不同维生素D状态下绝经后糖尿病患者骨折风险的临床研究

目的比较骨密度(BMD)、FRAX及血清25(OH) D在预测绝经后2型糖尿病患者发生骨质疏松性骨折(OPF)中的有效性和实用性。方法选取2019年9月至2020年9月期间在本院就诊的绝经后2型糖尿病患者604例,按照患者血清中25(OH) D水平将其分为3组,分别为25(OH) D缺乏组(201例)、25(OH) D不足组(204例)和25(OH) D充足组(199例),比较各组一般资料、BMD及FRAX评分的差异。多因素回归分析探索OPF发生的危险因素,并通过AUC曲线评价各指标用于预测OPF的灵敏度、特异性及在绝经后2型糖尿病患者中的最佳截点值。结果随着血清25(OH) D水平的升高,患者桡骨远端1/3和股骨颈的T值均显著升高(P均0.01); FRAX、FRAX-股骨颈和FRAX-桡骨远端1/3随着25(OH) D的升高显著降低(P均0.001)。25(OH) D、桡骨远端1/3 BMD、股骨颈BMD、FRAX、FRAX-桡骨远端1/3及FRAX-股骨颈均为OPF发生的独立危险因素。FRAX-股骨颈预测OPF风险的ROC曲线下面积最大(AUC=0.93),桡骨远端1/3BMD预测OPF风险的ROC曲线下面积最小(AUC=0.82)。25(OH) D预测OPF风险的ROC曲线下面积为0.86。结论结合血清25(OH) D及BMD、FRAX评分,综合判断绝经后2型糖尿病患者发生OPF的风险,能最大限度预防OPF的发生。

A clinical study of fracture risk in postmenopausal diabetes patients with different vitamin D status

Objective To compare the efficacy of bone mineral density(BMD), FRAX and serum 25(OH)D in predicting osteoporotic fracture (OPF) of postmenopausal patients with type 2 diabetes. Methods We enrolled 604 postmenopausal patients with type 2 diabetes in our hospital during September 2019 - September 2020. They were divided into three groups, 25(OH)D deficiency group (201 cases), insufficient 25(OH)D group (204 cases) and sufficient 25(OH)D group (199 cases) according to the levels of serum 25(OH)D. The differences in general information, BMD and FRAX scores were compared between groups. Multivariate regression analysis was used to explore the risk factors of OPF. AUC curve was used to evaluate the sensitivity, specificity and optimal cut-off value of OPF in postmenopausal patients with type 2 diabetes. Results With the increase of serum 25(OH)D, the T value of distal 1/3 of radius and femoral neck of patients were significantly increased (All P<0.01). FRAX, FRAX-femoral neck and FRAX- distal 1/3 were significantly reduced with the increase of the levels of serum 25(OH)D (All P<0.001). 25(OH)D, distal radius 1/3 BMD, femoral neck BMD, FRAX, FRAX-distal radius 1/3, and FRAX-femoral neck were all independent risk factors for OPF. The area under the ROC curve of the FRAX-femoral neck was the largest risk factor that predicting OPF (AUC=0.93). The area under the ROC curve of the distal radius 1/3 BMD was the least risk factor that predicting OPF (AUC=0.93). The area under ROC curve predicted by 25(OH)D for risk of OPF was 0.86. Conclusion Combined with serum 25(OH)D, BMD and FRAX, the risk of OPF in postmenopausal patients with type 2 diabetes should be comprehensively determined to prevent OPF occurrence to the maximum extent.