住院2型糖尿病患者的骨密度变化及其与代谢指标的相关性分析

发布时间：2018-01-11 06:31

本文关键词：住院2型糖尿病患者的骨密度变化及其与代谢指标的相关性分析　出处：《南昌大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:研究住院2型糖尿病(T2DM)患者的骨密度(BMD)变化及合并骨质疏松的相关因素,为糖尿病性骨质疏松(DOP)的早期诊断与防治提供依据。方法:将入选的733例住院2型糖尿病患者按照平均骨密度值分为骨量正常组(A组)、骨量减低组(B组)和骨质疏松组(C组),对比三组患者的性别、年龄、体重指数(BMI)、病程、空腹血糖(FPG)、餐后1h血糖(1h PG)、餐后2h血糖(2h PG)、空腹胰岛素(FINS)、餐后1h胰岛素(1h INS)、餐后2h胰岛素(2h INS)、胰岛素抵抗指数(Homa-IR)、胰岛素敏感指数(ISI)、糖化血红蛋白(Hb A1c)、尿微量白蛋白定量、血脂、尿酸、甲状旁腺素(PTH)、血钙(Ca)、血磷(P)和骨碱性磷酸酶(BALP)等指标之间的差异,并进行相关性分析。结果:1、住院T2DM患者中骨量减少的检出率为49.7%,骨质疏松(OP)的检出率为12.4%,其中女性患者OP的检出率大于男性,有明显统计学差异(P0.05)。2、在一般临床资料的对比中,C组的年龄和病程均明显大于A、B两组(P0.05),且B组的年龄明显大于A组(P0.05),但是病程在A、B两组间则无明显差异(P0.05);而A、B组的BMI均明显大于C组(P0.05),A组的BMI明显大于B组。3、在血糖及胰岛素水平的比较中,C组的FPG、2h PG均明显大于A、B两组(P0.05),且B组的2h PG明显大于A组(P0.05),但是FPG在A、B两组间无统计学差异(P0.05);A组的Homa-IR明显小于B、C两组(P0.05),A组的ISI明显大于B、C两组(P0.05),但Homa-IR、ISI在B、C两组间均无统计学差异(P0.05);而1h PG、FINS、1h INS、2h INS、Hb A1c在三组中均无统计学差异(P0.05)。4、在代谢指标的对比中,C组的HDL-C水平明显高于A、B两组(P0.05);A、B组的尿酸水平明显高于C组(P0.05),且A组的尿酸明显高于B组(P0.05);而尿微量白蛋白、TC、TG、LDL-C在三组间无明显差异(P0.05)。5、在骨代谢指标及BMD值的对比中,A、B组的腰椎L1-L4及双侧股骨颈的BMD值均明显大于C组(P0.05),且A组各部位的BMD值均大于B组(P0.05);A、B组的BALP、PTH均明显小于C组(P0.05),且A组的BALP明显小于B组(P0.05),但PTH在A、B组间无统计学差异(P0.05);而血钙、磷在三组间无明显差异(P0.05)。6、T2DM患者的BMI、FINS、ISI、尿酸与各部位BMD值呈正相关(P0.05),年龄、FPG、2h PG、Homa-IR、HDL-C与各部位BMD值呈负相关(P0.05)。7、进一步进行多元逐步回归分析后,年龄(β=-0.041,P=0.000)、BMI(β=0.063,P=0.005)、FPG(β=-0.236,P=0.000)、HDL-C(β=-0.649,P=0.005)、尿酸(β=0.002,P=0.047)仍与骨密度独立相关。结论:1、住院的50岁以上2型糖尿病患者中骨量减少及OP的发生率占60%以上,其中绝经后女性较男性更易患OP。2、高龄、低体重、糖尿病病程长、空腹血糖控制不佳、胰岛功能差、胰岛素抵抗、高高密度脂蛋白胆固醇、低尿酸均是2型糖尿病合并骨质疏松的高危因素。
[Abstract]:Objective: to study the changes of bone mineral density (BMD) and the related factors of osteoporosis in patients with type 2 diabetes mellitus (T2DM). Methods: 733 inpatients with type 2 diabetes mellitus were divided into two groups according to the average bone mineral density (BMD). Sex, age, body mass index (BMI), course of disease, fasting blood glucose (FPG), postprandial blood glucose (1 h) and postprandial blood glucose (1 h) were compared between group B (group B) and group C (group C). 2 h postprandial blood glucose, 2 h PGN, fasting insulin, 1 h insulin, 1 h insulin, 2 h postprandial insulin, 2 h ins). Insulin resistance index (ISI), insulin sensitivity index (ISI), glycosylated hemoglobin (HbA1cN), urinary albumin, serum lipids and uric acid. The differences of PTH, Ca, P) and BALP (bone alkaline phosphatase) were analyzed. Results: 1. The detectable rate of osteopenia and osteoporosis OPO in T2DM patients was 49.7 and 12.4respectively. The detection rate of op in female patients was higher than that in men. The age and course of disease in group C were significantly larger than those in group A and B (P 0.05). The age of group B was significantly larger than that of group A (P 0.05), but there was no significant difference in the course of disease between group A and group B (P 0.05). The BMI of group A was significantly higher than that of group C (P 0.05). The BMI of group A was significantly larger than that of group B (0.3), and the level of blood glucose and insulin in group C was significantly higher than that of group C (FPG). 2 h PG was significantly higher than that of Agna B group (P 0 05), and 2 h PG in B group was significantly higher than that in A group (P 0 05), but FPG was higher in A group than that in A group (P 0 05). There was no statistical difference between group B and group B (P 0.05). The Homa-IR of group A was significantly lower than that of group A (P 0.05), but the ISI of group A was significantly higher than that of group B (P 0.05), but Homa-IRI was higher than that of group B (P 0.05). There was no statistical difference between group C and group C (P 0.05). However, there was no significant difference in HbA1c between the three groups in 1h PGN FINSN 1h and 1h INS1c, and there was no significant difference among the three groups (P0.05A1c) in the comparison of metabolic indexes. The level of HDL-C in group C was significantly higher than that in group A and B (P 0.05). The level of uric acid in group A was significantly higher than that in group C (P 0.05), and the level of uric acid in group A was significantly higher than that in group B (P 0.05). However, there was no significant difference in LDL-C between the three groups in urine microalbuminuria (TCX) and TGG. 5. There was no significant difference between the three groups (P < 0. 05), and there was no significant difference between the three groups in bone metabolism index and BMD value. The BMD values of L1-L4 and bilateral femoral neck in group B were significantly higher than those in group C (P 0.05), and the BMD values in group A were higher than those in group B (P 0.05). The BALP of group A was significantly lower than that of group B (P 0.05), but that of group A was lower than that of group B (P 0.05), but the PTH of group A was lower than that of group A. There was no statistical difference between group B and group B (P 0.05). However, there was no significant difference in serum calcium and phosphorus among the three groups. There was a positive correlation between uric acid and BMD value in all parts of BMI-FINSISI. There was a negative correlation between HDL-C and BMD value in two hours of PGHA-IRL. Further multivariate stepwise regression analysis was carried out. Age (尾 -0.041) and BMI0.000 (尾 -0.063 / P0. 005 / FPG (尾 -0.236 / P0. 000)). HDL-C (尾 -0.649) and uric acid (尾 -0.002) were still independent of BMD. Conclusion: 1. The incidence of osteopenia and op accounted for more than 60% in the hospitalized patients over 50 years old with type 2 diabetes mellitus. Postmenopausal women were more likely to develop OP.2than men, the elderly, low body weight and long course of diabetes. Poor control of fasting blood glucose, poor islet function, insulin resistance, high density lipoprotein cholesterol and low uric acid were all high risk factors for type 2 diabetes mellitus with osteoporosis.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R587.1;R580

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