糖尿病对骨量的影响及其相关因素的分析

为评估糖尿病对骨量的影响及各种相关因素对骨丢失的意义，本文对３００例糖尿病患者和１８００例正常人的前臂进行了骨密度测定。根据骨密度结果的不同，在骨量正常和降低组间进行了有关因素的比较，对可能影响骨量的各种因素进行了逐步回归分析。结果为：糖尿病人骨量减少的发生率为５８％。Ⅰ型和Ⅱ型糖尿病骨量减少的发生率和程度无显著性差异。骨量减少的发生率与病程长短无关。血碱性磷酸酶和尿羟脯氨酸在骨密度降低组显著增高，可作为观察骨量减少较为敏感的两项生化指标。多因素逐步回归分析结果所分析的指标对骨量无显著影响。由于病程对骨量减少无明显影响，我们认为骨量减少有可能是糖尿病基础病变的一部分。胰岛素缺乏所导致的骨形成不足和骨重建负平衡可能为骨量减少的原因。若给予足量的胰岛素治疗对预防和减轻骨量减少是有效的。

The effect of diabetes on bone mass and the analysis of factors associated with bone loss

In an attempt to evaluate the effect of diabetes on bone mass and the signiflcance of the factors associated with bone loss,forearm bone density of 300 diabetics and 1800 age-matched controls was measured by using single photon absorptiometry.Insulin,glucose,glycosylated hemoglobin(HbAlc),calciuln,phosphate,alkaline phosphatase(AKP)and hydroxyproline were compared between the diabetics with normal and low bone density,These factors were analysed by stepwise regression. Low bone mass was reported in 58% of the diabetics,of this group 41% were 10% below normal values. There was no significant difference between the bone loss in patients IDDM and NIDDM. The incidence and degree of bone loss were not correlated with the duration of diatotes.There was no significant difference in blood glucose(P=0.26),HbAlc(P=0.42),insulin(P=0.61),calcium(P=0.42),phosphate(P=0.24)and urinary calcium(P=0. 31),phosphate(P=0.70).AKP(P=0.04)and urinary hydroxyproline excretion(P=0.038)were significantly increased in the patients with low bone density. However,the multi-variate regression analysis showed that none of the variates were correlated with bone mass.Our results suggest that AKP and urinary hydroxyproline may be regarded as sensitive biorhemical indexes for bone loss.Because the bone loss occurred in the early stages of diabetes and the duration of the disease had minimal effect on the overall bone loss, the bone loss might be considered as a part of the underlying changes in diabetes. Deficient insulin secretion leading to insufficient bone formation and negative bone balance may be the cause of bone loss,It is advised that appropriate insulin treatment is beneficial for prevention and reduction of bone loss in diabetics.