成人隐匿性自身免疫性糖尿病患者骨密度变化及影响因素分析

目的探讨成人隐匿性自身免疫性糖尿病(latent autoimmune diabetes in adults,LADA)患者骨密度(bone mineral density,BMD)变化及其影响因素。方法选取2013年4月至2016年6月于武警浙江总队杭州医院内分泌科确诊的LADA患者43例,作为LADA组,另选同期健康体检人员40名作为对照组。检测两组受试者代谢指标空腹血糖(fasting plasma glucose,FPG)、餐后2 h血糖(2 h postprandial blood glucose,2 h PBG)、糖化血红蛋白(glycosylated hemoglobin,HbA1c)、血钙、血磷、24 h尿钙、24 h尿磷、碱性磷酸酶(alkaline phosphatase,ALP)、尿微量蛋白(microalbuminuria,MAU)水平,并检测腰椎2~4BMD及股骨颈BMD进行比较。同时研究L2~4BMD及股骨颈BMD与代谢指标水平之间的关系,并分析L2~4BMD及股骨颈BMD的影响因素。结果两组受检者血磷、24 h尿磷、ALP水平均无明显差异(P0.05),LADA组FPG、2hPBG、HbA1c、24h尿钙及MAU均明显高于对照组(P0.05),LADA组血钙明显低于对照组(P0.05);LADA组L2~4、股骨颈BMD均明显低于对照组(P0.05);L2~4BMD与HbA1c、MAU呈负相关(r=-0.351、-0.242,P0.05),与血钙呈正相关(r=0.396,P0.05);股骨颈BMD与HbA1c、MAU呈负相关(r=-0.462、-0.118,P0.05),与血钙呈正相关(r=0.411,P0.05)。结论LADA患者的骨密度明显低于健康受试者,性别、血钙、MAU为L2~4BMD的影响因素,年龄、性别、血钙、MAU为股骨颈BMD的影响因素。

Changes of and influencing factors of bone mineral density in patients with latent autoimmune diabetes in adults

Objective To investigate the changes in bone mineral density (BMD) in patients with latent autoimmune diabetes in adults (LADA), and to explore the related influencing factors. Methods 43 adults with LADA were selected as LADA group, and 40 healthy subjects were selected as control group. Metabolic indexes including fasting plasma glucose (FPG), 2h postprandial blood glucose (2h PBG), glycosylated hemoglobin (HbA1c), serum Ca, serum P, 24h urinary calcium, 24h urinary P, alkaline phosphatase (ALP) and microalbuminuria (MAU), and BMD of lumbar spine (L2-4) and femoral neck were tested and compared between the two groups. Partial correlation analysis was used to evaluate the relationship between L2-4 BMD, femoral neck BMD and metabolic indexes, and linear regression analysis was used to investigate the influencing factors of BMD of L2-4 and femoral neck in patients with LADA. Results There were no significant differences in P, 24h urinary phosphorus and ALP between the two groups (P>0.05). FPG, 2h PBG, HbA1c, 24h urinary calcium and MAU of LADA group were significantly higher than those in the control group (P<0.05), and serum Ca of LADA group were significantly lower than that in the control group (P<0.05). BMD of L2-4 and femoral neck of LADA group were significantly lower than that in the control group (P<0.05). BMD of L2-4 negatively correlated with HbA1c and MAU in patients with LADA (r=-0.351, -0.242; P<0.05), BMD of L2-4 positively correlated with serum Ca in patients with LADA (r=0.396, P<0.05). BMD of femoral neck negatively correlated with HbA1c and MAU in patients with LADA (r=-0.462, -0.118; P<0.05). BMD of femoral neck positively correlated with serum Ca in patients with LADA (r=0.411, P<0.05). Conclusion The BMD of LADA patients was lower than that of healthy people. Sex, serum calcium and MAU are the influencing factors of L2-4 BMD, and age, sex, serum calcium and MAU are the influence factors of femoral neck BMD in patients with LADA.