CAJ | 학술논문

目的探讨老年男性2型糖尿病患者睡眠障碍与骨质疏松的关系.方法应用匹兹堡睡眠质量指数,将2011年7月至2014年7月收治的428例老年男性2型糖尿病患者分为无睡眠障碍组和睡眠障碍组,应用双能X线骨密度仪测量股骨颈、Wards三角区、大转子、腰椎L2～L4的骨密度值,测定生化指标,行口服葡萄糖耐量试验及胰岛素、胰高糖素释放试验,比较两组骨密度值、空腹和糖负荷后胰岛α和β细胞功能变化,对睡眠障碍行相关及回归分析.结果睡眠障碍组股骨颈、Wards三角区、大转子、腰椎L2～L4的骨密度值低于无睡眠障碍组,骨质疏松患病率高于无睡眠障碍组(均P＜0.05).睡眠障碍组糖化血红蛋白(HbA1c)为(8.1±1.9)％,果糖胺为(0.32±0.11)mmol/L,空腹胰岛素为(13.29±4.48)mU/L,稳态模型胰岛素抵抗指数(HOMA IR)为4.58±0.81,均高于无睡眠障碍组[分别为(7.5±1.7)％,(0.30±0.09) mmol/L,(12.26±4.38) mU/L,3.72±0.76](均P＜0.05).睡眠障碍组胰岛素敏感指数为-4.26±0.52,低于无睡眠障碍组的-4.06±0.48(P＜0.05).睡眠障碍组各时间点胰高糖素水平及胰高糖素曲线下面积明显高于无睡眠障碍组(均P＜0.05),睡眠障碍组0、30、180 min胰高糖素/胰岛素比值及0、30、60、180 min胰高糖素/血糖比值明显高于无睡眠障碍组(均P＜0.05).Logistic回归分析显示睡眠障碍与HOMA-IR、胰高糖素/胰岛素比值、骨质疏松呈正相关,与胰岛素敏感指数呈负相关(均P＜0.05).结论睡眠障碍可能通过多种机制引起骨质疏松,改善睡眠障碍可能有助于减少骨质疏松.
목적 탐토노년남성2형당뇨병환자수면장애여골질소송적관계.방법 응용필자보수면질량지수,장2011년7월지2014년7월수치적428례노년남성2형당뇨병환자분위무수면장애조화수면장애조,응용쌍능X선골밀도의측량고골경、Wards삼각구、대전자、요추L2～L4적골밀도치,측정생화지표,행구복포도당내량시험급이도소、이고당소석방시험,비교량조골밀도치、공복화당부하후이도α화β세포공능변화,대수면장애행상관급회귀분석.결과 수면장애조고골경、Wards삼각구、대전자、요추L2～L4적골밀도치저우무수면장애조,골질소송환병솔고우무수면장애조(균P＜0.05).수면장애조당화혈홍단백(HbA1c)위(8.1±1.9)％,과당알위(0.32±0.11)mmol/L,공복이도소위(13.29±4.48)mU/L,은태모형이도소저항지수(HOMA IR)위4.58±0.81,균고우무수면장애조[분별위(7.5±1.7)％,(0.30±0.09) mmol/L,(12.26±4.38) mU/L,3.72±0.76](균P＜0.05).수면장애조이도소민감지수위-4.26±0.52,저우무수면장애조적-4.06±0.48(P＜0.05).수면장애조각시간점이고당소수평급이고당소곡선하면적명현고우무수면장애조(균P＜0.05),수면장애조0、30、180 min이고당소/이도소비치급0、30、60、180 min이고당소/혈당비치명현고우무수면장애조(균P＜0.05).Logistic회귀분석현시수면장애여HOMA-IR、이고당소/이도소비치、골질소송정정상관,여이도소민감지수정부상관(균P＜0.05).결론 수면장애가능통과다충궤제인기골질소송,개선수면장애가능유조우감소골질소송.
Objective To investigate the association between sleep disorders and osteoporosis in elderly male patients with type 2 diabetes.Methods Four hundred and twenty-eight elderly male patients with type 2 diabetes mellitus treated from July 2011 to July 2014 were divided into two groups according to Pittsburgh Sleep Quality Index:patients without sleep disorders and patients with sleep disorders.The bone mineral density of the femoral neck,Ward triangle,greater trochanter and lumbar spine (L2-L4) was measured by dual-energy X-ray absorptiometry.Biochemical indicators were detected in the two groups.Oral glucose tolerance test,insulin releasing test and glucagon releasing test were performed.We compared differences in bone mineral density and α-cell and β-cell function after fasting and glucose-loading between the two groups.The correlation between sleep disorders and other indicators was analyzed and regression analysis was performed.Results The bone mineral density of the femoral neck,Ward triangle,greater trochanter and lumbar spine (L2-L4) was lower and the prevalence of osteoporosis was higher in patients with sleep disorders than in patients without sleep disorders (all P＜0.05).Glycosylated hemoglobin A1c (HbA1c),fructose amine,fasting insulin,and homeostasis model assessment of insulin resistance index (HOMA-IR)were higher in patients with sleep disorders than in patients without sleep disorders [(8.1 ±1.9)％vs.(7.5±1.7)％,(0.32±0.11) mmol/L vs.(0.30±0.09) mmol/L,(13.29±4.48) mU/L vs.(12.26±4.38) mU/L,(4.58±0.81) vs.(3.72±0.76),respectively,all P＜0.05].The insulin sensitivity index was lower in patients with sleep disorders than in patients without sleep disorders [(4.26±0.52) vs.(4.06±0.48),P＜0.05].The level of glucagon at each time point and the area under the curve of glucagon were higher in patients with sleep disorders than in patients without sleep disorders.The glucagon/insulin ratio and glucagon/glucose ratio at 0,30,60,and 180 min were higher in patients with sleep disorders than in patients without sleep disorders (all P＜0.05).Logistic regression analysis showed that sleep disorders were positively correlated to HOMA-IR,glucagon/ insulin ratio and osteoporosis,and negatively correlated to insulin sensitivity index (all P＜0.05).Conclusions Sleep disorders may cause osteoporosis through various mechanisms.Improvement in sleep may help to reduce the incidence of osteoporosis.