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

Change of bone mineral density in postmenopausal women with type 2 diabetes and its related factors

Objective To explore the change in bone mineral density(BMD) and its related factors in postmenopausal women with type 2 diabetes(T2DM).Methods BMD of the lumbar(L 2-4) and proximal femur was measured by dual-energy X-ray absorptiometry in 112 postmenopausal T2DM patients and 74 non-diabetic controls. Serum Ca,P and alkaline phosphatase(ALP) were measured in two groups.HbA1c,cholesterin and triglyceride were also measured in the diabetic patients.Results Postmenopausal T2DM patients had significantly higher BMD at L 2,L 3,L 4,femoral neck,ward triangle and greater trochanter(GT) as compared with non-diabetic controls(P< 0.01).Diabetes mellitus(DM) A group(DM course no more than 5 years) and DM-B group(DM course more than 5 years) had higher BMD than non-diabetic controls at the above areas.Over all areas studied except L 2,DM-A group had higher BMD than DM-B group.By stepwise multiple regression analysis,BMD at femoral neck,ward triangle and GT was negatively correlated with age(P< 0.01),BMD at L 2,L 3,and L 2-L 4 was negatively correlated with years since menopause(YSM) and HbA1c(P< 0.05),BMD at L 2 and GT was positively correlated with body mass index(BMI)(P< 0.05).There were no significant difference in Ca,P and ALP values in serum between the diabetes and controls.Conclusion BMD in postmenopausal T2DM patients had significantly higher than non-diabetic controls.Age,HbA1c and YSM appeared to be the risk factors for decreased BMD in the diabetic patients.BMI may be protected against bone loss.