青中年1型糖尿病及合并微血管并发症者骨密度变化

目的探究青中年1型糖尿病及其微血管并发症患者的骨密度的变化。方法回顾性选取2010年至2019年12月在我科住院的18～50岁的1型糖尿病(type 1 diabetes mellitus,T1DM)患者共129人,并选取同期在我院体检的129名非糖尿病对照,其中所有女性受试者均未绝经。测定所有受试者一般生化指标、25羟维生素D、血清钙、磷、糖化血红蛋白(Hb A1c);测定腰椎、股骨颈及髋部骨密度值;筛查1型糖尿病患者的微血管并发症情况;运用t检验、卡方检验、协变量分析、单因素方差分析、多元线性回归的统计方法研究青中年T1DM及其合并微血管并发症的患者的骨密度变化。结果在男性组中,T1DM患者所有测量部位的BMD均低于非糖尿病对照(P=0.000、0.000、0.018),进一步调整相关临床变量后,各部位骨密度值仍低于对照(P=0.018、0.036、0.018)。多元线性回归发现,病程、血清25羟维生素D浓度、有无微血管并发症可能是影响男性BMD的因素,且合并两种及以上微血管并发症的患者骨密度显著低于1种或无并发症的患者。女性患者的BMD在各种调整模型中均未发现较对照组有统计学差异。结论青中年男性T1DM容易发生骨量流失,尤其是那些合并微血管并发症的患者,因此在青中年男性患者中筛查BMD是十分重要的。

Changes of bone mineral density in young and middle-aged patients with type 1 diabetes mellitus and microvascular complications

Objective To investigate the changes of bone mineral density (BMD) in young and middle-aged patients with type 1 diabetes mellitus and microvascular complications. Methods A total of 129 patients with type 1 diabetes mellitus (T1DM) aged from 18 to 50 years old who were hospitalized in our department from 2010 to December 2019 were retrospectively selected, and 129 non-diabetic control subjects who underwent physical examination in our hospital during the same period were selected. Among them, female subjects were premenopaual. The biochemical indexes, 25 hydroxyvitamin D, serum calcium, phosphorus, glycosylated hemoglobin (HbA1c), bone mineral density (BMD) of the lumbar spine, femoral neck, and hip were measured. Microvascular complications in patients with type 1 diabetes mellitus were screened. The changes of bone mineral density in young and middle-aged patients with T1DM and microvascular complications were studied using t test, Chi square test, covariant analysis, one way ANOVA, and multiple linear regression. Results In the male group, BMD of all measured sites in T1DM patients was lower than that in non-diabetic controls (P=0.000, 0.000, 0.018). After further adjustment of relevant clinical variables, BMD of all sites was still lower than that of control (P=0.018, 0.036, 0.018). Multiple linear regression analysis showed that the course of disease, serum 25 hydroxyvitamin D concentration, and microvascular complications may be the influencing factors of male BMD. BMD in patients with two or more microvascular complications was significantly lower than that of patients with one or no complications. There was no significant difference in BMD in female patients compared with the control group. Conclusion Young and middle-aged men with T1DM are prone to bone loss, especially those with microvascular complications. Therefore, it is very important to exam BMD in young and middle-aged male patients.