影响2型糖尿病患者骨密度减低的多因素分析

发布时间：2018-05-12 07:54

本文选题：2型糖尿病 + 骨密度减低　；参考：《华北理工大学》2015年硕士论文

【摘要】：目的探讨影响2型糖尿病患者骨密度减低的相关因素,为预防2型糖尿病患者骨密度减低、发生骨质疏松症,并降低病理性骨折风险提供相关理论依据。方法选取河北联合大学附属医院内分泌科住院的2型糖尿病(T2DM)患者216例,依据骨密度(BMD)测定结果分为骨密度正常组(76例,52.78±6.61岁)、骨密度减低组(68例,53.82±8.02岁)、骨质疏松症组(72例,56.96±7.49岁)。入组患者均测定腰椎前后位总体(L1-4)面积BMD,分析T2DM患者BMD与性别、年龄、糖尿病病程、体重指数(BMI)、糖化血红蛋白(Hb A1c)、碱性磷酸酶(ALP)、甲状旁腺激素(PTH)、降钙素(CT)、血钙、血磷的相关性,以及T2DM患者BMD与糖尿病并发症(早期糖尿病肾病、糖尿病视网膜病变、糖尿病周围神经病变、糖尿病周围血管病变)的相关性。结果三组间经单因素方差分析显示,骨质疏松症组与骨密度正常组比较,年龄、BMI、Hb Alc较高,差异有统计学意义(P值分别为0.001、0.002、0.000);骨质疏松症组与骨密度减低组比较,年龄、BMI、Hb Alc较高,差异有统计学意义(P值分别为0.013、0.007、0.000);骨密度减低组与骨密度正常组比较,Hb Alc较高,差异有统计学意义(P=0.004)。三组间经卡方检验显示,性别构成比、糖尿病周围神经病变构成差异有统计学意义(P0.05),其中骨质疏松症组女性、合并糖尿病周围神经病变所占比例高,而三组间是否合并早期糖尿病肾病、糖尿病视网膜病变、糖尿病周围血管病变的差异无统计学差异(P0.05)。将单因素方差分析及卡方检验有统计学差异的变量作为自变量,以是否合并骨质疏松症为因变量进行二分类Logistic回归分析,结果显示,年龄(OR=1.050)、Hb A1c(OR=1.531)、并发糖尿病周围神经病变(OR=2.149)、性别(女)(OR=2.084)为T2DM患者合并骨质疏松症的危险因素,而高BMI(OR=0.868)为T2DM患者骨质疏松症的保护因素。Pearson相关分析结果显示,年龄、糖尿病病程、BMI、Hb A1c、PTH、性别构成比及并发糖尿病周围神经病变比例与骨密度减低严重程度存在相关性(P0.05),将上述相关分析有统计学意义的变量纳入多元线性回归分析,结果显示,性别(女)(r=-0.056,P=0.001)、年龄(r=-0.004,P=0.000)、Hb A1c(r=-0.029,P=0.000)、糖尿病周围神经病变(r=-0.054,P=0.002)与T2DM患者骨密度呈独立负相关,而BMI值(r=0.005,P=0.048)与T2DM患者骨密度呈独立正相关。结论女性患者、年龄增长、Hb A1c水平升高、合并糖尿病周围神经病变为T2DM患者骨密度降低的独立相关因素,而一定程度上的高BMI对T2DM患者骨密度减低具有保护作用。
[Abstract]:Objective to investigate the related factors affecting the decrease of bone mineral density in patients with type 2 diabetes, and to provide relevant theoretical basis for preventing the decrease of bone mineral density, developing osteoporosis and reducing the risk of pathological fracture in type 2 diabetes mellitus. Methods 216 patients with type 2 diabetes mellitus (T2DM) were selected from Endocrinology Department of affiliated Hospital of Hebei Union University. According to the results of BMD, 76 patients with normal bone mineral density (BMD) were divided into normal BMD group (n = 76), BMD group (n = 68), BMD group (n = 68) and osteoporosis group (n = 72) (56.96 卤7.49 years old). The total L1-4) area of lumbar spine was measured in all patients with T2DM. The correlation between BMD and sex, age, diabetes course, BMI, HbA1cP, ALP, PTH, calcitonin, serum calcium and phosphorus were analyzed. And the correlation between BMD and diabetic complications (early diabetic nephropathy, diabetic retinopathy, diabetic peripheral neuropathy, peridiabetic vascular disease) in patients with T2DM. Results the univariate analysis of variance showed that the age of BMIHb Alc in osteoporosis group was higher than that in normal BMD group (P = 0.001 卤0.002), and that in osteoporosis group was higher than that in BMD group (P < 0.05), and the age of BMIHb Alc was higher in osteoporosis group than that in BMD reduction group. The difference was statistically significant (P = 0.013 ~ 0.007 ~ 0.000 ~ 0.000), and HB Alc was higher in BMD reduction group than that in normal BMD group, and the difference was statistically significant (P = 0.004). Chi-square test showed that there were significant differences in sex composition and diabetic peripheral neuropathy among the three groups (P 0.05). In osteoporosis group, the proportion of diabetic peripheral neuropathy was high in female. However, there was no significant difference between the three groups in early diabetic nephropathy, diabetic retinopathy and peridiabetic vascular disease (P 0.05). The univariate ANOVA and chi-square test variables with statistical differences were taken as independent variables, and the two classification Logistic regression analysis was carried out with the dependent variables of osteoporosis. The results showed that, The age of T2DM patients was 1.050 HbA1cP 1.531D, and the incidence of diabetic peripheral neuropathy was 2.149%. Sex (female) was the risk factor of osteoporosis in patients with T2DM, while high BMIA OR1 (0.868) was the protective factor of osteoporosis in T2DM patients. Pearson correlation analysis showed that age, and sex were the risk factors of osteoporosis in patients with T2DM, and the results of Pearson correlation analysis showed that age, and sex were the risk factors of osteoporosis in T2DM patients. There was a correlation between the ratio of sex composition and the proportion of peripheral neuropathy complicated with diabetes mellitus and the severity of bone mineral density reduction (P 0.05). The variables with statistical significance were included in the multivariate linear regression analysis. There was an independent negative correlation between the sex (RV -0.056, P = 0.001), age (n = 0.004), HbA1cn (n = 0.029), and diabetic peripheral neuropathy (n = 0.054, P ~ (0.002), but an independent and positive correlation between the BMI value and the bone mineral density (BMD) in patients with T2DM (P = 0.048, P = 0.048, P = 0.048, P = 0.048, P = 0.048, P = 0.048, P = 0.048, P = 0.048, P = 0.048, P = 0.048, P = 0.048, P = 0.048, P = 0.048, P = 0.048). Conclusion the increase of HbA1c level in female patients with age and diabetic peripheral neuropathy is an independent correlation factor of BMD decrease in T2DM patients, while high BMI has protective effect on BMD in T2DM patients to a certain extent. [WT5HZ] [WT5 "BZ] [WT5" BZ] [WT5 "BZ] [WT5" BZ]
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.1;R580

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