绝经后2型糖尿病女性雌激素水平与骨质疏松的相关性研究

【目的】探讨绝经后2型糖尿病（T2DM）合并骨质疏松（OP）妇女雌激素水平及骨密度的变化及其相关性。【方法】120例绝经后女性T2DM患者根据骨密度值分为骨密度正常组即T组（62例）,骨质疏松组即P组（58例）。另选取60例血糖及骨密度均正常的绝经后女性作为正常对照组,即N组（60例）。比较三组骨代谢、糖代谢及性激素等指标。【结果】P组骨碱性磷酸酶（sBAP）、骨钙素（sOC）、Ⅰ型胶原交联C 端肽（sCTx）和尿Ⅰ型胶原交联N 端肽（uNTx）明显低于T组。P组与T组、N组比较,血清卵泡刺激素（FSH）、促黄体激素（LH）升高,雌二醇（E2）下降（ P＜0．05）。相关性分析显示,患者O P与糖尿病病程、年龄、糖化血红蛋白（HbA1C）、空腹血糖（FPG）、FSH、LH、uNTx与肌酐（Cr）呈显著负相关,与sBAP、sOC、sCTx无相关性。【结论】绝经后T2DM妇女骨质疏松与糖代谢及雌激素水平有关。     

外源性胰岛素对2型糖尿病的骨密度和骨代谢指标的影响

目的研究外源性胰岛素对2型糖尿病(T2DM)患者的骨密度及骨代谢指标的影响。方法运用QCT测定43例年龄≥50岁健康对照组以及39例年龄≥50岁使用口服降糖药控制血糖的T2DM患者(口服药物组)和36例使用胰岛素3年以上的≥50岁T2DM患者(胰岛素组)的腰椎骨密度,同时记录年龄、体质量指数、运动及日照时间、饮食习惯、糖尿病病程、绝经年限(女性),检测糖化血红蛋白、胰岛素及C肽(空腹及餐后2h)、血钙、磷、总碱性磷酸酶、骨钙素和尿钙。结果 (1)与对照组比较,口服药物组骨密度差异无统计学意义(P>0.05),(2)与口服药物组比较,胰岛素组骨密度明显增加;(3)胰岛素组骨钙素和餐后2小时胰岛素水平明显高于健康对照组和口服药物组,差异有统计学意义(P<0.01)。结论外源性胰岛素治疗对2型糖尿病骨质疏松有益,这可能与其体内胰岛素水平较高有关。     

2型糖尿病女性患者骨密度与骨转换率的相关性

目的探讨2型糖尿病(T2DM)女性患者骨密度与骨转换及骨重建的相关性。方法回顾性分析纳入在南方医科大学第三附属医院内分泌科住院的201例T2DM女性患者住院期间的临床数据,采用双能X线骨密度仪,测量骨密度,包括腰椎、左侧股骨颈和髋部总体,将纳入对象分为骨量正常组85例(T>-1)、骨量减少组87例(-2.5 < T < -1)和骨质疏松组29例(T < -2.5),检测骨钙素N端中分子片段和β-Ⅰ型胶原C-末端交联分别评估骨形成和骨吸收。根据骨形成和骨吸收的T值分别计算骨转换率和骨重建率,比较T2DM患者骨质疏松组和骨量正常组患者的的骨转换率T值以及骨重建率T值的差异,并评估T2DM女性患者骨转换率T值和骨重建率T值与骨密度之间的相关性。结果T2DM女性患者骨质疏松组的骨转换率T值与T2DM女性患者骨量正常组的骨转换率T值差异有统计学意义(P=0.041),T2DM女性患者骨转换率T值与髋部骨密度负相关(r=-0.14,P =0.049)。校正糖化血红蛋白后,T2DM女性患者骨转换T值与髋部仍呈骨密度负相关(r=-0.144,P=0.043)。结论在T2DM女性患者中,随着骨转换率的增高,患者骨密度越低,并发低创伤性骨折的风险也会随之增高。      

雌激素受体基因多态性与2型糖尿病患者骨密度的关系

目的探讨雌激素受体(ER)基因多态性与2型糖尿病患者骨密度(BMD)的相关性。方法运用双能量X线吸收法(DEXA)测定61例2型糖尿病患者的BMD,PCR-RFLP检测ER基因多态性。结果2型糖尿病组PP型的BMD与Pp型相比,在L2,L3,L4及L2～4有显著的统计学差异(P值分别为0.045,0.021,0.019和0.019);与pp型相比,在L4有显著的统计学差异(P=0.037)。Pp型与pp型相比,各部位BMD均无显著的统计学差异。ER基因型分布频率为PP型0.128,pp型0.333,Pp型0.539,PP型腰椎BMD明显低于Pp型与pp型。结论2型糖尿病易合并骨量减少和骨质疏松,ER基因PP型与2型糖尿病患者腰椎低BMD密切相关。     

绝经后2型糖尿病合并骨质疏松症患者外周血NLR、PLR、Cys-C水平与骨密度的相关性分析

目的 研究绝经后2型糖尿病合并骨质疏松症(OP)患者外周血中性粒细胞淋巴细胞比值(NLR)、血小板淋巴细胞比值(PLR)、胱抑素C(Cys-C)水平与骨密度的相关性.方法 回顾性选择2020年9月至2021年6月北京市大兴区医院内分泌及骨科门诊就诊的绝经后2型糖尿病患者192例,按照患者骨量情况分为骨量正常组、骨量减少...     

老年2型糖尿病与非酒精性脂肪性肝病相关性研究

[目的]探讨老年2型糖尿病（T2DM）合并非酒精性脂肪肝的临床相关因素.[方法]对老年T2DM合并非酒精性脂肪性肝病（NAFLD）或无NAFLD患者及健康对照志愿者进行血脂水平、空腹血糖（FBG）及空腹胰岛素（FINS）的测定,并计算体质量指数（BMI）,腰臀比值（WHR）及胰岛素敏感指数（HOMA-IR）,并进行分析.[结果]与对照组（n=35）、不合并NAFLD组比较（n=40）,合并NAFLD的T2DM患者（n=42）的BMI、WHR、血甘油三酯（TG）、收缩压（SBP）、HOMA-IR显著增高,HOMA-β降低（P〈0.05或P〈0.01）.[结论]T2DM患者合并NAFLD,与肥胖（主要是腹型肥胖）、血脂紊乱、血压增高相关;导致糖尿病合并NAFLD的最主要原因为胰岛素抵抗及其所包含的脂代谢紊乱.     

护骨素基因T950C及A163G多态性与老年2型糖尿病患者的骨密度

背景：2型糖尿病患者发生骨质疏松症的比率较高。目的：观察老年2型糖尿病患者护骨素基因启动子区域T950C、A163G位点多态性与骨密度的关系。方法：纳入147例老年2型糖尿病患者,男性100例,女性47例,应用多聚酶链反应-限制性片段长度多态性方法测定患者护骨素基因T950C、A163G的基因型;采用双能X线骨密度吸收仪测定患者腰椎、髋部及前臂的骨密度。结果与结论：在老年女性2型糖尿病患者中,T950C不同基因型在特定部位具不同骨密度,CC基因型的腰椎L2、L4骨密度高于TC或TT型;在老年男性2型糖尿病患者中,未发现T950C不同基因型与骨密度相关。在老年女性2型糖尿病患者中,A163G不同基因型在特定部位具不同骨密度,AA型的股骨大转子、前臂骨密度高于AG或GG型;在老年男性2型糖尿病患者中AA型的腰椎L3、L4骨密度高于AG或GG型。表明护骨素基因启动子区T950C基因多态性与老年女性2型糖尿病患者的骨密度相关,A163G基因多态性与老年男、女性2型糖尿病患者的骨密度皆相关。     

A Biomarker-Based Score for Risk of Hospitalization for Heart Failure in Patients With Diabetes

OBJECTIVEHeart failure (HF) is an impactful complication of type 2 diabetes mellitus (T2DM). We aimed to develop and validate a risk score for hospitalization for HF (HHF) incorporating biomarkers and clinical factor(s) in patients with T2DM.RESEARCH DESIGN AND METHODSWe derived a risk score for HHF using clinical data, high-sensitivity troponin T (hsTnT), and N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) from 6,106 placebo-treated patients with T2DM in SAVOR-TIMI 53 (Saxagliptin Assessment of Vascular Outcomes Recorded in Patients with Diabetes Mellitus–Thrombolysis in Myocardial Infarction 53). Candidate variables were assessed using Cox regression. The strongest indicators of HHF risk were included in the score using integer weights. The score was externally validated in 7,251 placebo-treated patients in DECLARE-TIMI 58 (Dapagliflozin Effect on CardiovascuLAR Events–Thrombolysis in Myocardial Infarction 58). The effect of dapagliflozin on HHF was assessed by risk category in DECLARE-TIMI 58.RESULTSThe strongest indicators of HHF risk were NT-proBNP, prior HF, and hsTnT (each P < 0.001). A risk score using these three variables identified a gradient of HHF risk (P-trend <0.001) in the derivation and validation cohorts, with C-indices of 0.87 (95% CI, 0.84–0.89) and 0.84 (0.81–0.86), respectively. Whereas there was no significant effect of dapagliflozin versus placebo on HHF in the low-risk group (hazard ratio [HR] 0.98 [95% CI 0.50–1.92]), dapagliflozin significantly reduced HHF in the intermediate-, high-, and very-high-risk groups (HR 0.64 [0.43–0.95], 0.63 [0.43–0.94], and 0.72 [0.54–0.96], respectively). Correspondingly, absolute risk reductions (95% CI) increased across these latter 3 groups: 1.0% (0.0–1.9), 3.0% (0.7–5.3), and 4.4% (−0.2 to 8.9) (P-trend <0.001).CONCLUSIONSWe developed and validated a risk score for HHF in T2DM that incorporated NT-proBNP, prior HF, and hsTnT. The risk score identifies patients at higher risk of HHF who derive greater absolute benefit from dapagliflozin.     

Serum Bone Markers Levels and Bone Mineral Density in Familial Mediterranean Fever

[Purpose] The aim of this study was to measure bone mineral density, serum and urinary bone turnover parameters, and to evaluate the influence of demographic and genetic factors on these parameters in FMF patients. [Subjects and Methods] Twenty-seven attack-free patients who were diagnosed with FMF (in accordance with Tel Hashomer criteria) were recruited at outpatient rheumatology clinics. We investigated whether there were any differences between the FMF patients and a control group in terms of lumbar and femur bone mineral density (BMD), standard deviation scores (Z scores and T scores) and bone markers. [Results] In terms of the median values of lumbar BMD (p = 0.21), lumbar T (p = 0.098) and Z (p = 0.109) scores, femoral neck BMD, femoral T and Z scores and total femur BMD, T (p = 0.788) and Z scores, there were no significant differences. [Conclusion] In our study, no statistically significant differences were found between FMF patients and a control group in terms of osteoporosis. The 25-OH vitamin D was found to be significantly lower in FMF patients than in the control group.Key words: Bone mineral density, Familial mediterranean fever, Serum bone markers levels     

男性阻塞性睡眠呼吸暂停低通气综合征对2型糖尿病患者骨代谢及骨密度的影响

目的 探讨男性阻塞性睡眠呼吸暂停低通气综合征（OSAHS）对2型糖尿病（T2DM）患者血糖、骨代谢及骨密度（BMD）的影响。方法 收集2016年5月至2019年4月就诊于甘肃省人民医院的T2DM男性患者,根据多导睡眠监测仪（PSG）中的睡眠呼吸暂停指数（AHI）分为单纯T2DM组（对照组）、T2DM合并轻度OSAHS组（轻度组）、T2DM合并中重度OSAHS组（重度组）,测定血清钙（Ca）、磷（P）、维生素D（VitD）、骨钙素（OSTE）和其β 胶原特殊序列（β CTX）的浓度, 同时测定平均血糖水平（MBG）、糖化血红蛋白（HbA1c）,应用美国双能X线骨密度仪测定受试者腰椎 (L1 4) 及左侧股骨(LF)骨密度（BMD）。分别比较3组血糖、骨代谢指标、骨密度指标,并分析AHI与上述指标的相关性。 结果 3组P、OSTE、β CTX、及L1 4 BMD差异无统计学意义（P＞0.05）;与对照组比较, 轻、重度组MBG、HbA1c增高,VitD、Ca及LF BMD降低（P＜0.05）;重度组VitD、Ca、MBG、HbA1c与轻度组比较,差异有统计学意义（P＜0.05）。相关性分析表明OSAHS合并T2DM患者AHI与BMI、MBG、β CTX呈正相关（r=0.607, 0.208, 0.169,P=0.000, 0.014, 0.046）;与VitD呈负相关(r=-0.276, P=0.001)。结论 OSAHS可能会进一步加剧T2DM患者糖代谢和骨代谢紊乱,且随着OSAHS的病情进展逐渐加重。     

定量CT评估1型糖尿病患者股骨骨密度和骨强度

[目的] 采用定量CT评估1型糖尿病患者股骨骨密度和骨强度,并探讨其与胰岛素样生长因子-1(IGF-1)的相关性.[方法] 选择本院收治的25例1型糖尿病患者为观察组,选择同期在本院健康体检的25例健康者为对照组.通过三维定量CT计算股骨不同部位体积骨密度(vBMD)和骨强度,检测血清IGF-1、骨特异性碱性磷酸酶(B-ALP)、骨钙素(sOC)、Ⅰ型前胶原氨基端肽(PⅠNP),分析1型糖尿病患者股骨骨密度和骨强度与IGF-1之间的相关性.[结果] 与对照组比较,观察组股骨颈皮质vBMD明显降低[(582.5±27.7) mg/cm3 vs (558.1± 31.9) mg/cm3,P<0.05] ;股骨粗隆总vBMD、皮质厚度和皮质横截面积显著降低[(258.4 ± 42.9) mg/cm3 vs(223.7± 27.3)mg/cm3;(3.3 ± 0.7)mm vs(2.8 ± 0.5)mm;(5.3 ± 1.2)cm2 vs (4.3 ± 0.5)cm2;均P<0.01] .与对照组比较,观察组屈曲比(BR)显著增加[(10.8 ±1.8) vs(12.9±1.9), P<0.01] .观察组和对照组血清B-ALP、sOC、PⅠNP水平比较,差异无统计学差异(P>0.05).血清IGF-1与1型糖尿病患者股骨颈总vBMD呈显著正相关性(r=0.48;P<0.05).[结论] 定量CT发现1型糖尿病患者股骨粗隆间vBMD、皮质横截面积和皮质厚度较低,血清IGF-1水平可显著影响1型糖尿病患者股骨颈总vBMD.     

The Effect of Swiss Ball Stabilization Exercise on Pain and Bone Mineral Density of Patients with Chronic Low Back Pain

[Purpose] The purpose of this study was to carry out a 16-week treatment of lumbar stabilization exercise with a ball targeting patients with chronic low back pain and investigate its effect on alleviation of low back pain and bone mineral density. [Subjects and Methods] The subjects of this study were 36 patients who were diagnosed with chronic low back pain. They were divided into a conservative treatment group (CTG, n=12), floor exercise group (FEG, n=12), and ball exercise group (BEG, n=12). The degree of recovery from pain was looked into using a visual analogue scale (VAS) and DEXXUM T (OsteoSys, Seoul, Korea) which was used to observe the changes in bone mineral density. [Result] Although the VAS score was reduced in FEG and BEG with treatment, it was not reduced in CTG. Also, the bone mineral density was increased in FEG and BEG, while it was reduced in CTG. [Conclusion] Lumbar stabilization exercises using a ball are thought to be an effective interventional therapy for the alleviation of chronic low back pain and to increase bone mineral density of patients.Key words: Chronic low back pain, Swiss ball exercise, Bone mineral density     

2型糖尿病患者骨密度的测定

INTRODUCTIONItisacceptedconclusionthattype１diabetescaninducedecreaseofbonemineraldensity犤１犦，butitisunderdiscussedwhethertype２diabetescaninducedecreaseofBMD．InordertoobservechangesofBMDintype２diabetespatients，weevaluateBMDoflumbarvertebraL２－４andproximalfemurintype２diabetespatientsbyusingdualenergyX－rayabsorptiometry（DEXA）andcomparedwithnormalcontrolwiththesamesex，age，weight．MATERIALSANDMETHODSMaterials６３casesoftype２diabeteswerecamefrompatientsreceivedfrom…     

强化糖尿病健康教育对胰岛素治疗的初诊糖尿病患者效果的影响

[目的]了解强化糖尿病(DM)教育对胰岛素治疗的初诊2 型糖尿病(T2DM)患者效果的影响.[方法]将100例初诊T2DM患者随机分成两组各50例,均予胰岛素降糖治疗,对照组予以常规糖尿病宣教,干预组同时给予强化DM健康教育,比较治疗前后及两组治疗后抑郁自评量表(SDS)评分,糖尿病相关知识得分及血糖等相关指标的变化....     

Association between mean platelet volume and bone mineral density in patients with ankylosing spondylitis and diagnostic value of diffusion-weighted magnetic resonance imaging

[Purpose] The aim this study was to assess the relation between bone mineral density (BMD) and mean platelet volume (MPV) in ankylosing spondylitis (AS) patients, and evaluate the diagnostic role of the diffusion-weighted magnetic resonance imaging (MRI). [Subjects and Methods] Fifty patients diagnosed with AS were divided into two groups on the basis of BMD, a normal group (n=30) and an osteopenic (n=20) group. [Results] Duration of disease in the group with a normal BMD was 10.3±7.0 years, while it was 16.7±12.2 years in the osteopenia group. MPV was high in the osteopenia group, while no significant differences were observed between the groups in terms of apparent diffusion coefficient (ADC) and platelet distribution width (PDW). There was a positive correlation between MPV and duration of disease. Correlations between ADC value and the lumbar T score, femoral neck T score, and duration of disease were insignificant. A negative correlation was observed between BMD and disease duration. [Conclusion] Diffusion-weighted imaging provides valuable results in osteoporosis but is not a suitable technique for evaluating BMD in patients with AS because of the local and systemic inflammatory effects in the musculoskeletal system. The common pathophysiology of atherosclerosis and osteoporosis plays an important role in the negative correlation observed between MPV and BMD in patients with AS.Key words: Ankylosing spondylitis, Bone mineral density, Mean platelet volume     

2型糖尿病合并非酒精性脂肪肝的临床特征分析

[目的]探讨2型糖尿病（T2DM）合并非酒精性脂肪肝（NAFLD）与胰岛素抵抗、血脂紊乱、尿酸的关系及其发病因素.[方法]对本院2011年1~8月的133例T2DM住院患者的临床资料进行回顾性分析,根据腹部B超结果分为合并NAFLD组（A组,70例）和不合并NAFLD组（B组,63例）,分析比较两组体重指数（BMI）、腰围（WL）、空腹胰岛素、餐后2 h胰岛素、脂代谢指标、尿酸的水平.[结果]与B组比较,A组的T2DM患者的BMI、WL、空腹胰岛素、血甘油三酯（TG）,低密度脂蛋白胆固醇（LDL-C）、胆固醇、尿酸显著增高（P均＜0.05）;同时高密度脂蛋白（HDL-C）显著降低（P＜0.05）;Logistic回归分析显示：BMI、WL、TG、HDL-C对T2DM合并NAFLD的发生有显著影响（P均＜0.05）.[结论]2型糖尿病患者合并NAFLD,与肥胖（主要是腹型肥胖）、血脂紊乱、尿酸增高相关;而与糖尿病病程、血糖控制程度、糖化血红蛋白不相关,导致糖尿病合并NAFLD的最主要原因为胰岛素抵抗及其所包含的脂代谢紊乱.     

中年糖尿病患者认知功能的观察

[目的]研究中年2型糖尿病（T2DM）患者认知功能损害的特点及危险因素.[方法]58例T2DM患者为病例组,年龄、性别、文化程度等与之相匹配的59例健康者为对照组;应用蒙特利尔认知评估（MoCA）北京版量表及简易精神状态评价（MMSE）量表评估两组对象的神经认知功能,并测定其空腹血糖（FBG）、血脂、肝肾功能.[结果]病例组在视空间与执行功能、延迟回忆评分、MoCA总分较对照组明显减低（P0.05）;患者体重指数（BMI）、FBG、非高密度脂蛋白胆固醇（NHDL-C）、胆固醇（TC）、甘油三酯（TG）较对照组明显增高（P〈0.01）,但高密度脂蛋白胆固醇（HDL-C）水平降低（P0.05）.[结论]中年T2DM患者认知水平降低,提示中年T2DM患者可能存在加速脑老化的因素,引起认知功能下降.     

老年2型糖尿病患者骨密度与血清胰岛素水平和BMI关系的临床观察

目的研究老年2型糖尿病(DM)患者骨密度的改变及探讨其与胰岛素水平的关系。方法应用DEXA测定38例老年2型DM患者和26例老年健康对照组L2-4及股骨近端骨密度(BMD)并测定2型DM患者血清胰岛素(Ins)及体重指数(BM I)。结果①2型糖尿病中男、女W ard`s区、男性腰椎、女性股骨颈BMD均显著低于正常对照组(P<0.05);男性股骨颈、女性腰椎的BMD低于正常对照组,但无统计学意义(P>0.05)。②将DM患者分成骨质疏松组(OP组)和非骨质疏松组(非OP组),比较两组的血Ins水平和BM I,发现非OP组空腹及餐后2 h Ins水平和BM I明显高于OP组(P<0.05)。结论①老年2型DM患者较易发生OP。②肥胖和血中高胰岛素水平对骨密度有一定保护作用。     

Evaluation of oxygen uptake adjusted by skeletal muscle mass in cardiovascular disease patients with type 2 diabetes

[Purpose] We aimed to evaluate oxygen uptake adjusted by total skeletal muscle mass in patients with cardiovascular disease with or without type 2 diabetes mellitus. [Participants and Methods] The participants included 54 males ≥50 years of age without heart failure who underwent cardiopulmonary exercise testing during cardiac rehabilitation. We divided the participants into two groups: patients with type 2 diabetes mellitus (DM group) and patients without type 2 diabetes mellitus (NDM group). [Results] We found no significant differences in age, weight, fat mass, or skeletal muscle mass between the groups. There were also no differences in cardiac function, body composition, and heart rate response. The DM group showed significantly lower peak oxygen uptake values adjusted by skeletal muscle mass, despite the absence of significant differences in skeletal muscle mass. A significant positive correlation was found between peak oxygen uptake and age, weight, and skeletal muscle mass. Stepwise regression analysis revealed that age, skeletal muscle mass, and medical history of diabetes were independent predictors of absolute peak oxygen uptake. [Conclusion] Peak oxygen uptake adjusted by skeletal muscle mass in patients with cardiovascular disease and type 2 diabetes mellitus is lower than that in those without type 2 diabetes mellitus.Key words: Cardiopulmonary exercise testing, Peak oxygen uptake, Skeletal muscle mass     

绝经后女性2型糖尿病患者骨密度的变化及相关因素分析

目的　探讨绝经后女性 2型糖尿病 (T2DM)患者骨密度 (BMD)改变及其相关因素。方法　用X线骨密度仪测定 112例绝经后T2DM患者和 74例非糖尿病对照者正位腰椎 (L2 ～L4)及股骨近端 [Neck区、Ward区、GT(大转子 ) ]BMD ,血钙 (Ca)、磷 (P)、碱性磷酸酶 (ALP) ,病例组加测糖化血红蛋白 (HbA1c)、血脂浓度。结果　绝经后T2DM患者L2 、L3 、L4、Neck、Ward区、GT的BMD值高于对照组 (P <0 .0 1) ;L2 ～L4BMD高于对照组 ,差异无统计学意义 (P >0 .0 5 )。除L2 外 ,糖尿病 5年以上组 (DM B)上述各部位BMD低于 5年及以下组 (DM A组 )。多元逐步回归分析后显示 :年龄与Neck、Ward区、GTBMD显著负相关 (P <0 .0 1) ,绝经年限与L2 、L2 ～L4BMD明显负相关 (P<0 .0 5 ) ,HbA1c同L2 、L3 、L2 ～L4BMD明显负相关 (P <0 .0 5 ) ,体重指数 (BMI)与L2 、GTBMD明显正相关 (P <0 .0 5 ) ,病程、血脂与骨密度无显著相关。T2DM患者血钙、血磷、ALP与对照组者比较差异无统计学意义 (P >0 .0 5 )。结论　绝经后T2DM患者各部位BMD明显高于对照组 ;年龄、绝经年限、血糖控制不良是BMD危险因素 ;BMI可能是T2DM患者BMD保护性因素之一