老年2型糖尿病患者合并骨质疏松症的危险因素分析
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摘要
目的探讨老年2型糖尿病(type 2 diabetic mellitus,T2DM)患者合并骨质疏松症的危险因素。方法选取2016年5月至2018年4月武汉市第一医院老年病科收治的老年T2DM患者273例,运用双能X线法测定所选取患者的骨密度(bone mineral density,BMD)。根据BMD将273例患者分为骨质疏松(osteoporosis,OP)组125例和非骨质疏松(non osteoporosis,non-OP)组148例。记录两组患者的性别、年龄、病程、体质量指数(bone mass index,BMI)、血钙(Ca)、血磷(P)、碱性磷酸酶(alkaline phosphatase,ALP)、空腹血糖(fasting blood-glucose,FBG)、空腹胰岛素水平(fasting insulin,Fins)、糖化血红蛋白(HbA1c)、血肌酐(Scr)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(hight-density lipoprotein lcholesterol,HDL-C)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、血清胰岛素样生长因子-1(insulin-like growth factor,IGF-1)水平,并计算稳态模型胰岛素抵抗指数(HOMA-IR),将2组各项指标进行比较。结果 OP组与non-OP组比较,病程、BMI、HbA1c、Scr、IGF-1差异有统计学意义(P<0.05),而年龄、性别、Ca、P、ALP、HOMA-IR、TG、TC、HDL-C、LDL-C差异无统计学意义(P>0.05);二元Logistic回归分析显示病程、BMI、IGF-1与OP有关。结论病程、BMI和IGF-1是影响2型糖尿病合并骨质疏松的相关危险因素。
Objective To explore the risk factors of osteoporosis in elder type 2 diabetic patients(T2 DM). Methods A total of 273 cases of elder T2 DM patients in the First Hospital of Wuhan from May 2016 to April 2018 were collected. Patients were divided to osteoporosis group(OP group, 125 cases) and non-OP group(148 cases) according to the BMD values. Sex, age, course of disease, BMI, levels of blood calcium(Ca), blood phosphorus(P), alkaline phosphatase(ALP), fasting blood-glucose(FBG), fasting insulin(Fins), hemoglobin AIC(HbAlc), serum creatinine(Scr), triglyceride(TG), total cholesterol(TC), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C), and insulin-like growth factor-1(IGF-1) were recorded. The homeostasis model assessment insulin resistance(HOMA-IR) was calculated. The clinical data were compared between the two groups. Results The course of disease, BMI, HbA1 c, Scr,and IGF-1 were significantly different between patients in OP group and non-OP group(P<0.05). However, age, sex, Ca, P, ALP, HOMA-IR, TG, TC, HDL-C, and LDL-C were not different between the two groups(P>0.05). Logistic regression analysis revealed that longer course of disease, lower BMI, and lower IGF-1 were correlated with osteoporosis. Conclusion The course of disease, BMI, and level of blood IGF-1 are the risk factors of osteoporosis in elder type 2 diabetes patients.
Objective To explore the risk factors of osteoporosis in elder type 2 diabetic patients(T2 DM). Methods A total of 273 cases of elder T2 DM patients in the First Hospital of Wuhan from May 2016 to April 2018 were collected. Patients were divided to osteoporosis group(OP group, 125 cases) and non-OP group(148 cases) according to the BMD values. Sex, age, course of disease, BMI, levels of blood calcium(Ca), blood phosphorus(P), alkaline phosphatase(ALP), fasting blood-glucose(FBG), fasting insulin(Fins), hemoglobin AIC(HbAlc), serum creatinine(Scr), triglyceride(TG), total cholesterol(TC), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C), and insulin-like growth factor-1(IGF-1) were recorded. The homeostasis model assessment insulin resistance(HOMA-IR) was calculated. The clinical data were compared between the two groups. Results The course of disease, BMI, HbA1 c, Scr,and IGF-1 were significantly different between patients in OP group and non-OP group(P<0.05). However, age, sex, Ca, P, ALP, HOMA-IR, TG, TC, HDL-C, and LDL-C were not different between the two groups(P>0.05). Logistic regression analysis revealed that longer course of disease, lower BMI, and lower IGF-1 were correlated with osteoporosis. Conclusion The course of disease, BMI, and level of blood IGF-1 are the risk factors of osteoporosis in elder type 2 diabetes patients.
引文
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[11] 张华芬,李成江. 老年糖尿病患者骨密度变化与空腹胰岛素水平的相关性[J.中国老年学杂志,2015,35(16):4541-4543.
[12] 何黎. 2型糖尿病并发骨质疏松临床分析[J].中国社区医师(医学专业),2012,14(5): 58.
[13] Prichard JM,Giangregorio LM,Atkinson SA,et al.Changes in trabecular bone microarchitecture in postmenopausal women with and without type 2diabetes:a two year longitudinal study[J].BMC Musculskelet Disord,2013,14:114.
[14] 王志全,戴芳芳.2型糖尿病合并骨质疏松相关因素的分析[J].中国骨质疏松杂志,2016,22(11): 1455-1458.
[15] Yamaguchi T.Bone fragility in type 2diabetes mellitus[J].World J Orthop,2010,1(1):3-9.
[16] 闫凤民,张永光,王志强,等.阿仑膦酸钠治疗男性2型糖尿病性骨质疏松症疗效观察[J].河北医药,2012,34(5): 718-719.
[17] 段京明,王瑞明,孟彩云,等. 细胞因子白细胞介素-6及胰岛素生长样因子-1与类风湿关节炎临床表现的关联性研究[J].中国骨质疏松杂志,2016,22(5): 560-569.
[18] 魏雨田,吴乃君,金秀平,等. 2型糖尿病患者骨密度与胰岛素样生长因子-1的相关性研究[J].华北理工大学学报(医学版),2017,19(1):19-22.
[2] 孙琴,冯玉兰,邢学农.2 型糖尿病合并骨质疏松症的相关因素分析[J].中华骨质疏松和骨矿盐疾病杂志,2013,6(1): 34-36.
[3] Zhou YJ,Li A,Song YL,et al.Role of sclerostin in the bone loss of postmennopausal chinese women with type 2 diabetes[J].Chin Med Sci J,2013,28(3):135-139.
[4] 沈浩,胡玲,王倩,等.2型糖尿病合并骨质疏松症的相关因素分析[J].实用临床医学,2013,17(1): 4-5,9.
[5] 郭玉卿,王丽娜,周慧敏,等. 抗氧化治疗老年糖尿病性骨质疏松的疗效[J].中国老年学杂志,2015, 35(3):671-672.
[6] 徐双迎,汪娅,吴红艳. 老年男性2型糖尿病患者瘦素水平与骨密度关系的研究[J].实用医学杂志,2012,28(4): 589-591.
[7] 唐伟,蔡娅,黄晓萍,等.中老年2 型糖尿病患者抑郁焦虑状况调查[J].实用老年医学,2009,23(5): 373-375.
[8] 李静怡,刘志民,葛军,等. 代谢综合征对老年男性2型糖尿病患者骨密度的影响[J].实用医学杂志,2016,32(3): 399-401.
[9] 刘嘉眉.老年2型糖尿病合并骨质疏松症患者发病的相关因素分析[J].中国医师杂志,2012,14 (1): 31-33.
[10] 王溪原,张远石,苑福生,等.2型糖尿病合并骨质疏松骨量及血清瘦素、骨代谢指标对照分析[J].中国误诊学杂志,2012,12(4):786.
[11] 张华芬,李成江. 老年糖尿病患者骨密度变化与空腹胰岛素水平的相关性[J.中国老年学杂志,2015,35(16):4541-4543.
[12] 何黎. 2型糖尿病并发骨质疏松临床分析[J].中国社区医师(医学专业),2012,14(5): 58.
[13] Prichard JM,Giangregorio LM,Atkinson SA,et al.Changes in trabecular bone microarchitecture in postmenopausal women with and without type 2diabetes:a two year longitudinal study[J].BMC Musculskelet Disord,2013,14:114.
[14] 王志全,戴芳芳.2型糖尿病合并骨质疏松相关因素的分析[J].中国骨质疏松杂志,2016,22(11): 1455-1458.
[15] Yamaguchi T.Bone fragility in type 2diabetes mellitus[J].World J Orthop,2010,1(1):3-9.
[16] 闫凤民,张永光,王志强,等.阿仑膦酸钠治疗男性2型糖尿病性骨质疏松症疗效观察[J].河北医药,2012,34(5): 718-719.
[17] 段京明,王瑞明,孟彩云,等. 细胞因子白细胞介素-6及胰岛素生长样因子-1与类风湿关节炎临床表现的关联性研究[J].中国骨质疏松杂志,2016,22(5): 560-569.
[18] 魏雨田,吴乃君,金秀平,等. 2型糖尿病患者骨密度与胰岛素样生长因子-1的相关性研究[J].华北理工大学学报(医学版),2017,19(1):19-22.