老年2型糖尿病双能X线及定量CT测量骨密度的临床分析

目的 探讨老年2型糖尿病临床与不同骨密度(BMD)测定方法之间的关系和特点。方法 测定45例老年2型糖尿病患者的空腹(FBG)及餐后血糖(PBG)、糖化血红蛋白(HbAlc)、胆固醇(TC)、甘油三脂(TG)、骨钙素(BGP)、血清Ⅰ型胶原C端肽(CICP)、血清骨特异性碱性磷酸酶(B-ALP)、尿吡啶啉(Pyd)、脱氧吡啶啉(D-Pyd)、尿羟脯胺酸(Hyp),对同一病人同时行双能X线测定(DEXA)及定量CT测定(QCT),并进行分组比较。结果 本组45例病人中同时用DEXA及QCT测定骨密度均有骨质疏松者18例,占45％(18/40),其中男性4例,女性14例,女性占骨质疏松组的77.78％(14/18)。单用DEXA测量出骨质疏松者23例,单用QCT测量出骨质疏松者21例,其中5例有2例示QCT正常,而用DEXA测定有骨质疏松;3例用QCT测定已有腰椎骨质疏松,而DEXA示腰椎正常,但股骨颈部有骨质疏松。结论 老年2型糖尿病的骨质疏松与糖尿病病程、餐后血糖、胆固醇密切相关。骨形成指标(BGP、CICP)在骨质疏松组中非但不降,反比非骨质疏松组有明显升高。本研究显示老年2型糖尿病同时用DEXA及QCT测定骨密度有很好的相关性,r=0.770,P<0.01,故仅做腰椎QCT也可作为老年2型糖尿病骨质疏松的诊断依据。

Clinical analysis of bone mineral density measurements by DEXA and QCT in elderly patients with type 2 diabetes mellitus

Objective To study the relationship between clinical characteristics and bone mineral densities (BMD) measurements by different methods in elderly patients with type 2 diabetes mellitus. Methods Forty-five elderly type 2 diabetic patients underwent the following tests: fasting blood glucose(FBG), postprandial blood glucose (PBG), hemoglobin Alc(HbAlc), cholesterol(TC), triglyceride(TG), serum osteocalcin(BGP) , collagen type IC-terminal peptide (CICP), serum bone specific alkaline phosphatase( B-ALP), urinary pyridinoline (Pyd), deoxypyridinoline(D-pyd), and urinary hydroxyprolin( HYP). The BMDS of all the 45 patients were measured by both DEXA and QCT at the same time. are conducted. Results Eighteen of 40 patients were diagnosed as haring osteoporosis, by both methods, accounting for 45% . Of them, 4 were males, and 14 females; the females in this group comprised 77.78% (14/18) . Twenty-three cases were diagnosed as having osteoporosis by DEXA alone,hereas 21 cases were diagnosed as osteoporotic by QCT alone. Two of 5 cases in analysed population had a normal QCT, but were diagnosed as having osteoporosis by DEXA, while the other 3 cases, diagnosed as having osteoporotic lumbar vertebrae by QCT showed normal lumbar vertebrae but osteoporotic femoral neck by DEXA. Conclusion 1) Osteoporosis in elderly type 2 diabetic patients is associated with the course of diabetes, PBG and cholesterol levels. 2) Instead of decreasing, the indexes of bone formation (BGP, CICP) increase in the group diagnosed as having osteoporosis, higher than those in the other gruop diagnosed as having no osteoporosis. 3) There is a high correlation between DEXA and QCT used simultaneously to diagnose osteoporosis for elderly type 2 diabetic patients (r = 0.770, P < 0.001) . Therefore, the lumbar vertebral BMD measuerd by QCT alone can serve as the criterion for diagnosing osteoporosis in elderly patients with type 2 diabetes mellitus.