2型糖尿病患者绝经后女性骨密度及其影响因素

目的研究2型糖尿病患者绝经后女性的骨密度变化及其相关影响因素。方法选取住院治疗的2型糖尿病患者绝经后女性（糖尿病组）42例,绝经后血糖正常女性（对照组）21例。所有研究对象全部进行一般项目、临床资料调查、生化指标测定。双能X线骨密度仪（DXA）测定L1、L2、L3、L4及腰椎前后位总体（LH）,股骨颈（Neck）、Ward’S三角区、股骨大粗隆、股骨的骨密度值（BMD）。连续性变量以均数±标准差表示,正态分布变量两组间比较采用t检验,多因素分析应用Logistic回归,显著性水准a设置为0．05。结果糖尿病组与对照组的年龄、绝经年龄、绝经年限、BMI、骨密度差异无统计学意义（P〉0．05）;根据骨密度测量结果,将糖尿病组进一步分为糖尿病组骨质疏松组、糖尿病骨量减少组、糖尿病骨量正常组,糖尿病骨质疏松组骨密度较骨量正常组显著下降（P〈0．01）;经多因素Logistic回归分析,骨质疏松的发生与年龄独立相关,与BMI独立负相关（P〈0．05）。结论2型糖尿病患者绝经后女性骨密度与绝经后血糖正常女性的骨密度无显著性差异,年龄、BMI是骨质疏松症的独立影响因素。     

2型糖尿病绝经后女性骨密度与大血管的相关性研究

目的 探讨2型糖尿病绝经后女性骨密度与大血管之间的相关性.方法 整取抽样2015年1月至2016年1月就诊并自愿参与本次研究的绝经后女性2型糖尿病患者96例,采用骨密度测量仪测定其骨密度(BMD)值,根据有无合并大血管并发症,分为大血管并发症组(n=64例)和无大血管并发症组(n=32例),比较2组BMD值,经多因素Logistic回归分析,分析其绝经后女性2型糖尿病患者骨密度与大血管并发症之间的相关性.结果 大血管并发症组年龄、糖尿病病程、绝经时间、SBP水平均高于无大血管并发症组(P<0.05);大血管并发症组HbA1c水平低于对照组(P<0.05);且大血管并发症组BMD值明显低于对照组(P<0.05);经多因素回归分析,发现骨质疏松症的发生与大血管并发症的发生存在一定相关性(P<0.05).结论 绝经后女性2型糖尿病患者BMD值的变化,可能与大血管并发症的发生、发展存在一定相关性.     

绝经后2型糖尿病患者与骨质疏松相关性研究

目的探讨绝经后2型糖尿病（T2DM）患者与骨质疏松相关性。方法选取86例在本科住院的绝经后T2DM患者为研究组,均符合1999年WHO T2DM诊断标准。另选78例非T2DM绝经女性为对照组,采用双光能X线骨密度检测仪对患者进行腰椎L2～4和左侧股骨近端（包括Neck、Troch、Ward三角区）骨密度测量,并测定空腹血糖（FBG）、糖化血红蛋白（HbA1c）、甘油三脂（TG）、胆固醇（TC）、高密度脂蛋白（HDL-C）、低密度脂蛋白（LDL-C）,结合年龄、病程、绝经年限等因素进行研究。结果两组FBG、HbA1c、TG、LDL-C差异有统计学意义（P〈0.05）,绝经后T2DM组Neck、Ward三角区、Troch骨密度均低于正常对照组,差异有统计学意义（P〈0.05）,两组年龄、绝经年限的比较差异无统计学意义（P〉0.05）。结论绝经后T2DM患者更易发生骨质疏松,骨折的危险性也高于非T2DM绝经女性,早期筛查血糖及骨密度具有重要意义。     

2型糖尿病腰椎骨密度及其相关因素分析

目的探讨2型糖尿病患者腰椎骨密度及其年龄、性别因素。方法对不同年龄、性别组2型糖尿病（（T2DM）患者与健康对照组的腰L1-3椎体骨密度（BMD）进行测定及相关性分析,判断有无骨质疏松。结果 2型糖尿病组与正常对照组年龄、性别构成比例均无统计学意义（P〉0.05）;2型糖尿病男性患者60～69年龄以下组腰椎骨密度值、骨质疏松患病率与对照组间差异无统计学意义（P〉0.05）;2型糖尿病女性患者70岁以上组的L1-3腰段差异有统计学意义（P〈0.05）,呈现骨质疏松。结论 2型糖尿病患者腰椎骨密度（BMD）和骨质疏松（OP）患病率均与正常对照人群基本相似。随着年龄增长,男、女性T2DM患者腰椎BMD呈下降趋势。     

绝经后女性2型糖尿病患者骨密度的变化

目的观察绝经后女性2型糖尿病患者骨密度的变化并分析其相关因素。方法对2013年3月至2013年10月我院64例绝经后女性2型糖尿病患者作为糖尿病组,与本院体检的60例绝经期健康妇女作为对照组,检测她们的骨密度(BMD)、血生化及性激素指标,进行相关性分析。结果糖尿病组骨量减少及骨质疏松的患者显著高于对照组(P<0.05);2型糖尿病患者骨密度的变化与患者年龄、病程、绝经年限、餐后两小时血糖(2hPBG)、低密度脂蛋白(LDL)、促黄体生成激素(LH)、促卵泡生成激素(FSH)呈显著负相关(P均<0.05),与血清雌二醇(E2)呈显著正相关(P<0.05)。结论 2型糖尿病患者更易发生骨质疏松症,应积极采取综合治疗措施,可能对预防骨质疏松症有益。     

2型糖尿病并发肾病的相关危险因素分析

目的 探讨2型糖尿病并发肾病的相关危险因素,为制定糖尿病肾病防治策略提供理论依据.方法 采用病例对照的研究方法,选择98例2型糖尿病肾病患者作为观察组,选取同期收治98例2型糖尿病不伴有肾病的患者做为对照组,对两组的相关危险因素进行单因素和多因素非条件的Logistic回归分析.结果 单因素分析结果显示糖尿病家族史、糖尿病病程、合并高血压、合并糖尿病视网膜病变、BMI、冠心病、糖化血红蛋白（HbA1c）、空腹血糖（FPG）、餐后2小时血糖（2hPG）、CRP等因素是2型糖尿病并发肾病的危险因素（均P ＜0.05）;多因素非条件的Logistic回归分析显示糖尿病病程、合并糖尿病视网膜病变、CRP、HbA1c、FPG是2型糖尿病并发肾病的独立危险因素（均P＜0.05）.结论 糖尿病病程、合并糖尿病视网膜病变、CRP、HbA1c、FPG是2型糖尿病并发肾病的独立危险因素.     

多因素干预下糖化血红蛋白对新诊2型糖尿病患者颈动脉内中膜厚度的影响

目的探讨多危因素强化干预条件下，糖化血红蛋白（HbAlc）水平对新诊2型糖尿病（T2DM）患者颈总动脉内中膜厚度（CCA-IMT）的预测作用。方法对90例病程1年以内的T2DM患者进行以抗血小板聚集为基础的强化血糖、血压、血脂及体重等综合干预治疗，以ACCA-IMT值是否≥0．02mm为界限，将T2DM患者分为CCA-IMT增厚组及非增厚组，比较强化干预1年前、后2组患者间代谢指标的差异及其与CCA-IMT增厚的关系。采用Logistic回归分析探讨影响CCA-IMT增厚的危险因素。结果经1年多因素强化治疗后，90例新诊T2DM患者中CCA-IMT增厚组患者24例，非增厚组66例；CCA-IMT增厚组患者有吸烟史、饮酒史、高血脂史、高血压史的比例及患者的年龄显著高于非增厚组患者（P〈0．05）；CCA-IMT增厚组患者HbAlc的下降幅度即△HbAlc[0．20（5．90～-2．80）：1．20（9．30～-2．70）]明显小于非增厚组（P〈0．05）；Logistic回归分析结果显示与CCA-IMT增厚密切关联的因素有年龄、△HbAlc。结论对新诊T2DM采取多危因素强化干预条件下，HbAlc的下降幅度能够预测CCA-IMT的进展。     

绝经后女性2型糖尿病患者血清胎球蛋白A水平及与糖脂代谢和骨密度的关系研究

目的研究绝经后女性2型糖尿病(T2DM)患者血清胎球蛋白A(Fetuin-A)水平及与骨密度(BMD)和糖脂代谢的关系。方法选择2008年10月至2010年3月在中南大学湘雅二医院内分泌科住院的绝经后T2DM女性患者44例,及年龄、绝经年限、体质量指数相匹配的绝经后健康女性41例。酶联免疫吸附法(ELISA)测定血清Fetuin-A。结果①2型糖尿病组血清Fetuin-A水平较对照组显著降低(359.18±80.06μg/mL,400.98±98.45μg/mL,P<0.05),两组第1~4腰椎(PAL1~4)、左侧股骨颈(FN)、股骨干(Inter)、大转子(Troch)及总股骨(Thip)各部位骨密度、HOMA-IR未见明显差异;②2型糖尿病组中,多元线性回归提示TG、BMI与Fetuin-A呈显著正相关(b'j=0.392,0.308,P<0.05),HbA1c与Fetuin-A呈独立负相关关系(b'j=-0.291,P<0.05)。结论①绝经后女性T2DM患者血清Fetuin-A水平降低,与高血糖密切相关;②血清Fetuin-A与BMD可能不存在直接关系。     

绝经后2型糖尿病患者骨密度变化与脊柱骨折的关系

目的 探讨绝经后妇女中2型糖尿病(type 2 diabetes mellitus,T2DM)患者骨密度(bone mineral density,BMD)的变化及其与脊柱骨折的关系.方法 随机选取绝经后T2DM患者119例为观察组,绝经后非T2DM妇女124例为对照组,应用双能X线骨密度吸收仪测定BMD,行脊柱X线摄片.结果 观察组患者腰椎BMD比对照组高(P＜0.05),绝经后T2DM患者中骨折组股骨颈、L2-4骨密度比非骨折组低,差异有统计学意义(P＜0.05).结论 绝经后T2DM患者随着年龄的增大、绝经年限的增加以及骨密度的改变,其骨折风险增加,需重视对BMD的监测,以防骨折的发生.     

2型糖尿病大血管病变的独立危险因素调查

目的探讨2型糖尿病（T2DM）合并大血管病变（MA）的独立危险因素。方法将107例T2DM患者临床数据进行大血管病变的单因素Logistic回归分析,对有统计学意义的危险因素再进行多因素非条件的Logistic回归分析。结果年龄（age）、病程、体重指数（BMI）、糖化血红白蛋白（GHbA1c）、高血压（HT）及微血管并发症（MI）在单因素Logistic回归分析中为大血管病变的危险因素（P〈0.05）;多因素非条件的Logistic回归分析结果显示HT是T2DM合并MA的独立危险因素（P〈0.01）;合并HT的T2DM患MA的几率为非HT的T2DM的11.038倍。结论HT是T2DM合并MA的独立危险因素,积极控制血压对糖尿病病人预防MA有重要意义。     

绝经后女性握力和体重指数与骨密度的相关研究

目的 探讨绝经后女性握力和体重指数与骨密度之间的相关性.方法 收集2012年3月至2013年3月在天津市红桥医院检查治疗973名女性志愿者,所有志愿者均接受足跟部骨密度测量（T指数）、握力测试和体重指数测量并进行相关性分析.结果 在单变量分析中,握力和体重指数与T指数相关（Pearson相关系数分别为0.201、0.115,P=0.001、0.009）,年龄与T指数呈负相关（Pearson相关系数为-0.358,P=0.001）.骨质疏松发病率18.7％（182/973）.有骨质疏松和无骨质疏松绝经年龄、握力比较[绝经年龄（48±6）岁比（49±5）岁,P=0.020;握力（23±6）kg比（24±6） kg,P=0.001].结论 体重指数和握力二者均与骨密度密切相关,二者可作为预示骨疾病的关键因子.     

绝经后妇女椎体骨折与骨密度的关系

目的探讨绝经后妇女骨质疏松性椎体骨折与骨密度(BMD)的关系。方法对骨质疏松性椎体骨折的绝经后妇女280例(骨折组)和无椎体骨折的绝经后妇女280例(对照组)行胸腰椎正侧位X线摄片,并用双能X线骨密度测量仪(DEXA)检测腰椎(L2~L4)和左髋部BMD和T值。结果骨折组腰椎及髋部BMD和T值均低于对照组(P<0.01)。随着年龄的增加,两组BMD均逐渐下降。结论绝经后妇女的骨质疏松性椎体骨折与腰椎BMD下降相关;随着年龄的增加,椎体骨折的危险性增加;对绝经后妇女应重视BMD和胸腰椎X线片检查。     

阿仑膦酸钠对绝经后女性2型糖尿病骨质疏松患者骨密度及骨代谢指标的影响

目的探讨阿仑膦酸钠对绝经后女性2型糖尿病(T2DM)合并骨质疏松(OP)患者骨密度(BMD)及骨形成和骨吸收指标的影响。方法将126例T2DM合并OP患者分为两组,治疗组76例,对照组50例。对照组服用钙尔奇D,每日1片,治疗组在服用钙尔奇D的同时,加用阿仑膦酸钠(福善美)70mg,每周1次,连续治疗6个月,比较2组腰椎(L1～4)和股骨颈(NECK)BMD与骨形成(骨碱性磷酸酶)和骨吸收(Ⅰ型胶原N端肽/肌酐)指标。结果治疗组腰椎、股骨颈BMD教对照组明显提高(P<0.05),骨碱性磷酸酶、Ⅰ型胶原N端肽/肌酐明显降低(P<0.01)。对照组BMD治疗前后无明显变化(P>0.05)。结论阿仑膦酸钠能提高T2DM合并OP患者的BMD,并能抑制骨吸收指标,单纯补钙治疗并不能增加骨密度。     

老年2型糖尿病患者血脂水平与骨密度的关系

目的 探讨老年2型糖尿病（T2DM）血脂水平与骨密度的关系。方法 将新疆维吾尔自治区人民医院346例T2DM老年患者,根据性别将患者分成A组（男性）153例、B组（女性）193例,通过实验室检查,分析血脂与骨密度的关系。结果 A组患者甘油三酯（TG）水平与不同部位骨密度均呈正相关性（P〈0．05）,水平越高,腰椎、右髋、股骨颈骨密度越大,B组患者高密度脂蛋白（HDL）水平与不同部位骨密度均呈负相关性（P〈0．05）,水平越高,腰椎骨密度越小。结论 老年T2DM男性患者高TG水平、女性低HDL水平对骨密度有一定的影响。     

Osteodensitometry in healthy postmenopausal women

(1) Osteodensitometry is the standard method for measuring bone mineral density. Since the 1990s, diagnosis of osteoporosis has been defined, by convention, by a bone density T score cut-off of less than -2.5. This threshold, based on population statistics, is appropriate for the diagnosis of osteoporosis in Caucasian postmenopausal women in Europe and North America but may not be suitable for other populations. (2) To determine whether measurement of bone mineral density is useful in the prevention of fractures in postmenopausal women, we reviewed the relevant literature using our established in-house methodology. (3) Two meta-analyses of cohort follow-up studies involving tens of thousands of women showed a statistically increased risk of fracture in women with low bone density, especially in those with osteoporosis diagnosed by means of osteodensitometry. However, the majority of postmenopausal fractures occur in women without osteoporosis. (4) Routine bone density measurement has no proven impact on fracture prevention. (5) Some drugs designed for primary fracture prevention have been tested in postmenopausal women selected on the basis of their bone mineral density. In these patients, alendronic acid and raloxifene were both effective in the prevention of asymptomatic vertebral fractures: about 2 fractures prevented per 100 women treated for 3 to 4 years. A rather shaky retrospective subgroup analysis suggests that alendronic acid can also prevent symptomatic fractures in women with osteoporosis diagnosed by means of osteodensitometry. The screening for osteoporosis in postmenopausal women, or exposing large numbers of women to the adverse effects of these drugs. (6) Severe osteoporosis in postmenopausal women is defined by the presence of both low bone mineral density and a history of fragility fractures following low-energy trauma. Alendronic acid is the best-assessed drug in these women, preventing about 3 symptomatic vertebral fractures and 1 hip fracture when 100 patients are treated for 3 years. After a first fracture, women should be asked questions designed to assess the severity of the trauma, and should undergo osteodensitometry to document osteoporosis before exposure to the potential adverse effects of bisphosphonates.     

Association of polymorphisms of the transforming growth factor-beta1 gene with genetic susceptibility to osteoporosis.

Osteoporosis exhibits a substantial genetic component. Although polymorphisms of a variety of genes have been associated with bone mineral density and genetic susceptibility to osteoporosis, the genes responsible for these traits have not been definitively identified. We have shown that a T869-->C polymorphism of the transforming growth factor-beta1 gene, which results in a Leu-->Pro substitution at amino acid 10, is associated with bone mineral density in Japanese adolescents and postmenopausal women, with genetic susceptibility to both osteoporosis and vertebral fracture, and with the outcome of treatment for osteoporosis with active vitamin D. We have also shown that a C-509-->T polymorphism in the promoter region of this gene is associated with both bone mineral density and the prevalence of osteoporosis in postmenopausal women. In addition, analysis of combined genotypes for both the C-509-->T and T869-->C polymorphisms revealed that bone mineral density decreases and the susceptibility to osteoporosis increases with the number of T alleles. Thus, combined genotyping of the C-509-->T and T869-->C polymorphisms may prove beneficial in the prevention of osteoporosis in postmenopausal Japanese women. I review here the association of transforming growth factor-beta1 gene polymorphisms with genetic susceptibility to osteoporosis, which has provided insight into the function of transforming growth factor-beta1 as well as into the role of genetic factors in the development of osteoporosis.     

The effects of 1-year gluten withdrawal on bone mass, bone metabolism and nutritional status in newly-diagnosed adult coeliac disease patients

OBJECTIVES: To evaluate the impact of a 1-year gluten-free diet on bone metabolism and nutritional status in coeliac disease. METHODS: Bone mineral density, serum indices of bone remodelling, clinical and biochemical nutritional assessment were evaluated in 86 consecutive newly-diagnosed, biopsy proven, coeliac disease patients (untreated). A complete reevaluation, including intestinal biopsy, was repeated within 1 year of dietary treatment (treated). RESULTS: Untreated: according to WHO criteria, 34% of patients had a normal bone mineral density, 40% had osteopenia and 26% osteoporosis. Between males and females there were no statistical differences in bone metabolism or in most of the nutritional indices, while, between fertile and postmenopausal women, bone mineral density and several bone metabolism markers were significantly different. Compared to subjects with a normal bone mineral density, osteopenics had higher bone specific alkaline phosphatase (BAP) and Bone-Gla-protein (BGP) values. In patients with a concomitant BAP increase and 25OH vitamin D serum level reduction, bone mineral density and several bone turnover markers were statistically different compared to patients without such a serological pattern. Treated: notwithstanding intestinal biopsy which showed a mucosal recovery in only 57%, gluten-free diet led, even in postmenopausal women, to a significant improvement in bone mineral density, bone metabolism and nutrition, except for folic acid, albumin and pre-albumin serum levels which persisted as abnormal in patients with obdurate mucosal impairment. CONCLUSIONS: Coeliac disease patients are at high risk for developing a low bone mineral density and bone turnover impairment. A gluten-free diet can improve this situation even in postmenopausal women and in patients with incomplete mucosal recovery.     

老年女性高尿酸血症与冠状动脉病变程度的相关性

目的 探讨老年女性高尿酸血症(Hyperuricemia,HUA)与冠状动脉造影确诊的冠心病的冠脉病变程度的关系.方法 回顾性分析400例老年女性,根据冠状动脉造影结果分为两组,冠心病组260例,非冠心病组即对照组140例,观察两组吸烟、高血压病、2型糖尿病、高脂血症、冠心病家族史、体重指数及高尿酸血症与冠心病发病的关系.再将老年女性按血尿酸浓度>360 μmol/L的标准诊断高尿酸血症分为HUA组与非HUA组,观察HUA与冠脉病变支数及Gensini积分的关系.结果 ①老年女性冠心病组高尿酸血症的比例(23.1%)高于对照组(12.1%),差异有统计学意义(P<0.05).②HUA为老年女性冠心病发生的影响因素(OR=2.171,95%CI:1.223~3.853,Wald χ2=6.99),但对其他指标进行校正采用多因素Logisitic逐步回归进行危险因素筛选,HUA并不是老年女性冠心病发生的独立危险因素.③老年女性病变血管支数的分布在HUA 组与非 HUA组之间差异有统计学意义(Z=2.78,P<0.05).老年女性HUA患者的Gensini 积分高于非HUA患者(Z=2.08 P<0.05),且在女性的全组、HUA 组及非HUA 组Gensini 积分与血尿酸水平均呈正相关(rs =0.177,0.213,0.152,P<0.05).结论 老年女性HUA与冠心病发生有一定关联,但不是独立危险因素,HUA是反应冠心病病情程度的一个重要指标.老年女性高尿酸血症患者在冠心病诊治上应引起重视.     

雌激素加钙剂与钙剂对比治疗绝经后妇女骨质疏松症的骨密度测定分析

目的 对使用雌激素加钙剂与钙剂治疗绝经后骨质疏松症妇女的骨密度进行测定分析。方法 将绝经后患骨质疏松症的妇女分成两组,一组75例,每天口服结合型雌激素（贝美力）0.3mg加含钙元素1g的钙剂,连脬6个月;另一组37例,每天口服含钙元素1g的钙剂,连服6个月,用以色列MYRIAD-SOUNDSCAN-2000型骨量超声测定仪检测胫骨中段骨密度。结果 口服雌激素加钙剂组骨密度总有效率100%,口服钙剂组骨密度总有效率70.3%。结论 使用雌激素加钙剂与钙剂均可以达到增加绝经后妇女的骨密度,预防和治疗绝经后骨质疏松症的目的,使用雌激素加钙剂较单补钙剂疗效更好。