CAJ | 학술논문

目的探讨2型糖尿病患者的血清25-羟维生素D[25(OH)D]以及甲状旁腺激素(PTH)水平与骨密度之间的关系.方法本研究为回顾性分析,共纳入2型糖尿病患者1 050例,采用双能X线吸收法骨密度仪检测腰椎2～4、股骨颈和全髋骨密度,同时测定血清PTH、25(OH)D以及血清钙、磷水平.结果相关性分析提示血清PTH与腰椎(r=-0.072,P=0.034)、股骨颈(r=-0.112,P=0.001)和全髋(r=-0.115,P=0.001)骨密度均呈明显负相关,且在校正年龄和体重指数后这种关系仍然存在.25(OH)D在校正了年龄和体重指数后,与股骨颈(r=0.099,P=0.007)和全髋(r=0.044,P=0.028)骨密度出现了显著的正相关.血清钙与磷水平与各部位骨密度之间无显著相关性.根据25(OH)D水平差异对2型糖尿病患者进行分组,其中维生素D缺乏者773例(73.5％)、不足者194例(18.5％)、充足者仅83例(8.0％),维生素D缺乏组的PTH水平显著高于充足组(P＜0.05),且维生素D缺乏组各部位骨密度均显著低于维生素D充足组(P＜0.05).多元逐步回归分析结果提示,年龄、体重指数和PTH是影响2型糖尿病患者骨密度变异的主要因素.结论 2型糖尿病患者中普遍存在维生素D缺乏状况,同时存在继发性PTH的升高,而伴有PTH水平升高的2型糖尿病患者更容易发生骨密度的降低,从而增加骨质疏松症甚至是脆性骨折的发病风险.
목적 탐토2형당뇨병환자적혈청25-간유생소D[25(OH)D]이급갑상방선격소(PTH)수평여골밀도지간적관계.방법 본연구위회고성분석,공납입2형당뇨병환자1 050례,채용쌍능X선흡수법골밀도의검측요추2～4、고골경화전관골밀도,동시측정혈청PTH、25(OH)D이급혈청개、린수평.결과 상관성분석제시혈청PTH여요추(r=-0.072,P=0.034)、고골경(r=-0.112,P=0.001)화전관(r=-0.115,P=0.001)골밀도균정명현부상관,차재교정년령화체중지수후저충관계잉연존재.25(OH)D재교정료년령화체중지수후,여고골경(r=0.099,P=0.007)화전관(r=0.044,P=0.028)골밀도출현료현저적정상관.혈청개여린수평여각부위골밀도지간무현저상관성.근거25(OH)D수평차이대2형당뇨병환자진행분조,기중유생소D결핍자773례(73.5％)、불족자194례(18.5％)、충족자부83례(8.0％),유생소D결핍조적PTH수평현저고우충족조(P＜0.05),차유생소D결핍조각부위골밀도균현저저우유생소D충족조(P＜0.05).다원축보회귀분석결과제시,년령、체중지수화PTH시영향2형당뇨병환자골밀도변이적주요인소.결론 2형당뇨병환자중보편존재유생소D결핍상황,동시존재계발성PTH적승고,이반유PTH수평승고적2형당뇨병환자경용역발생골밀도적강저,종이증가골질소송증심지시취성골절적발병풍험.
Objective To investigate the correlation between 25-hydroxyvitamin D [25 (OH) D] and parathyroid hormone (PTH) with bone mineral density (BMD) in patients with type 2 diabetes mellitus.Methods The study is a retrospective analysis.1 050 patients with type 2 diabetes mellitus were enrolled.BMDs at lumbar spine (2-4),femoral neck,and total hip were measured by dual-energy X-ray absorptiometry.Serum PTH,25 (OH) D,Ca,and P levels were tested simultaneously.Results Pearson's correlation analysis revealed that PTH was negatively correlated with lumbar spine (r =-0.072,P =0.034),femoral neck (r =-0.112,P =0.001),and total hip (r =-0.115,P=0.001) BMD,partial correlation analysis showed that the relationship was still significant even after adjusted for age and body mass index;25 (OH) D had a significant positive correlation with femoral neck (r =0.099,P =0.007) and total hip (r =0.044,P =0.028) BMD after adjustment for age and body mass index.There was no correlation of Ca,P with BMD.Grouping according to differences in 25 (OH) D levels in patients with type 2 diabetes mellitus,the number of cases with vitamin D deficiency was 773 (73.5％),the number of cases with vitamin D insufficiency was 194 (18.5 ％),and the number of cases with adequate vitamin D was only 83 (8.0％).The level of PTH in cases with vitamin D deficiency was significantly higher than that in cases with adequate vitamin D (P＜0.05);and BMD in cases with vitamin D deficiency was significantly lower than that with adequate vitamin D (P ＜ 0.05).Multiple stepwise regression analysis revealed that age,body mass index,and PTH were the main factors that influenced the change of BMDs in patients with type 2 diabetes mellitus.Conclusions There was prevalence of vitamin D deficiency in patients with type 2 diabetes mellitus,meanwhile there was secondarily raised PTH.Type 2 diabetic patients with raised PTH levels were more prone to develop lowered BMD,thus increasing the incidence of osteoporosis and even the risk of brittle fracture.