绝经后2型糖尿病女性患者骨密度与血清促甲状腺激素水平的关系

目的 通过测定甲状腺功能正常的绝经后2型糖尿病妇女的骨密度，探讨正常范围内促甲状腺激素（TSH）的水平与骨密度的关系。方法 选取在我院内分泌科住院治疗的甲功正常的绝经后T2DM女性患者220例，根据血清TSH水平，以1.60 mU/L和2.90 mU/L为界，将入选患者分为3组，即A组(0.27mU/L~1.60mU/L)、B组（1.60mU/L~2.90mU/L）、C组（2.90mU/L~4.20mU/L）。比较各组的一般情况、生化指标、骨密度（BMD）的差异。结果 ①与B组相比，A组患者左股骨颈、转子和全髋部BMD降低，差异有统计学意义（P<0.05），而AC、BC两两比较差异无统计学意义（P>0.05，P>0.05）；②对于甲功正常的绝经后T2DM女性患者，血清FT3与全髋部BMD呈正相关（r=0.292，P=0.039），TSH、FT4与全髋部BMD无相关（r=0.078，P=0.594；r=-0.043，P=0.771）；③校正年龄、绝经年限、BMI后，FT3与全髋部BMD仍呈正相关（r=0.401，P=0.006），TSH、FT4与全髋部BMD仍无相关（r=0.013，P=0.929；r=0.039，P=0.797）；④在多元线性回归中，FT3仍与全髋部BMD独立相关（B=0.114，P=0.006）。结论 在甲功正常的绝经后T2DM妇女中，低TSH会降低全髋BMD；血清FT3与全髋BMD呈正相关，而TSH、FT4与全髋部BMD无相关。

The relationship between bone mineral density and serum TSH level in postmenopausal women with type 2 diabetes

Objective To investigate the relationship between normal range of thyroid stimulating hormone (TSH) and hip bone mineral density (BMD) in postmenopausal women with type 2 diabetes by BMD test. Methods Two hundred and twenty postmenopausal females with type 2 diabetes were chosen from hospitalized patients in our endocrinology. They were divided into 3 groups according to their levels of serum TSH, group A (0.27-1.60 mU/L), group B (1.60-2.90 mU/L), and group C (2.90-4.20 mU/L). Their general condition, biochemical parameters, and BMD were compared. Results (1) BMD of the left femoral neck, trochanter, and total hip decreased significantly in group A comparing to that in group B (P<0.05), while there was no statistical difference between group A and C, and between group B and C (P>0.05). (2) For postmenopausal females with type 2 diabetes who had normal thyroid function, serum FT3 was positively correlated with total hip BMD (r=0.292, P=0.039), while there was no correlation between TSH, FT4 and total hip BMD (r=0.078, P=0.594; r=-0.043, P=0.771). (3) After adjustment for age, postmenopausal time, and BMI, serum FT3 was still positively correlated with total hip BMD (r=0.401, P=0.006), while there was still no correlation between TSH, FT4 and total hip BMD (r=0.013, P=0.929; r=0.039, P=0.797). (4) In the multiple liner regression, FT3 was still associated with total hip BMD independently (B=0.114, P=0.006). Conclusion Low TSH level decreases total hip BMD in postmenopausal females with type 2 diabetes and normal thyroid function. Serum FT3 is positively correlated with total hip BMD. FT4 and TSH are not correlated with total hip BMD.