老年糖尿病足患者骨密度分析

目的探讨老年2型糖尿病(T2DM)合并糖尿病足(DF)患者骨密度(BMD)的变化及影响因素。方法采用双能X线骨密度仪测定T2DM患者、T2DM合并DF患者及正常人的腰椎和股骨的BMD,并对其与病程、体重指数(BMI)、糖化血红蛋白(HbA1c)、血糖、C肽、超敏C反应蛋白(hsCRP)、尿微量白蛋白(u-MA)及骨代谢指标的相关性进行分析。结果(1)男女T2DM患者腰椎和股骨的BMD均与正常对照组相似(P>0.05)。(2)男女DF患者腰椎和股骨的BMD均低于正常对照组(P<0.05)。(3)多元逐步回归分析显示,影响男性DF患者BMD的因素为年龄、BMI和餐后C肽(PCP)水平,影响女性DF患者BMD的因素为年龄、BMI和hsCRP水平。结论老年T2DM患者的BMD与正常人相似。老年DF患者BMD较正常人明显降低。高龄、低体重、胰岛功能减退和CRP水平增高加重骨量丢失。     

2型糖尿病患者骨密度的变化及其相关因素分析

目的 探讨2型糖尿病(12DM)患者骨密度(BMD)改变并分析其相关因素.方法 采用双能x线骨密度仪,测定T2DM患者302例和正常人282例的BMD,并对T2DM患者的年龄、体质指数、病程、糖化血红蛋白、血清胰岛素及血脂等指标与BMD的关系作多元线性回归分析.结果 (1)男性T2DM患者腰椎和股骨的BMD和骨质疏松(OP)的患病率均与正常人相似;女性T2DM患者腰椎(L3)、和股骨(Wards)的BMD低于正常人(P＜0.05),其余部位的BMD和OP的患病率与正常人相似.(2)多元线性回归分析显示,影响男性T2DM患者BMD的因素为年龄、体质指数和总胆固醇水平,而影响女性T2DM患者的BMD的因素为年龄、体质指数和餐后2小时胰岛素水平.结论 T2DM患者腰椎和股骨的BMD和OP的患病率均与正常人相似.     

2型糖尿病对绝经后妇女骨密度的影响

目的探讨2型糖尿病(T2DM)和绝经后妇女骨密度(BMD)的相关性。方法选择四川绵阳地区绝经后妇女208例,用双能X线骨密度仪(DEXA)检测正位第2～4腰椎、左侧股骨颈、股骨大转子和Ward’s三角区BMD;T2DM诊断根据美国糖尿病协会2010年诊断标准。结果T2DM患者骨质疏松(OP)患病率53.13%、非T2DM患者OP患病率45.10%,T2DM绝经后女性OP患病率显著高于非T2DM患者(P<0.01)。T2DM患者股骨颈(0.647±0.138)、Ward’s三角区(0.608±0.149)BMD明显低于非T2DM患者股骨颈(0.836±0.186)、Ward’s三角区(0.731±0.097)BMD(P<0.05),T2DM患者第2～4腰椎、大转子BMD与非T2DM组比较无明显差异(P>0.05)。结论 T2DM与绝经后妇女的BMD存在相关性,T2DM是导致绝经后妇女低BMD的一个危险因素。     

老年2型糖尿病患者并发骨质疏松的临床分析

目的　探讨老年 2型糖尿病 (T2DM)患者骨质疏松的患病率。　方法　将老年T2DM患者 338例分为 6 0～ 6 9岁和 70～ 79岁组 ,应用DPX L骨密度仪测定患者腰椎、左侧股骨Ward’区骨密度 ,并与非老年 (5 0～ 5 9岁 )T2DM患者 199例及本地区健康老年人 (老年对照组 ) 5 31例进行骨密度及骨质疏松患病率的比较。　结果　 (1)女性老年T2DM组腰椎、Ward’s区的骨质疏松患病率均高于非老年T2DM组 ,但低于老年对照组 ,差异均有显著性 (P <0 0 5～ 0 0 0 1,70～ 79岁组腰椎除外 ) ;(2 )男性老年T2DM组腰椎骨质疏松的患病率与非老年T2DM组和老年对照组比较 ,差异无显著性 ;6 0～ 6 9岁组Ward’s区骨质疏松的患病率高于非老年T2DM组和同龄对照组 ,但 70～ 79岁组低于同龄对照组 ,差异均有显著性 (P <0 0 5～ 0 0 0 1) ;(3)老年T2DM组患病前的体质指数 (BMI)高于老年对照组 ,差异有显著性 (P <0 0 5～ 0 0 0 1)。　结论　老年T2DM患者骨质疏松的患病率因年龄、性别和部位的不同而表现为高于或等于非老年T2DM患者 ,低于或等于健康老年人。     

中老年汉族男性2型糖尿病患者合并骨质疏松的危险因素

目的探讨中老年汉族男性2型糖尿病(T2DM)患者合并骨质疏松(OP)的危险因素。方法选择汉族T2DM男性患者115例(T2DM组)及50~79岁健康男性汉族体检人群148例(对照组)。观察T2DM组、对照组的OP发病率的关系。比较T2DM腰椎1~4、股骨颈、全髋部位的骨密度(BMD)与龄、体重指数(BMI)分层的关系,同时进行T2DM组相关因素的分析。结果中老年汉族男性T2DM患者OP的发病率是13.8%,明显高于对照组(2.7%,P<0.05)。T2DM组腰椎1~4、股骨颈、全髋的BMD与年龄、BMI分层无相关性(P>0.05)。多元线性回归分析结果显示糖尿病病程、饮酒史与BMD独立正相关(P<0.05);BMI、游离三碘甲状腺原氨酸(FT3)与BMD独立负相关(P<0.01),高密度脂蛋白胆固醇(HDL-C)、甲状腺球蛋白抗体(TgAb)与BMD呈独立负相关(P<0.05)。结论 BMI、糖尿病病程延长、长期饮酒及高水平FT3、TgAb、HDL-C是中老年汉族男性T2DM患者发生OP的重要风险因素。     

男性2型糖尿病患者骨密度变化及相关因素分析

目的探讨男性2型糖尿病(T2DM)患者骨密度(BMD)的变化及相关因素。方法男性T2DM患者68例,均测量身高、体重、糖化血红蛋白(HbA1c)、胰岛素生长因子-1(IGF-1)、胰岛素生长因子结合蛋白-3(IGF-BP3)和骨密度。并根据BMD分为骨量正常组,骨量减少组,骨质疏松(OP)组进行比较。结果 (1)男性T2DM患者骨量减少的检出率为48.5%,OP的检出率为22%。(2)与骨量正常组相比,骨量减少组及OP组受检部位骨量明显下降(P<0.01);与骨量减低组比较,OP组L2、大转子(Troch)处的骨量下降不明显,未发现统计学差异(P>0.05)。Ward三角处的骨量在各组均明显低于其他受检部位。(3)与骨量正常组比较,骨量减低组的HbA1c明显升高(P<0.01)。(4)年龄和Neck的骨量呈负相关,BMI是维持骨量的有利因素,IGF-1及IGF-BP3、病程与骨量无明显相关性。结论男性T2DM患者骨量减少及OP的发病率高于流行病学调查的男性正常人群发病率。随着年龄增加,应定期对男性T2DM患者股骨BMD进行筛查。血糖控制水平对男性T2DM患者OP发病早期有重要影响。男性T2DM患者的BMI应维持在适当水平。骨量减少是糖尿病基础病变的一部分,性别的差异可能影响血清IGF-1在男性T2DM患者骨代谢中的作用。     

老年男性2型糖尿病患者骨密度情况及相关影响因素

目的探讨老年男性2型糖尿病(T2DM)患者骨密度(BMD)情况及其合并骨质疏松(OP)的相关影响因素。方法双能X线骨密度仪测定170例老年男性T2DM患者股骨颈(N)及腰椎1~4(L1~4)的BMD,按BMD结果分为OP组、骨量减少组及骨量正常组,比较不同组间患者的临床、生化指标的差异,分析老年男性T2DM患者合并OP的影响因素。结果与骨量正常组相比,骨量减少组及OP组T2DM患者空腹血糖(FPG)、餐后2 h血糖(2 h PG)及糖化血红蛋白(Hb A1c)水平更高(P<0.01),且OP组较骨量正常组T2DM病程更长、年龄更大、体重指数(BMI)更低(P<0.01),同时骨量减少组T2DM患者病程也较骨量正常组更长(P<0.05)。与骨量减少组相比,OP组T2DM患者病程更长,年龄更大,BMI较低,FPG、2 h PG及Hb A1c水平更高(P<0.01)。Logistic回归分析显示老年男性T2DM患者中,吸烟,高龄,长T2DM病程,高FPG、2 h PG及Hb A1c,低BMI为OP发生的危险因素。结论老年男性T2DM患者中吸烟、高龄、长病程、高FPG、2 h PG、高Hb A1c及低BMI患者更易罹患OP。     

老年2型糖尿病合并糖尿病足患者骨密度的临床分析

目的 探讨老年2型糖尿病(T2DM)合并糖尿病足患者骨密度变化及其影响因素.方法 采用双能X线骨密度仪检测T2DM、T2DM合并糖尿病足患者及健康老年人腰椎(L2～4)和股骨(Neck)的骨密度,并对其与年龄、病程、体质指数(BMI)、糖化血红蛋白、血清胰岛素、血脂、尿微量白蛋白排泄率、骨钙素及性激素等指标的关系进行多元线性回归分析.结果 (1)老年T2DM组腰椎、股骨骨密度和骨质疏松患病率与同性别健康对照组比较(男性:腰椎(1.13±0.17)g/cm2和(1.15±0.18)g/cm2,股骨(0.87±0.13)g/cm2和(0.90±0.16)g/cm2,骨质疏松患病率36%和35%;女性:腰椎(0.96±0.15)g/cm2和(0.97±0.14)g/cm2,股骨(0.78±0.12)g/cm2和(0.82±0.15)g/cm2,骨质疏松患病率61%和62%],差异无统计学意义(P>0.05);(2)老年糖尿病足组男性腰椎骨密度(1.05±0.17)g/cm2、股骨(0.80±0.15)g/cm2;女性腰椎骨密度(0.89±0.11)g/cm2、股骨(0.72±0.13)g/cm2,均低于同性别T2DM组和健康对照组(P<0.01或P<0.05),骨质疏松患病率(男性54%,女性82%)均高于T2DM组和缝康对照组(P<0.05);(3)多元线性回归分析显示,影响老年男性糖尿病足患者骨密度的因素为年龄、BMI和空腹胰岛素水平,影响老年女性糖尿病足患者骨密度的因素为年龄、BMI和雌二醇水平.结论 老年T2DM患者骨密度和骨质疏松患病率与健康老年人相似,与老年T2DM患者和健康老年人比较,老年糖尿病足患者骨密度显著降低,骨质疏松患病率显著增高.     

老年女性2型糖尿病患者尿酸水平、白细胞计数与骨密度的关系

目的探讨老年女性2型糖尿病(T2DM)患者血尿酸(UA)、白细胞计数与骨密度的关系。方法采用双能X线吸收法测定老年女性T2DM患者及正常对照组患者腰椎及左股骨颈的BMD,检测其空腹及餐后2 h血糖(2 h PG)、糖化血红蛋白(Hb A1c)、血尿酸(UA)、血清钙(ALP)、血清磷、血清总碱性磷酸酶(ALP)水平、白细胞计数、淋巴细胞计数。结果 (1)老年女性T2DM患者腰椎、左股骨颈BMD值显著低于正常对照组,UA水平显著高于正常对照组(P<0.05)。(2)老年女性T2DM患者高UA组L1~L3 BMD值显著低于正常UA组(P<0.05)。(3)Logistic回归分析示,年龄、T2DM和血UA是老年女性骨质疏松或骨含量降低的危险因素,而外周白细胞计数则为保护因素(OR值分别为1.108、5.911、1.005、0.689,P<0.05)。结论老年女性T2DM患者BMD降低,定期检测血UA水平和外周白细胞计数,可预测老年女性T2DM患者的BMD。     

2型糖尿病患者血尿酸水平与骨密度的相关性研究

目的 探讨2型糖尿病患者(T2DM)血清尿酸水平(SUA)与骨密度(BMD)的关系.方法 收集2型糖尿病患者235例(其中男性128例,女性107例)的相关临床资料.应用Pearson相关分析检验患者SUA与BMD的相关性；多元逐步回归分析BMD的影响因素.结果 (1)男性2型糖尿病患者SUA水平、BMD均明显高于女性(P＜0.01).女性2型糖尿病患者SUA水平与腰椎及股骨颈BMD呈正相关.(2)多元逐步回归分析结果显示,年龄、SUA水平是女性2型糖尿病患者腰椎及左股骨颈BMD的独立相关因素.而高密度脂蛋白胆固醇(HDL-C)只与女性2型糖尿病患者腰椎BMD独立相关.结论 女性2型糖尿病患者的SUA水平与BMD密切相关.     

老年男性2型糖尿病患者骨密度及相关因素分析

目的 探讨老年男性2型糖尿病患者骨质疏松发病的危险因素. 方法 应用双能X线骨密度仪测定80例老年男性2型糖尿病患者的腰椎和股骨骨密度.并检测血清和尿液中骨代谢及血糖相关的生化指标,分析影响患者骨密度的相关危险因素. 结果所有患者中依据任一部位的骨密度值,骨质疏松的检出率为18.6%,骨量减少的检出率为53.8%.体质量和体质量指数(BMI)与腰椎、股骨颈和Ward's三角的骨密度呈正相关(r=0.202～0.298,P<0.05或P<0.01),年龄、糖化血红蛋白(HbAlc)与腰椎和股骨颈的骨密度呈负相关(r=-0.172～-0.211,均P<0.05).瘦素除与股骨颈和Ward's三角骨密度呈正相关外,尚与体质量、BMI、空腹血糖、血清总胆固醇、HbAlc相关(r=0.219～0.509,P<0.05或P<0.01).多元逐步回归分析显示,体质量是所有部位骨密度的影响因素,HbAlc影响股骨颈骨密度,瘦素影响Ward's三角区骨密度(r~2=0.196～0.276,均P<0.01). 结论 老年男性2型糖尿病患者中,不同部位的骨密度受不同的因素影响.     

Osteopenia in insulin-dependent diabetes mellitus; prevalence and aspects of pathophysiology

The objective was to evaluate the prevalence and severity of osteopenia in patients with uncomplicated insulin-dependent diabetes mellitus (IDDM) and to obtain more information on the pathophysiology of diabetic osteopenia. In 35 patients with uncomplicated IDDM (21 men and 14 women; age 37.6+/-9.9 yr; duration of disease 8.5+/-3.5 years) bone mineral density was measured by dual energy X-ray absorptiometry (DEXA). In addition, markers of bone formation [plasma insulin-like growth factor I (IGF-I), serum alkaline phosphatase (ALP), serum bone alkaline phosphatase (BAP) and serum osteocalcin] and bone resorption [urinary excretion of calcium and of the cross-linked N-telopeptide of type 1 collagen, both corrected for the excretion of creatinine] were measured in the diabetic patients and in 33 healthy controls, matched for sex, age, height, weight and body mass index (BMI). In 67% of the diabetic men and 57% of the diabetic women osteopenia of the femoral neck and/or the lumbar spine (T-value < or = -1 SD) was present. Fourteen percent of the male patients, but none of the female patients, met the criteria for osteoporosis (T-value < or = -2.5 SD). In the whole group of diabetic patients the mean plasma IGF-I level tended to be lower (p<0.10) as compared to that in the controls. In the diabetic patients with femoral neck osteopenia, the mean plasma IGF-I level was significantly lower (p<0.05) than in those without osteopenia at this site. There were no differences in the mean serum ALP, BAP and osteocalcin levels between the diabetic patients and the controls, nor between the diabetic patients with and without femoral neck osteopenia. Considering only the male diabetic patients, significantly lower mean plasma IGF-I (-26%), serum ALP (-24%) and serum osteocalcin (-38%) levels were present in the patients with femoral neck osteopenia than in those without osteopenia at this site, suggesting lowered bone formation. The bone resorption markers were similar in all (sub)groups of diabetic patients and not different between diabetic patients and controls. Bone mineral density (BMD) did not correlate with plasma levels of glycosylated hemoglobin (HbA1c). BMD values were not related to any of the bone resorption or formation markers, except for plasma IGF-I both in the femoral neck (r=+0.38, p=0.026) and the lumbar spine (r=+0.34, p=0.043). Our data demonstrate that at least in male patients with IDDM, osteopenia is the consequence of a lowered bone formation with a predominance of bone resorption over formation.     

糖尿病对骨密度及相关激素的影响

目的 观察DM患者骨密度（bone mineral density,BMD)及其相关激素的改变，并探讨其发生机制。方法 采用双能（线吸收法测量2型DM患者68例、1型DM患者54例和健康人62例的BMD，放免法测定血清骨钙素、降钙素和25羟维生素D3，免疫放射法测定血清完整甲状旁腺素及I型胶原羧基末段前肽。结果 ①两组DM患者全血HbA1c水平均显著高于对照组（P＜0．01），血清骨钙素水平显著低于对照组（P＜0．01）；②2型DM组BMI、大转子BMD显著高于对照组和1型DM组（BMI，P＜0．01；BMD，P＜0．05）；1型DM组股骨颈BMD低于对照组和2型DM组（P＜0．05），经BMI纠正后，1型DM组股骨颈BMD仍低于对照组（P＜0．05）；③1型DM组各位点BMD与血清I型胶原羧基末段前肽水平呈负相关（P＜0．05），2型DM组腰椎和大转子BMD与全血HbA1c水平呈负相关（P＜0．05）。结论 与健康人群相比，1型DM患者BMD明显降低，2型DM患者BMD明显增高，但经BMI纠正后，这种差异性消失；骨转化降低以及糖尿病代谢紊乱可能参与了糖尿病骨质疏松的发生。     

绝经后2型糖尿病患者骨密度与颈动脉内膜中膜厚度的关系

目的 探讨绝经后2型糖尿病患者骨密度与颈动脉内膜中膜厚度的关系.方法 选择符合纳入标准的93例绝经后2型糖尿病患者和55例健康对照者,测定其正位腰椎L_(1～4)及左股骨颈骨密度,并根据骨密度将2型糖尿病患者分为并发骨质疏松症组和无骨质疏松症组,同时测定颈动脉内膜中膜厚度,并收集三组患者的年龄、绝经年限、体质指数等资料.结果 骨质疏松症组与无骨质疏松症组比较年龄、绝经年限、病程及体质指数差异有统计学意义(P<0.01);与无骨质疏松症组和对照组比较,骨质疏松症组正位腰椎L_(1～4)、左股骨颈骨密度下降(P<0.01),颈动脉内膜中膜厚度增厚(P<0.01),斑块发生率增高(P<0.05).相关分析显示,2型糖尿病患者正位腰椎L_(1～4)和左股骨颈骨密度与患者年龄、病程、绝经年限及颈动脉内膜中膜厚度呈负相关,与体质指数呈正相关.结论 绝经后2型糖尿病患者骨密度与颈动脉体质指数存在一定的联系,低骨密度绝经后2型糖尿病患者更易发生动脉粥样硬化.     

Prevalence and predictors of osteopenia and osteoporosis in adults with Type 1 diabetes

Aims To determine the prevalence and biochemical/hormonal determinants of osteopenia and osteoporosis in adults with Type 1 diabetes. Methods One hundred and two patients (52 female, 50 male) with Type 1 diabetes aged 20–71 years underwent cross‐sectional assessment of biochemical/hormonal markers of bone metabolism, and bone mineral density (BMD) measurement at forearm, hip and spine using dual energy x‐ray absorptiometry. BMD data were available for 102 age‐ and gender‐matched population‐based control subjects. Results After adjusting for age and body mass index (BMI), osteopenia and osteoporosis were more common at the spine in males with Type 1 diabetes than in control subjects (P = 0.030). In Type 1 males, after adjustment for age and BMI, BMD, T‐ and Z‐scores at the hip, femoral neck and spine were lower compared with age‐matched control subjects (P ≤ 0.048). Female Type 1 patients and control subjects had similar BMDs and T‐ and Z‐scores at all sites. On multiple linear regression analysis, which adjusted for the natural logarithm of the sex hormone binding globulin concentration, smoking status and alcohol consumption, and (for women) menopausal status, each of BMI, serum ionized calcium and serum alkaline phosphatase (negatively) were independently associated with BMD at the hip and femoral neck in Type 1 diabetic subjects. Conclusions Adult males with Type 1 diabetes have reduced bone density at the hip, femoral neck and spine when compared with age‐matched control subjects. Impaired bone formation may occur in Type 1 diabetes.     

Healthy elderly individuals do not inevitably lose bone density and weight as they age

There have been relatively few extended longitudinal studies of bone mineral density (BMD) and anthropometric characteristics in the elderly. We recorded baseline measurements (height, weight, body mass index (BMI)) and BMD in 292 relatively healthy individuals (mean age: 75 years females, 76 years males) who were followed up over 8 years. At baseline, a significant inverse relationship was noted between increasing age and BMD at the neck of femur in both sexes. In female subjects, baseline age was inversely related to BMD at the total hip site. There was a significant positive relationship between baseline weight/BMI in both sexes and BMD at the total hip and neck of femur. Weight and BMI were positively related to BMD at the spine in female participants. After a mean follow-up period for males and females of 7.6 and 8.0 years, respectively, there was a significant fall in height for male and female subjects although weight and BMI did not significantly vary in either sex. Follow-up hip BMD fell marginally but significantly in female subjects only. A significant relationship existed between change in hip BMD and change in weight in females. Measurements of the neck of femur did not change significantly on follow-up in either sex. While cross-sectional measurements show weight and age are related to bone density in elderly people, longitudinal evaluation over 8 years failed to demonstrate consistent reductions in males and females. In addition, there was good maintenance of BMD at most sites.     

男性2型糖尿病患者骨密度变化及其相关因素分析

目的 探讨男性T2DM患者骨密度（BMD）的变化,并分析主要相关因素. 方法 选取 156例男性T2DM患者和104名健康体检者,分为BMI＜25 kg/m2（Nob组）以及BMI≥25 kg/m2 （Ob组）,分别测定两组股骨颈大转子处BMD及T值,比较组间差异并分析T2DM患者BMD的相关因素.结果 （1）两组中T2DM患者（A、C亚组）与健康体检者（B、D亚组）的BMD差异无统计学意义.（2）相关分析表明,T2DM患者的BMD与体重、BMI及WC呈正相关,与Cr呈负相关;与年龄、HbA1c、TC、病程等无相关性.BMI是男性T2DM患者BMD改变的因素（r2=0.361,P＜0.05）. 结论 男性T2DM患者与股骨颈大转子处BMD无相关性.     

中老年妇女骨转换生化指标和骨密度的变化

目的 探讨中老年妇女骨转换生化指标与骨密度随绝经的变化.方法 408名符合条件40 ～80岁的女性志愿者,同一时间段留取血清和晨尿,统一用酶免方法 测定血清骨碱性磷酸酶(BAP)、骨钙素和尿I型胶原氨基末端肽(uNTX);用舣能X线骨密度仪测定前后位腰椎1-4(L1-4)、左侧股骨颈的骨密度.结果 (1)BAP、骨钙素和uNTX与年龄、孕次、生育次数和绝经年限呈正相关(均P相似文献