2型糖尿病患者骨密度改变及其影响因素探讨

目的探讨2型糖尿病患者合并骨质疏松症时骨密度变化与身高、体重、体重指数、血糖、胰岛素等相关因素的关系。方法采用双能X线骨密度仪对78例2型糖尿病患者(糖尿病组)和72例健康体检者(对照组)进行腰椎2~4及左股骨近端骨密度测定,同时观察糖尿病患者骨密度变化与身高、体重、体重指数、血糖、糖化血红蛋白、胰岛素水平的相互关系。结果糖尿病组中诊断为骨质疏松症者为37例(47.43%),对照组中诊断为骨质疏松症者为25例(34.72%),糖尿病组骨密度测定值明显低于对照组,差异有统计学意义(P<0.05)。2型糖尿病患者的骨密度改变与血糖、糖化血红蛋白呈负相关,与胰岛β细胞功能、体重、身高、体重指数呈正相关。结论(1)2型糖尿病患者合并骨质疏松症的发病率明显高于对照组,患者的骨密度与血糖、胰岛β细胞功能有关,胰岛β细胞功能衰竭、机体胰岛素分泌相对不足、血糖控制不良时,患者骨密度明显降低。(2)低体重是发生骨折的危险因素之一,低体重糖尿病组与低体重对照组相比骨密度变化差异有统计学意义(P<0.01)。对2型糖尿病患者应严格控制好血糖,定期进行骨密度测定,防治骨质疏松症的发生,降低骨折的危险性。

Change of bone mineral density in type 2 diabetes and its influential factors

Objective To investigate the relations between bone mineral density changes in the patients with type 2 diabetes complicating osteoporosis and height,weight,body mass index,blood glucose,insulin related factors.Methods Seventy-eight patients with type 2 diabetic and 72 healthy persons were selected,and measured their bone mineral density in the second to fourth lumber and the proximal left femur with the dual-energy X BMD measuring instrument.The relation between changes of bone mineral density in the patients with diabetes mellitus and height,weight,body mass index,blood glucose,HbA1c and insulin levels was observed.Results Diabetes group with osteoporosis had 37 cases(47.43%),non-diabetic group with osteoporosis had 25 cases(34.72%).The bone mineral density of diabetic group was significantly lower than that of the control group,there was significant difference(P<0.05).The bone mineral density in the patients with type 2 diabetes was negatively correlated to glucose,glycated and positively correlated to pancreatic B-cell function,weight,height,body mass.Conclusion(1)The incidence of type 2 diabetic patients with osteoporosis is significantly higher than that of healthy control group.The bone mineral density is correlated to blood glucose,insulin B-cell function.B-cell failure,the relative shortage of islet insulin secretion and poor control of blood sugar also decrease the bone mineral density significantly.(2)low weight is one of the risk factors of fractures,the changes in bone mineral density have significant difference between the type 2 diabetes group with low weight and the control group with low weight(P<0.01).Therefore,the patients with type 2 diabetes should strictly control the blood sugar,detect the bone mineral density regularly,prevent the occurrence of osteoporosis and reduce the risk of fractures.