2型糖尿病患者不同部位骨密度变化及骨折情况分析
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摘要
目的探讨2型糖尿病(T2DM)患者不同部位骨密度(BMD)的特征及骨折情况。方法 2012—2015年青岛市城阳区人民医院内分泌科住院T2DM患者125例为观察组,健康体检者240例为对照组,收集一般临床资料;双能X线吸收法测定腰椎(L)后前位1-4椎体和左侧股骨近端各部位(股骨颈、股骨干、大粗隆、Ward's三角和全髋部)的BMD。结果男性DM腰椎(L2)的BMD低于非糖尿病(NDM)组,差异有统计学意义(P<0.05);女性DM的Ward's三角区和股骨颈BMD低于NDM组,差异有统计学意义(P<0.05)。骨质疏松(OP)患病率,女性DM(55.20%)和NDM(29.16%)均高于男性DM(28.80%)和NDM(21.66%),差异有统计学意义(P<0.05);男性DM患者(28.80%)高于NDM患者(21.66%),其中L2和L1-4(5.40%和16.00%)高于NDM患者(1.66%和9.58%),差异有统计学意义(P<0.05);女性DM患者(55.20%)高于NDM患者(29.16%),其中Ward's三角、股骨颈和股骨全部(20.00%、12.80%和42.40%)高于NDM患者(3.33%、5.00%和17.91%),差异有统计学意义(P<0.05)。男性和女性DM患者骨折人数最多部位为腰椎。结论 T2DM患者易伴发OP,其中L2和Ward's三角区可分别作为男性和女性患者早期诊断OP的首选检查部位。
Objective To investigate the characteristics of bone mineral density(BMD) and fracture in different parts of patients with type 2 diabetes mellitus(T2 DM). Methods Totally 125 patients with T2 DM admitted to department of endocrinology in Chengyang District People's Hospital of Qingdao city in 2012-2015 were selected as the observation group, and 240 healthy cases were selected as the control group. The general clinical data were collected, anddual energy X-ray absorptiometry was used to determine BMD of the anterior part of the lumbar spine(L) and the 1-4 vertebrae and the left proximal femur(femoral neck, femoral shaft, trochanter, Ward's triangle and total hip). Results For male patients, BMD of L2 in diabetic group was lower than that in the non-diabetic group(P<0.05).For female patients, BMDs of Ward's triangle and femoral neck in diabetic group were lower than those in the non-diabetic group(P<0.05). Prevalence rates of osteoporosis(OP) in female diabeticgroup(55.20%) and non-diabetic group(29.16%) were higher than thosein males diabetic group(28.80%) and non diabetic group(21.66%), and there were significant differences between diabetic group and non-diabetic group in the same gender(all P<0.05). For male patients, OP prevalence rates in L2 and L1-4(5.40% and 16.00%) in diabetic group were higher than those of non-diabetic patients(1.66% and 9.58%). For female patients, OP prevalence rate of Ward's triangle, femoral neck and femur(20.00%, 12.80% and 42.40%) in diabetic group were higher than those in the nondiabetic group(3.33%, 5.00% and 17.91%)(all P<0.05). The most parts of fractures were all the lumbar spine in both male and female diabetic groups. Conclusion T2 DM is associated with OP. L2 and Ward's triangle could be used as the preferred examination sites for early diagnosis of OP in male and female patients, respectively.
Objective To investigate the characteristics of bone mineral density(BMD) and fracture in different parts of patients with type 2 diabetes mellitus(T2 DM). Methods Totally 125 patients with T2 DM admitted to department of endocrinology in Chengyang District People's Hospital of Qingdao city in 2012-2015 were selected as the observation group, and 240 healthy cases were selected as the control group. The general clinical data were collected, anddual energy X-ray absorptiometry was used to determine BMD of the anterior part of the lumbar spine(L) and the 1-4 vertebrae and the left proximal femur(femoral neck, femoral shaft, trochanter, Ward's triangle and total hip). Results For male patients, BMD of L2 in diabetic group was lower than that in the non-diabetic group(P<0.05).For female patients, BMDs of Ward's triangle and femoral neck in diabetic group were lower than those in the non-diabetic group(P<0.05). Prevalence rates of osteoporosis(OP) in female diabeticgroup(55.20%) and non-diabetic group(29.16%) were higher than thosein males diabetic group(28.80%) and non diabetic group(21.66%), and there were significant differences between diabetic group and non-diabetic group in the same gender(all P<0.05). For male patients, OP prevalence rates in L2 and L1-4(5.40% and 16.00%) in diabetic group were higher than those of non-diabetic patients(1.66% and 9.58%). For female patients, OP prevalence rate of Ward's triangle, femoral neck and femur(20.00%, 12.80% and 42.40%) in diabetic group were higher than those in the nondiabetic group(3.33%, 5.00% and 17.91%)(all P<0.05). The most parts of fractures were all the lumbar spine in both male and female diabetic groups. Conclusion T2 DM is associated with OP. L2 and Ward's triangle could be used as the preferred examination sites for early diagnosis of OP in male and female patients, respectively.
引文
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[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,2011,4(1):2-17.
[14]黄薇,陈芳,李茂蓉,等.老年2型糖尿病与骨质疏松相关因素分析[J].中国骨质疏松杂志,2015,21(5):603-606.
[15]Isidro ML,Ruano B.Bone disease in diabetes[J].Current Diabetes Reviews,2010,6(3):144-155.
[16]Shan PF,Wu XP,Zhang H,et al.Age-related bone mineral density,osteoporosis rate and risk of Vertebral fracture in mainland chinese women with type 2 diabetes mellitus[J].J Endocrinol Invest,2011,34(3):190-196.
[17]Nicodemus KK,Folsom AR.Type 1 and type 2 diabetes and incident hip fractures in posmenopausal women[J].Diabetes Care,2001,24(7):1192-1197.
[18]杨生,徐晓光,岳桂英,等.2型糖尿病患者骨密度间的特征分析[J].中国临床康复,2004,8(6):1010-1011.
[19]饶子亮,赵士海,刘盛来,等.2型糖尿病伴随高脂血症大鼠模型的建立及二甲双胍的干预[J].实验动物科学,2009,26(1):15-17.
[20]燕娟,郭巍伟,梁执群,等.2型糖尿病大鼠模型的建立及其验证[J].临床和实验医学杂志,2009,8(4):5-6.
[21]唐志荣,尹东,黄东,等.老年性骨质疏松患者股骨近端骨质量的改变[J].中国临床康复,2005,9(3):200-201.
[2]熊莉华,刘建仁,范冠杰,等.糖尿病骨质疏松症与蛋白质组学[J].中华综合临床医学杂志,2007,9(5):51.
[3]Liu EY,Wactawski WJ,Donahue RP,et al.Does low bone mineral density start in postteenage years in women with type 1 diabetes[J].Diabetes Care,2003,26(8):2365-2369.
[4]Schwartz AV,Sellmeyer DE,Strotmeyer ES,et al.Diabetes and bone loss at the hip in older black and white adults[J].J Bone Miner Res,2005,20(4):596-603.
[5]Dominguez LJ,Muratore M,Quarta E,et al.Osteoporosis and diabetes[J].Reumatismo,2004,56(4):235-241.
[6]Yaturu S.Diabetes and skeletal health[J].J Diabetes,2009,1(4):246-254.
[7]Botushanov NP,Orbetzova MM.Bone mineral density and fracture risk in patients with type 1 and type 2 diabetes mellitus[J].Folia Medica,2009,51(4):12-17.
[8]Yaturu S,Humphrey S,Landry C,et al.Decreased bone mineral density in men with metabolic syndrome alone and with type 2 diabetes[J].Med Sci Monit,2009,15(1):CR5-9.
[9]Gupta R,Mohammed AM,Mojiminiyi OA,et al.Bone mineral density in premenopausal arab women with type 2diabetes mellitus[J].J Clin Densitom,2009,12(1):54-57.
[10]Anaforoglu I,Nar-Demirer A,Bascil-Tutuncu N,et al.Prevalence of osteoporosis and factors affecting bone mineral density among post-menopausal Turkish women with type 2 diabetes[J].J Diabetes Complications,2009,23(1):12-17.
[11]Negrean V,Suciu I,Sampelean D,et al.Rheological changes in diabetic Microangiopathy[J].Rom J Intern Med,2004,42(2):407-413.
[12]中华医学会糖尿病学分会委员会.中国2型糖尿病防治指南(2013版)[J].中华糖尿病杂志,2011,6(7):447-495.
[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,2011,4(1):2-17.
[14]黄薇,陈芳,李茂蓉,等.老年2型糖尿病与骨质疏松相关因素分析[J].中国骨质疏松杂志,2015,21(5):603-606.
[15]Isidro ML,Ruano B.Bone disease in diabetes[J].Current Diabetes Reviews,2010,6(3):144-155.
[16]Shan PF,Wu XP,Zhang H,et al.Age-related bone mineral density,osteoporosis rate and risk of Vertebral fracture in mainland chinese women with type 2 diabetes mellitus[J].J Endocrinol Invest,2011,34(3):190-196.
[17]Nicodemus KK,Folsom AR.Type 1 and type 2 diabetes and incident hip fractures in posmenopausal women[J].Diabetes Care,2001,24(7):1192-1197.
[18]杨生,徐晓光,岳桂英,等.2型糖尿病患者骨密度间的特征分析[J].中国临床康复,2004,8(6):1010-1011.
[19]饶子亮,赵士海,刘盛来,等.2型糖尿病伴随高脂血症大鼠模型的建立及二甲双胍的干预[J].实验动物科学,2009,26(1):15-17.
[20]燕娟,郭巍伟,梁执群,等.2型糖尿病大鼠模型的建立及其验证[J].临床和实验医学杂志,2009,8(4):5-6.
[21]唐志荣,尹东,黄东,等.老年性骨质疏松患者股骨近端骨质量的改变[J].中国临床康复,2005,9(3):200-201.