2型糖尿病患者微血管病变与骨密度的相关性

目的分析2型糖尿病(type 2 diabetes mellitus,T2DM)并发微量白蛋白尿、视网膜病变患者的骨密度变化。方法选择49例T2DM无微量白蛋白尿、无视网膜病变患者(A组)、52例T2DM伴微量白蛋白尿或视网膜病变两者之一患者(B组)、43例T2DM同时合并微量白蛋白尿和视网膜病变患者(C组),60例来我院体检的健康对照组(N组)。采用双能X线骨密度仪对4组受试者测定腰椎2~4、左侧股骨颈及Ward三角区的骨密度,分析组间骨密度差异。结果 C组腰椎、股骨颈、Ward三角区骨密度均低于B组、A组及N组,差异均有统计学意义(P0.05)。B组腰椎骨密度低于A组及N组,但差异无统计学意义,股骨颈及Ward三角区骨密度低于A组及N组,差异有统计学意义(P0.05)。A组腰椎骨密度与N组差异无统计学意义,但股骨颈及Ward三角区骨密度高于N组,差异有统计学意义(P0.05)。T2DM患者骨密度与年龄、糖尿病病史、空腹血糖、糖化血红蛋白、尿微量白蛋白/肌酐比值呈负相关(P0.05),与体重指数、空腹胰岛素水平呈正相关(P0.05)。结论T2DM无微量白蛋白尿、无视网膜病变时骨密度呈增高趋势,但发展到微量白蛋白尿和视网膜病变时骨密度明显降低,尤其是股骨近端可出现较快的骨量流失。

Correlation between microangiopathy and bone mineral density in patients with type 2 diabetes

Objective To analyze the change of bone mineral density (BMD) in type 2 diabetic (T2DM) patients with microalbuminuria and ocular fundus retinopathy. Methods The subjects of the study were 49 T2DM patients without microalbuminuria or ocular fundus retinopathy (Group A), 52 T2DM patients with either microalbuminuria or ocular fundus retinopathy (Group B), 43 T2DM patients with both microalbuminuria and ocular fundus retinopathy (Group C), and 60 normal controls (Group N). The BMD of lumbar vertebrae 2-4 (L2-4), left femoral neck, and Ward''s triangle region was measured using dual energy X-ray absorptiometry (DEXA). The difference of BMD among the groups was analyzed. Results The BMD of L2-4, left femoral neck, and Ward''s triangle region was significantly lower in Group C than that in Group B, A, and normal controls (P<0.05). The BMD of left femoral neck and Ward''s triangle region was lower in Group B than in Group A and normal controls (P<0.05). The BMD of left femoral neck and Ward''s triangle region was higher in Group A than that in normal controls (P<0.05). BMD was negatively correlated with age, course of disease, fasting blood glucose, hemoglobin a1c, the urinary ratio of albumin to creatinin, but positively correlated with body mass index and fasting insulin in T2DM patients (P<0.05). Conclusion BMD shows an increase trend in T2DM patients without microangiopathy. It significantly reduces when accompanies with microalbuminuria and ocular fundus retinopathy. Fast loss of bone mass occurs in the proximal femur especially.