2型糖尿病患者微血管病变与骨密度、骨代谢指标的相关性分析
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摘要
①目的探讨2型糖尿病患者微血管病变与骨密度及骨代谢指标的相关性。②方法收集华北理工大学附属医院内分泌科住院的T2DM患者病例198例,按合并微血管并发症情况分为2型糖尿病合并1种微血管病变组(A组)60例、2型糖尿病合并2种微血管病变组(B组)50例、2型糖尿病不合并微血管病变组(C组)88例。应用统计学方法对3组BMD及骨代谢指标进行比较,并对各组骨代谢指标进行相关性分析。③结果 3组BMD及骨代谢指标比较均存在统计学意义(P<0.05),其中β-CTX反映骨量差异最敏感;比较T2DM合并微血管病变者及不合并微血管者的骨质疏松症发病率,T2DM合并微血管病变者发生骨质疏松症的风险是不合并微血管病变者的4.392倍;3组内相关性分析显示T2DM不合并糖尿病微血管病变时β-CTX与PINP、HbA1c呈正相关(r分别为:0.418、0.556,P<0.05);T2DM合并糖尿病微血管病变时β-CTX与PINP、股骨颈及腰椎BMD、糖尿病病程、HbA1c、BMI均具有相关性(r合并DR或DN分别为:0.550、-0.347、-0.291、0.382、0.541、-0.477,P<0.05;r合并DR及DN分别为:0.859、-0.376、-0.325、0.462、0.482、-0.271,P<0.05);T2DM同时合并DR及DN时β-CTX与ALP呈正相关(r:0.225,P<0.05)。④结论 T2DM合并微血管病变时,较不合并微血管病变骨量明显减低,β-CTX能更敏感地反映这一骨量变化,随着微血管病变种类的叠加,BMD及PINP反映骨量的敏感性亦增强;长期高血糖的状态及高血碱性磷酸酶可能促进骨吸收过程,加快骨量减低。
Objective To investigate the correlation between microvascular lesion and bone density and bone metabolism in type 2 diabetes mellitus.Methods To collect 198 cases of T2DM patients in the department of endocrinology of the affiliated hospital of north China university of science and technology,according to the complications of microvascular complications198 cases are divided into:Sixty patients in the type 2 diabetes mellitus group with 1 type of microvascular disease(group A),50 patients in the type 2 diabetes mellitus group with 2 types of microvascular disease(group B),and 88 patients in the type 2 diabetes mellitus group without 1 type of microvascular disease(group C).BMD and bone metabolism indexes of the three groups were compared by statistical method,and the correlation between BMD and bone metabolism indexes of each group was analyzed.Results BMD and bone metabolism indexes of the three groups were statistically significant(P<0.05).β-CTX is the most sensitive indicator of bone mass differences;To compare the incidence of osteoporosis in T2DM patients with microvascular disease and those without microvascular disease,The risk of osteoporosis in T2DM patients with microvascular disease was 4.392 times higher than that in those without microvascular disease.Correlation analysis showed that within three groups of T2DM when not in diabetes mellitus microangiopathy β-CTX was positively correlated with PINP,HbA1c(r,respectively:0.418,0.556,P<0.05);T2DM diabetes mellitus microangiopathy β-CTX and PINP,femoral neck and lumbar spine BMD,duration of diabetes,HbA1c,BMI has correlation(r merger DR or DN are:0.550,0.347,0.291,0.382,0.541,0.477,P<0.05;rcombined DR and DN are:0.859,-0.376,-0.325,0.462,0.482,-0.271,P<0.05,respectively).When T2DM combines DR and DN at the same time,β-CTX is positively correlated with ALP(r:0.225,P<0.05).Conclusion When T2DM was combined with microvascular lesions,the bone mass was significantly reduced compared with that without microvascular lesions,β-CTX can more sensitively reflect this bone mass change,as the microvascular lesion is aggravating, BMD and PINP reflect sensitivity also increase bone mass;long-term hyperglycemia and high blood alkaline phosphatase may promote bone absorption process and accelerate bone loss.
Objective To investigate the correlation between microvascular lesion and bone density and bone metabolism in type 2 diabetes mellitus.Methods To collect 198 cases of T2DM patients in the department of endocrinology of the affiliated hospital of north China university of science and technology,according to the complications of microvascular complications198 cases are divided into:Sixty patients in the type 2 diabetes mellitus group with 1 type of microvascular disease(group A),50 patients in the type 2 diabetes mellitus group with 2 types of microvascular disease(group B),and 88 patients in the type 2 diabetes mellitus group without 1 type of microvascular disease(group C).BMD and bone metabolism indexes of the three groups were compared by statistical method,and the correlation between BMD and bone metabolism indexes of each group was analyzed.Results BMD and bone metabolism indexes of the three groups were statistically significant(P<0.05).β-CTX is the most sensitive indicator of bone mass differences;To compare the incidence of osteoporosis in T2DM patients with microvascular disease and those without microvascular disease,The risk of osteoporosis in T2DM patients with microvascular disease was 4.392 times higher than that in those without microvascular disease.Correlation analysis showed that within three groups of T2DM when not in diabetes mellitus microangiopathy β-CTX was positively correlated with PINP,HbA1c(r,respectively:0.418,0.556,P<0.05);T2DM diabetes mellitus microangiopathy β-CTX and PINP,femoral neck and lumbar spine BMD,duration of diabetes,HbA1c,BMI has correlation(r merger DR or DN are:0.550,0.347,0.291,0.382,0.541,0.477,P<0.05;rcombined DR and DN are:0.859,-0.376,-0.325,0.462,0.482,-0.271,P<0.05,respectively).When T2DM combines DR and DN at the same time,β-CTX is positively correlated with ALP(r:0.225,P<0.05).Conclusion When T2DM was combined with microvascular lesions,the bone mass was significantly reduced compared with that without microvascular lesions,β-CTX can more sensitively reflect this bone mass change,as the microvascular lesion is aggravating, BMD and PINP reflect sensitivity also increase bone mass;long-term hyperglycemia and high blood alkaline phosphatase may promote bone absorption process and accelerate bone loss.
引文
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[8] 邱明才,戴晨琳.代谢性骨病学[M].北京:人民卫生出版社,2012.236
[9] Zhukouskaya VV,Eller-Vainicher C,Shepelkevich AP,et al.Bone health in type 1 diabetes:focus on evaluation and treatment in clinical practice[J].Journal of Endocrinological Investigation,2015,38(9):941-950
[10] 杨华梅,路志凯.2型糖尿病患者骨病变与视网膜病变程度相关性的临床分析[J].中国骨质疏松杂志,2012,18(10):903-904
[11] Shah P,Bajaj S,Virk H,et al.Rapid Progression of Coronary Atherosclerosis:A Review[J].Thrombosis,2015,(2015-12-28),2015,2015(2):1-6
[12] Avbersek-Luznik I,Gmeiner Stopar T,Marc J.Activity or mass concentration of bone-specific alkaline phosphatase as a marker of bone formation[J].Clinical Chemical Laboratory Medicine,2007,45(8):1014-1018
[13] 中华医学会骨质疏松和骨矿盐疾病分会.原发性骨质疏松症诊治指南(2011年)[J].中华骨质疏松和骨矿盐疾病杂志,2011,4(1):2-17
[14] Shanbhogue VV,Hansen S,Frost M,et al.Compromised cortical bone compartment in type 2 diabetes mellitus patients with microvascular disease[J].European Journal of Endocrinology,2016,174(2):115
[15] Maghbooli Z,Shabani P,Gorganifiruzjaee S,et al.The association between bone turnover markers and microvascular complications of type 2 diabetes[J].J Diabetes Metab Disord,2016,15(1):51
[16] Ogata M,Ide R,Takizawa M,et al.Association between basal metabolic function and bone metabolism in postmenopausal women with type 2 diabets[J].Nutrition,2015,31(11-12):1394-1401
[2] Karimifar Mansoor,Pasha Morteza Aghajan Poor,Salari Amirhossein,et al.Evaluation of bone loss in diabetic postmenopausal women[J].Journal of Research in Medical Sciences:The Official Journal of Isfahan University of Medical Sciences,2012,17(11):1033-1038
[3] 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
[4] Shanbhogue VV,Hansen S,Frost M,et al.Bone disease in diabetes:another manifestation of microvascular disease[J].Lancet Diabetes & Endocrinology,2017,5(10):827-838
[5] 陆再英,钟南山.内科学[M].第7版.北京:人民卫生出版社,2008.236
[6] Shanbhogue VV,Hansen S,Frost M,et al.Compromised cortical bone compartment in type 2 diabetes mellitus patients with microvascular disease[J].European Journal of Endocrinology,2016,174(2):115
[7] Seo SK,Lee BS,Cho S,et al.Renal function is associated with bone mineral density and arterial stiffness in healthy postmenopausal women-Bone[J].Gynecologic&obstetric Investigation,2014,17(6):480-486
[8] 邱明才,戴晨琳.代谢性骨病学[M].北京:人民卫生出版社,2012.236
[9] Zhukouskaya VV,Eller-Vainicher C,Shepelkevich AP,et al.Bone health in type 1 diabetes:focus on evaluation and treatment in clinical practice[J].Journal of Endocrinological Investigation,2015,38(9):941-950
[10] 杨华梅,路志凯.2型糖尿病患者骨病变与视网膜病变程度相关性的临床分析[J].中国骨质疏松杂志,2012,18(10):903-904
[11] Shah P,Bajaj S,Virk H,et al.Rapid Progression of Coronary Atherosclerosis:A Review[J].Thrombosis,2015,(2015-12-28),2015,2015(2):1-6
[12] Avbersek-Luznik I,Gmeiner Stopar T,Marc J.Activity or mass concentration of bone-specific alkaline phosphatase as a marker of bone formation[J].Clinical Chemical Laboratory Medicine,2007,45(8):1014-1018
[13] 中华医学会骨质疏松和骨矿盐疾病分会.原发性骨质疏松症诊治指南(2011年)[J].中华骨质疏松和骨矿盐疾病杂志,2011,4(1):2-17
[14] Shanbhogue VV,Hansen S,Frost M,et al.Compromised cortical bone compartment in type 2 diabetes mellitus patients with microvascular disease[J].European Journal of Endocrinology,2016,174(2):115
[15] Maghbooli Z,Shabani P,Gorganifiruzjaee S,et al.The association between bone turnover markers and microvascular complications of type 2 diabetes[J].J Diabetes Metab Disord,2016,15(1):51
[16] Ogata M,Ide R,Takizawa M,et al.Association between basal metabolic function and bone metabolism in postmenopausal women with type 2 diabets[J].Nutrition,2015,31(11-12):1394-1401