绝经后女性2型糖尿病患者的骨密度、骨标志物水平及微循环情况的研究

发布时间：2018-01-28 08:46

本文关键词： 骨质疏松骨标志物绝经后女性 2型糖尿病甲襞微循环　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨绝经后女性2型糖尿病患者的骨密度、骨标志物水平及甲襞微循环状况,为早期发现、早期预防绝经后2型糖尿病妇女罹患骨质疏松症及指导治疗提供参考依据。方法:选择2014年12月~2016年3月在309医院骨内科住院的绝经后女性患者128例,其中60例为2型糖尿病患者,定为研究组,年龄50-69岁,平均年龄60.8岁;无糖尿病者68例,定为对照组,年龄50-69岁,平均年龄59.8岁,采用美国好乐杰公司双光能骨密度仪测量所有患者进行腰椎L2-L4和左侧股骨近端及全髋骨密度,采用微循环检测仪(徐州众联医疗器械有限公司)对所有患者进行甲襞微循环检测,并测量其身高及体重,记录其入院时生化血脂,血钙、磷、镁、空腹血糖情况,采用酶联免疫吸附法测定各组的B-ALP、TRAP5b、PINP、25羟维生素D的水平,比较两组间骨密度值、生化指标及骨标志物水平、甲襞微循环是否存在统计学差异。然后将所有研究对象按骨密度情况分为三组,其中骨质疏松45例,年龄51-69岁,平均年龄61.5岁;骨量减少45例,年龄50-69岁,平均年龄59.4岁;正常骨密度38例,年龄50-69岁,平均年龄58.8岁;比较三组间的生化指标、骨标志物水平及甲襞微循环是否存在统计学差异。结果:糖尿病组与对照组间一般情况如年龄、身高、体重、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血镁、血脂水平无统计学差异,两组髋部及腰1-4椎体骨密度水平、25羟维生素D及PTH无统计学差异。糖尿病组空腹血糖、血钙水平、TRAP-5b、甲襞微循环形态积分及总积分高于对照组,而OC、ALP值比对照组降低,差异显著(P0.05)。pearson相关分析研究发现,骨转换标志物OC、TRAP、B-ALP与骨密度值呈负相关趋势,且有统计学意义(P0.05);特别是TRAP-5b及OC与骨密度值相关性良好。将所有研究对象分为骨质疏松组、骨量减少组、正常骨密度三组后发现,三组之间在一般情况(年龄、身高、体重、BMI)及血生化指标(Ca、P、Mg、GLU、TG、总胆固醇、HDL-C、LDL-C)、微循环加权积分值方面不存在统计学差异(P0.05),骨质疏松组与骨密度正常组在酒石酸酸性膦酸酶(TRAP5b)、骨钙素(OC)水平存在统计学差异,骨量减少组与骨密度正常组在骨钙素(OC)水平上存在统计学差异(P0.05)。结论:绝经后2型糖尿病妇女骨转换标志物异常,可能是预测糖尿病性骨质疏松的一个标志。骨量减少患者在进行预防骨质疏松治疗时,应重视抑制破骨细胞活性治疗,同时注意改善微循环的状况。
[Abstract]:Objective: to investigate the bone mineral density (BMD), bone marker level and nailfold microcirculation in postmenopausal women with type 2 diabetes. Early prevention and treatment of osteoporosis in postmenopausal type 2 diabetic women. Methods:. A total of 128 postmenopausal female patients were selected from December 2014 to March 2016 in Department of Osteology, 309 Hospital. Among them, 60 patients with type 2 diabetes mellitus were selected as study group, aged 50-69 years, with an average age of 60.8 years. 68 cases without diabetes mellitus were selected as control group, aged 50-69 years, with an average age of 59.8 years. The lumbar L2-L4 and left femur proximal and total hip bone density were measured with the dual optical energy bone mineral density (BMD). All the patients were examined by microcirculation tester (Xuzhou Zonglian Medical Instruments Co., Ltd), and their height and weight were measured, and the biochemical blood lipid, blood calcium, phosphorus and magnesium were recorded when they were admitted to hospital. Fasting blood glucose levels were measured by enzyme linked immunosorbent assay (Elisa) and bone mineral density (BMD) was compared between the two groups. Biochemical indexes and bone markers, nailfold microcirculation were statistically different. Then all the subjects were divided into three groups according to BMD, 45 cases of osteoporosis, age 51 to 69 years old. Average age 61.5 years; The bone mass was reduced in 45 cases, aged 50-69 years, with an average age of 59.4 years. Normal bone mineral density (BMD) was found in 38 cases, aged 50-69 years, with an average age of 58.8 years. The biochemical indexes, bone markers and nailfold microcirculation were compared between the three groups. Results: the general conditions of diabetes group and control group such as age, height, weight, total cholesterol. There was no significant difference in high density lipoprotein cholesterol, low density lipoprotein cholesterol, serum magnesium and blood lipid levels between the two groups. 25 hydroxyvitamin D and PTH had no statistical difference. The fasting blood glucose, serum calcium level and total score of nail fold microcirculation in diabetic group were higher than those in control group. The ALP value was significantly lower than that of the control group, and the correlation analysis showed that the bone turnover marker OCTRAPAPB-ALP was negatively correlated with bone mineral density (BMD). And there was statistical significance (P0.05). In particular, TRAP-5b and OC had good correlation with BMD. All the subjects were divided into three groups: osteoporosis group, osteopenia group, normal BMD group and normal BMD group. Height, body weight (BMIs) and blood biochemical indexes (Ca-Pu, MgGLU, TG, HDL-C, LDL-C). There was no significant difference in the weighted integral value of microcirculation between osteoporosis group and normal bone mineral density group (TRAP5b). Osteocalcin (OC) levels were significantly different. There was significant difference in osteocalcin (OC) level between the osteopenia group and the normal bone density group (P 0.05). Conclusion: the markers of bone turnover in postmenopausal women with type 2 diabetes are abnormal. It may be a marker for predicting diabetic osteoporosis. In the treatment of osteoporosis prevention, we should pay attention to the inhibition of osteoclast activity and the improvement of microcirculation.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2;R580

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