血清睾酮水平与2型糖尿病合并骨质疏松症的相关性研究

目的 探讨血清睾酮水平与2型糖尿病(type 2 diabetes mellitus, T2DM)合并骨质疏松症的相关性.方法 回顾性分析2015年9月至2016年5月于四川大学华西医院住院的T2DM合并骨质疏松症患者53例(DO组)、单纯性骨质疏松症患者60例(OP组)和骨量正常者42例(N组),分析比较3组患者之间的骨密度、血清总睾酮(TT)、性激素结合球蛋白(SHBG)和血清游离睾酮(FT)水平.结果 与N组比较,DO组和OP组患者腰椎(L1-L4)、股骨颈部、W-三角和粗隆的骨密度均降低,差异有统计学意义(P<0.05);血清SHBG水平显著降低,差异有统计学意义(P<0.05);血清总睾酮和游离睾酮水平无明显改变,差异无统计学意义(P>0.05).与OP组比较,DO组患者骨密度、血清TT、SHBG和FT水平比较,差异均无统计学意义(P>0.05).线性回归分析发现,性别与总睾酮(r=-21.339,P<0.001)和游离睾酮(r=-22.8,P<0.001)呈负相关.亚组分析发现,女性DO患者FT水平明显高于女性OP患者,差异有统计学意义(P<0.05);但骨密度比较,差异无统计学意义(P>0.05).男性DO患者Ward-三角及粗隆骨密度明显升高,差异有统计学意义(P<0.05);血清TT水平DO组高于OP组,差异有统计学意义(P<0.05).结论 血清睾酮水平与2型糖尿病合并骨质疏松的关系可能存在性别差异.对于男性可能是保护因素,对于女性则可能是危险因素.

A Study on the Correlation Between Serum Testosterone and T2DM Combined with Osteoporosis

Objective To investigate the correlation between serum testosterone and type 2 diabetes mellitus (T2DM) combined with osteoporosis.Methods The inpatients from September of 2015 to May of 2016 in West China Hospital of Sichuan University were analyzed retrospectively and divided into the T2DM and osteoporosis group (DO), osteoporosis group (OP) and normal bone mass group (N).The bone mineral density (BMD) and the levels of total testosterone (TT), sex hormone-binding globulin (SHBG) and free testosterone (FT) were analyzed and compared among the three groups.Results A total of 155 patients (53 in the DO group, 60 in the OP group and 42 in the N group) were included.Compared with the N group, the BMD of lumbar vertebrae (L1-L4), femoral neck, W-triangle and tuberosity was significantly decreased (P<0.05) and the level of serum SHBG was significantly decreased (P<0.05) in the DO and OP groups respectively, while there were no significant differences in the levels of serum TT and FT (P>0.05).There were no significant differences in BMD and the levels of serum TT, SHBG and FT between the OP group and the DO group (P<0.05).The results of Linear regression analysis showed that gender was negatively correlated with TT (r=-4.95, P<0.001) and FT (r=-82.372, P<0.001) respectively.The results of the subgroup analysis showed that the FT level of the female patients was significantly higher in the DO group than in the OP group (P<0.05), while no significant differences were found in BMD (P>0.05).The BMD of Ward-triangular and tuberosity was significantly increased in the male patients of the DO group (P<0.05).The level of TT in DO group was significantly higher than in OP group (P<0.05).Conclusion There may be differences in gender between the level of serum testosterone and T2DM combined with osteoporosis.Serum testosterone may be a protective factor against osteoporosis in the male with T2DM and a risk factor in the female with T2DM.