2型糖尿病患者合并骨质疏松的多因素分析

目的 研究糖尿病合并骨质疏松或骨量减少有关的危险因素。方法 使用多因素统计方法，分析住院治疗的185例2型糖尿病患各种与骨质疏松相关的危险因素。骨质疏松按跟骨超声骨密度低于同性别正常人均值减两个标准差诊断，骨量减少按跟骨超声骨密度低于同性别正常人均值减1个标准差诊断，据此将研究对象分为两组；合并骨质疏松或骨量减少组（OP）和正常骨密度组（NOP）。结果 （1）185例2型糖尿病患中有85例合并骨质疏松或骨量减少，OP发生率为45.95%，（2）糖尿病合并OP与众多的因素有关，高龄，低体重，女性患，长期糖尿病史，E2水平降低等都是其危险因素。（3）在男性患，各年龄段分组未见对OP发生率有明显的差异。而在女性患中，60岁后OP的发生率明显增高，（4）在OP与NOP两组比较中BGP差异无显性。（5）糖尿病合并OPPTH和24h尿磷排泄增高，但血浆钙磷水平无明显变化。结论 （1）糖尿病合并骨质疏松与众多的因素有关，高龄，低体重，女性患，长期糖尿病史，E2水平降低等都是其危险因素，而PTH和尿磷排泄增高为OP的继发性改变，与大量钙镁磷从尿中丢失有关。（2）在男性患，糖尿病对OP的影响明显超过年龄的作用，而在女性患中，糖尿病和年龄对OP的发生均有重要作用。（3）虽然糖尿病合并OP常伴有BGP水平的降低，但BGP不是早期诊断糖尿病合并OP的敏感指标。

Multivariate analysis of diabetic patients with osteoporosis

Objective To study the risk factors related to osteoporosis or osteopenia in diabetic inpatients. Methods Multivariate analysis was used for studying the risk factors in 185 inpatients with type 2 diabetes mellitus.Osteoporosis and osteopenia were diagnosed according to ultrasonic bone mineral density below F scores of mean-2 SD and mean 1SD,respectively,of the same sex and young adult group.All patieuts were divided into two groups:OP group(including osteoporosis and osteopenia)and NOP group(normal bone mineral density). Results (1)Of 185 cases,85 had osteoporosis or osteopenia,the incidence of OP being 45.956%.(2)There were many factors related to OP,including advanced age,female sex,low weight,long history of diabetes,and low level of estradiol.(3)There was no difference in the incidence of OP between differnet age groups of male diabetic,but the incidence of OP was higher in female diabetic patients over 60 years.(4) There was no difference in plasma BGP level between OP and NOP groups.(5)PTH level and urine phosphorus(P)were higher in OP group,but there was no difference in plasma Ca and P levels between the two groups. Conclusion (1)There are many factors related to OP,including advanced age,female sex,low weight,long history of diabetes mellitus and low level of estradiol.High level of PTH and urine are secondary to OP,which has relationship with great loss of Mg,Ca and P from urine.(2)The effects of diabetes mellitus on the incidence of OP are greater than those of age in male group,but diabetes mellitus as well as age has effects on the incidence in female group.(3)The level of BGP cannot be used as a sensitive method in diagnosis of OP,though it always decreases in advanced period of diabetes mellitus with osteoporosis.;