老年2型糖尿病患者骨密度与骨代谢标志物的相关性

目的：探讨老年2型糖尿病患者的骨密度（BMD）与骨代谢标志物的相关性。方法取大于60岁老年2型糖尿病患者197例，根据BMD水平进行分三组，骨量正常组72例、骨量减少组73例和骨质疏松组52例。测定患者空腹血糖（FBG）、早餐后2 h血糖（2 hPG）、糖化血红蛋白（HbAlc）及尿蛋白定量（U-PRO），测定三组患者的骨钙素（BGP）、Ⅰ型胶原羧基末端肽（β-CTX）、总骨Ⅰ型前胶原N端肽（TP1NP）及25-羟维生素D [25（OH）D]的水平，比较三组患者一般临床资料和骨代谢指标并进行统计学分析。结果三组患者的FBG、PPG、HbAlc、病程及尿微量白蛋白比较差异均无统计学意义（P〉0.05），而骨质疏松组的BGP、β-CTX和TP1NP与骨量正常组比较均升高，差异均有统计学意义（P〈0.05），BMD与BGP、β-CTX和TP1NP呈负相关（r值分别为-0.191、-0.244、-0.176， P值分别为〈0.01、〈0.05、〈0.05），与25（OH）D正相关（r=0.325，P〈0.01）。结论老年2型糖尿病患者的骨密度与骨代谢标志物存在密切的相关性，联合应用骨代谢标志物的检测有助于老年2型糖尿病患者骨质疏松的早期诊断，减少骨折风险。

Relationship between bone mineral density and bone metabllistic markers in elderly patients with type 2 diabetes

Objective To investigate the relationship between bone mineral density and bone metabllistic markers in elderly patients with type 2 diabetes. Methods A total of 197 elderly patients with type 2 diabetes were di-vided into three groups according to BMD level： normal group （n=72）, osteopenic group （n=73） and osteoporosis group （n=52）. Fasting blood glucose （FBG）, 2-hour postprandial glucose （2 hPG）, glycated hemoglobin （HbAlc）, uri-nary protein （UPro） and levels of BGP,β-CTX, TP1NP and 25（OH）D were determined. General information and bone metabolic markers were statistically analyzed and compared between the three groups. Results There were no signif-icant differences in 1evels of FBG, 2 hPG, HbAlc, and duration between the three groups （all P〉0.05）. For the compar-ison of normal group with osteoporosis groups, BGP,β-CTX and TP1NP were increased （ P〈0.05）, BMD was posi-tively correlated with BGP,β-CTX and TP1NP （r=-0.191, P〈0.01;r=-0.244, P〈0.05;r=-0.176, P〈0.05）, and BMD was negatively correlated with 25（OH）D （r=0.325, P〈0.01）. Conclusion The change of BMD is closely related with bone metabolisitic markers in elderly patients with type 2 diabetes. The combined application of bone metabolistic markers is helpful for the early diagnosis of osteoporosis in elderly patients with type 2 diabetes, and can reduce the risk of fractures.