国际内分泌代谢杂志
國際內分泌代謝雜誌
국제내분비대사잡지
INTERNATIONAL JOURNAL OF ENDOCRINOLOGY AND METABOLISM
2015年
2期
88-92
,共5页
糖尿病%骨质疏松%骨密度%25羟维生素D3%甲状旁腺激素
糖尿病%骨質疏鬆%骨密度%25羥維生素D3%甲狀徬腺激素
당뇨병%골질소송%골밀도%25간유생소D3%갑상방선격소
Type 2 diabetes mellitus%Osteoporosis%Bone mineral density%25-hydroxy vitamin D3%Parathyroid hormone
目的 观察2型糖尿病(T2DM)患者骨代谢生化指标、血清25-羟维生素D3[25 (OH)D3]和甲状旁腺激素(PTH)水平,分析其对骨密度的影响并探讨T2DM患者骨量的变化.方法 选择天津医科大学总医院T2DM患者127例(男57例,女70例)作为糖尿病组;另选年龄、性别相匹配的健康体检者68名作为对照组.按糖尿病病程或HbA1c将糖尿病组分为4个亚组,A组:病程≤10年,B组:病程＞10年,C组:HbA1c≤8％,D组:HbA1c＞ 8％;按骨量不同分为3个亚组:骨密度正常组(T值＞-1.0 SD);骨量减少组(-2.5 SD ＜T值≤-1.0 SD);骨质疏松组(T值≤-2.5 SD).测定所有受试者血钙、磷、镁、碱性磷酸酶(ALP)、24 h尿钙、25(OH)D3和PTH,采用双能X线骨密度仪对所有受试者进行骨密度测定.结果 糖尿病组血钙、血镁、25(OH)D3、股骨颈和全髋骨密度较对照组显著降低(t=0.235～ 1.884,P均＜0.05),PTH较对照组显著升高(t=1.067,P＜0.01);A组、B组血钙、血镁、25(OH)D3较对照组显著降低,且B组血镁低于A组(P均＜0.05),PTH显著高于对照组,且B组高于A组(P＜0.01);C组、D组血钙、血镁、25(OH)D3较对照组显著降低(P均＜0.05),PTH显著高于对照组(P ＜0.01);A组、B组股骨颈、全髋骨密度较对照组显著下降(P均＜0.05);D组股骨颈、全髋骨密度较对照组和C组均明显降低(P均＜0.01),全身骨密度低于对照组(P＜0.05);C组各部位骨密度较对照组差异均无统计学意义;糖尿病组骨质疏松和骨量减低[39.37％(50/127),47.24％(60/127)]的比例显著高于对照组[26.47％(18/68),32.35％ (22/68),x2=3.852,4.708,P均＜0.05)],并且糖尿病骨质疏松组糖尿病病程、HbA1c、PTH也均较骨密度正常组和骨量减低组明显升高(P均＜0.05)Logistic回归分析显示糖尿病病程、HbA1c、PTH是糖尿病患者骨密度降低的危险因素.结论 T2DM患者存在骨代谢紊乱,维生素D水平下降,PTH水平升高和骨密度的下降,以糖尿病病程长和血糖控制差者为著.
目的 觀察2型糖尿病(T2DM)患者骨代謝生化指標、血清25-羥維生素D3[25 (OH)D3]和甲狀徬腺激素(PTH)水平,分析其對骨密度的影響併探討T2DM患者骨量的變化.方法 選擇天津醫科大學總醫院T2DM患者127例(男57例,女70例)作為糖尿病組;另選年齡、性彆相匹配的健康體檢者68名作為對照組.按糖尿病病程或HbA1c將糖尿病組分為4箇亞組,A組:病程≤10年,B組:病程＞10年,C組:HbA1c≤8％,D組:HbA1c＞ 8％;按骨量不同分為3箇亞組:骨密度正常組(T值＞-1.0 SD);骨量減少組(-2.5 SD ＜T值≤-1.0 SD);骨質疏鬆組(T值≤-2.5 SD).測定所有受試者血鈣、燐、鎂、堿性燐痠酶(ALP)、24 h尿鈣、25(OH)D3和PTH,採用雙能X線骨密度儀對所有受試者進行骨密度測定.結果 糖尿病組血鈣、血鎂、25(OH)D3、股骨頸和全髖骨密度較對照組顯著降低(t=0.235～ 1.884,P均＜0.05),PTH較對照組顯著升高(t=1.067,P＜0.01);A組、B組血鈣、血鎂、25(OH)D3較對照組顯著降低,且B組血鎂低于A組(P均＜0.05),PTH顯著高于對照組,且B組高于A組(P＜0.01);C組、D組血鈣、血鎂、25(OH)D3較對照組顯著降低(P均＜0.05),PTH顯著高于對照組(P ＜0.01);A組、B組股骨頸、全髖骨密度較對照組顯著下降(P均＜0.05);D組股骨頸、全髖骨密度較對照組和C組均明顯降低(P均＜0.01),全身骨密度低于對照組(P＜0.05);C組各部位骨密度較對照組差異均無統計學意義;糖尿病組骨質疏鬆和骨量減低[39.37％(50/127),47.24％(60/127)]的比例顯著高于對照組[26.47％(18/68),32.35％ (22/68),x2=3.852,4.708,P均＜0.05)],併且糖尿病骨質疏鬆組糖尿病病程、HbA1c、PTH也均較骨密度正常組和骨量減低組明顯升高(P均＜0.05)Logistic迴歸分析顯示糖尿病病程、HbA1c、PTH是糖尿病患者骨密度降低的危險因素.結論 T2DM患者存在骨代謝紊亂,維生素D水平下降,PTH水平升高和骨密度的下降,以糖尿病病程長和血糖控製差者為著.
목적 관찰2형당뇨병(T2DM)환자골대사생화지표、혈청25-간유생소D3[25 (OH)D3]화갑상방선격소(PTH)수평,분석기대골밀도적영향병탐토T2DM환자골량적변화.방법 선택천진의과대학총의원T2DM환자127례(남57례,녀70례)작위당뇨병조;령선년령、성별상필배적건강체검자68명작위대조조.안당뇨병병정혹HbA1c장당뇨병조분위4개아조,A조:병정≤10년,B조:병정＞10년,C조:HbA1c≤8％,D조:HbA1c＞ 8％;안골량불동분위3개아조:골밀도정상조(T치＞-1.0 SD);골량감소조(-2.5 SD ＜T치≤-1.0 SD);골질소송조(T치≤-2.5 SD).측정소유수시자혈개、린、미、감성린산매(ALP)、24 h뇨개、25(OH)D3화PTH,채용쌍능X선골밀도의대소유수시자진행골밀도측정.결과 당뇨병조혈개、혈미、25(OH)D3、고골경화전관골밀도교대조조현저강저(t=0.235～ 1.884,P균＜0.05),PTH교대조조현저승고(t=1.067,P＜0.01);A조、B조혈개、혈미、25(OH)D3교대조조현저강저,차B조혈미저우A조(P균＜0.05),PTH현저고우대조조,차B조고우A조(P＜0.01);C조、D조혈개、혈미、25(OH)D3교대조조현저강저(P균＜0.05),PTH현저고우대조조(P ＜0.01);A조、B조고골경、전관골밀도교대조조현저하강(P균＜0.05);D조고골경、전관골밀도교대조조화C조균명현강저(P균＜0.01),전신골밀도저우대조조(P＜0.05);C조각부위골밀도교대조조차이균무통계학의의;당뇨병조골질소송화골량감저[39.37％(50/127),47.24％(60/127)]적비례현저고우대조조[26.47％(18/68),32.35％ (22/68),x2=3.852,4.708,P균＜0.05)],병차당뇨병골질소송조당뇨병병정、HbA1c、PTH야균교골밀도정상조화골량감저조명현승고(P균＜0.05)Logistic회귀분석현시당뇨병병정、HbA1c、PTH시당뇨병환자골밀도강저적위험인소.결론 T2DM환자존재골대사문란,유생소D수평하강,PTH수평승고화골밀도적하강,이당뇨병병정장화혈당공제차자위저.
Objective To observe the levels of biochemical index of bone metabolism,25-hydroxy vitamin D3[25 (OH) D3] and parathormone (PTH) in patients with type 2 diabetes mellitus (T2DM),and analyze their effects on bone mineral density(BMD) and discuss the changes of bone mass in T2DM patients.Methods One hundred and twenty-seven patients with T2DM were selected,including 57 male cases and 70 female cases as diabetes group ; 68 healthy people (sex and age matched) were choosed as control group.Diabetes group was divided into 4 subgroup according to diabetic duration or HbA1c,group A:diabetic duration ≤ 10 years,group B:diabetic duration ＞ 10 years,group C:HbA 1 c ≤ 8％,group D:HbA 1 c ＞ 8％ ; meanwhile diabetes group was divided into 3 subgroup according to BMD,normal BMD group:T ＞-1.0 SD; osteopenia group:-2.5 SD ＜ T ≤-1.0 SD ; osteoporosis group:T ≤-2.5 SD.Blood calcium,phosphorus,magnesium,alkaline phosphatase (ALP),24 h urinary calcium,25 (OH)D3 and PTH were measured.BMD was determined by using dual-energy X-ray absorptiometry (DEXA).Results Compared with control group,blood calcium,magnesium,25(OH)D3,femoral neck and total hip BMD in diabetes group were significantly decreased (t =0.235-1.884,all P ＜0.05),PTH was significantly increased (t =1.067,P ＜ 0.01).Blood calcium,magnesium,25(OH) D3 in group A,group B were significantly decreased than those in control group,and blood magnesium in group B was also lower than that of group A(all P ＜0.05),the level of PTH in group A,group B was significantly increased than that in control group,and its value in group B was also higher than that in group A(P ＜0.01).Compared with control group,blood calcium,magnesium,25(OH) D3 in group C,group D were significantly decreased (all P ＜ 0.05),the level of PTH was significantly increased (P ＜0.01).Femoral neck and total hip BMD in group A,group B were declined significantly than those in control group (all P ＜ 0.05).Femoral neck and total hip BMD in group D were declined significantly than those in control group and group C(all P ＜ 0.01),the whole body BMD was significantly lower than that in control group (P＜0.05).Each part of BMD in group C had no significant difference compared with control group.The rate of osteoporosis and osteopenia in diabetes group[39.37％ (50/127),47.24％ (60/127)] were significantly higher than those in control group [26.47％ (18/68),32.35％ (22/68),x2=3.852,4.708,all P＜ 0.05],and diabetic duration,HbAlc,and PTH in osteoporosis group were significantly higher than those in normal BMD group and osteopenia group (all P＜ 0.05).Logistic regression analysis showed that diabetic duration,HbA 1 c,PTH and were the risk factors of decease of BMD in diabetic patients.Conclusions Patients with T2DM have bone metabolic disorders,decrease of vitamin D levels,increase of PTH and reduction of BMD.It would be more significant in patients with longer diabetic duration and poor glycemic control.
