-4.020)and PTH(OR=2.536,95%CI 1.600-4.020) were the main risk factors of osteoporosis in T2DM patients. Conclusion： The course of T2DM patients, PBG, 25(OH)D, PTH, calcium, OC, β-CTX have a certain correlation with bone mineral density, and the increaseof disease duration, elevated levels of β-CTX and PTH are closely related to the occurrence of osteoporosis. It is necessary to combine various factors to prevent and treat the abnormal bone mass of T2DM patients.

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