绝经后2型糖尿病患者体成分与骨密度关系初步探讨

目的探讨绝经后2型糖尿病患者骨密度与体成分的关系。方法选择绝经后2型糖尿病患者(DM组)68例,绝经后血糖正常女性(NC组)73例。详细记录全部受试者年龄、身高、体重、体重指数、绝经年限,双能X线吸收测定仪检测正位腰椎(L_(2-4))、股骨(股骨颈、大转子、粗隆间)骨密度(BMD)与全身各部位的脂肪和肌肉含量,并进行临床指标测定,分析骨密度与对应的肌肉和脂肪含量的相关关系。结果 2组受试者的年龄、BMI、绝经年限差异无统计学意义(P0.05);DM组空腹血糖(FBG)、餐后2 h血糖(PBG)、糖化血红蛋白(HbAlc)均明显高于NC组,差异有统计学意义(P0.05);DM组L_(2-4)、股骨颈、大转子BMD较NC组显著下降,差异有统计学意义(P0.05);DM组躯干、腿部、总肌肉含量均较NC组显著下降,差异有统计学意义(P0.05);DM组躯干、总脂肪含量较NC组明显增加,(P0.05)。根据骨密度测定结果将糖尿病组进一步分为糖尿病骨质疏松组(DM-OP组)和糖尿病非骨质疏松组(DM-NP组):2组受试者年龄、BMI、绝经年限的差异无统计学意义(P0.05);DM-OP组DM病程、FBG、PBG、HbAlc明显高于DM-NP组(P0.05),DM-OP组躯干、腿部、总肌肉含量均明显低于DM-NP组(P0.05);总脂肪含量DM-OP组明显高于DM-NP组(P0.05),其他部位脂肪含量2组间的差异无统计学意义(P0.05)。多元线性回归分析显示,糖尿病患者L_(2-4)、股骨均值BMD与年龄、绝经年限、糖尿病病程、BMI、TLM、TKLM关系最为密切。结论绝经后2型糖尿病患者较血糖正常女性容易发生骨质疏松,绝经后2型糖尿病患者肌肉含量、脂肪含量均与骨密度密切相关,肌肉含量较脂肪含量对骨密度影响更为显著。

The relationship between bone mineral density and body composition in postmenopausal patients with type 2 diabetes

Objective To discuss the relationship between bone mineral density and body composition in postmenopausal patients with type 2 diabetes. Methods 68 postmenopausal women with type 2 diabetes （DM） were chosen as study group and 73 healthy non-diabetic postmenopausal women were chosen as controls （NC）. Age, BMI, years of menopause and course of diabetes in DM patients were all recorded, BMD of L2 - L4 lumbar vertebrae, femur （ neck, trochanter, InterTro and total）, whole body fat, lean composition were measured by DEXA （dual energy X-ray absorptiometry） in all subjects. Clinical parameter and related analysis were all preformed, as well as the correlationship between body composition and bone mineral density. Results There were no significant differences found in age, BMI, MPY between two groups （P 〉 O. 05 ）. Compared with NC group, patients with DM have higher FBG, PBG, HbAlc levels （all P 〈0.05）, but lower BMD in L2-4, femoral neck （NK） and greater trochanter （GT） （P 〈 0. 05）. Lean masses in trunk, legs and the total were significantly lower （ P 〈 0. 05 ） whereas total and trunk fat mass were higher in DM patients compared with NC group （P 〈0. 05 ） ; According to BMD, patients with DM had been further divided into diabetes with OP （DM-OP） and those without OP （DM-NP） ： there were no differences existed in age, BMI and MPY between two groups （P 〉0. 05） ; DM course, FBG, PBG and HbAlc were higher in DM-OP group when compared with DM-NP group （ P 〈 0. 05 ） ; Lean mass in trunk, legs, and total were significantly lower whereas total fat mass were higher in DM-OP group than those in DM-NP group. There were no differences found in fat mass of trunk and legs between these two groups. Results from linear regression analysis showed that in DM patients, BMD of L2.4 and femur were positively related with age, MPY, diabetes course, BMI, TLM and TKLM. Conclusion Postmenopausal patients with type 2 diabetes were prone to osteoporosis than normal women, lean and fat mass in Postmenopausal patients with type 2 diabetes were closely correlated with BMD. However, lean mass seems to have more impact on BMD than fat mass.