2型糖尿病与骨质疏松关系的探讨

杜凌超??郭彩霞??茹志成

[摘要] 目的 探討2型糖尿病（T2DM）患者与骨质疏松（osteo porosis，OP）的相关性。 方法 选取2015年9月～2017年2月我院收治的180例2型糖尿病患者，将90例2型糖尿病患者血糖控制达标设为A组；另外90例2型糖尿病患者空腹（血糖≥7.0mmoL/L）及餐后2小时血糖（血糖≥10.0mmoL/L）均升高为B组。另选择我院同期健康体检者90例作为对照组，采用美国GDR-2000型Hologac Sahara超声骨密度仪测量跟骨骨密度。测定全部受试者均测量身高、体重，计算体重指数（BMI）。过夜空腹12h以上，次日晨采静脉血，检测糖化血红蛋白（HbAlc）、血磷、尿钙、血钙、血镁、甲状旁腺激素（PTH）、25羟维生素D3（25（OH）D3）及碱性磷酸酶（ALP）等临床生化指标。 结果 A组尿钙、血钙、血镁、PTH、25（OH）D3等指标与对照组比较差异有统计学意义（P<0.05）；B组尿钙、血钙、血镁、PTH、25（OH）D3、ALP等指标与对照组比较差异有统计学意义（P<0.05）；B组尿钙明显高于A组，而血镁、25（OH）D3、ALP等指标明显低于A组，且比较差异有统计学意义（P<0.05）；骨质疏松组患者HbAlc、PTH、糖尿病病程等指标均明显高于骨量减低组和骨密度正常组，且比较差异军有统计学意义（P<0.05）；病程、HbAlc、PTH是糖尿病患者骨密度降低的危险因素。 结论 血糖控制未达标T2DM患者骨密度水平低于血糖控制达标2型糖尿病患者，T2DM与OP二者有相关性。病程、HbAlc、PTH是影响T2DM患者骨密度水平的因素。

[关键词] 2型糖尿病；骨质疏松；骨密度

[中图分类号] R587.1 [文献标识码] A [文章编号] 2095-0616（2017）12-192-04

Relationship between type 2 diabetes and osteoporosis

DU Lingchao GUO Caixia RU Zhicheng

Internal Medicine Ward II，Dongguan Eighth People's Hospital，Dongguan 523325，China

[Abstract] Objective To investigate the correlation between osteoporosis（OP） and type 2 diabetes mellitus （T2DM）. Methods 180 patients with type 2 diabetes mellitus in our hospital from January 2015 to February 2017 were selected.90 patients with type 2 diabetes mellitus were divided into group A，and 90 patients with type 2 diabetes with fasting（blood glucose≥7.0mmol/L） and 2 hours postprandial blood glucose （blood glucose≥10.0mmol/L） were divided into group B.And 90 cases of healthy physical examination in our hospital were selected as the control group.The bone mineral density of calcaneus was measured by American GDR-2000 Hologac Sahara Ultrasound Bone Minimetry.All subjects were measured for height，body weight，and body mass index （BMI）.（HbAlc），blood phosphorus，urinary calcium，serum calcium，blood magnesium，parathyroid hormone（PTH），25-hydroxy vitamin D3（25（OH）D3） were measured on the morning fasting for more than 12 hours.And alkaline phosphatase（ALP） and other clinical biochemical indicators. Results The levels of urinary calcium，serum calcium，magnesium，PTH and 25（OH）D3 in group A were significantly higher than those in control group（P<0.05）.The levels of urinary calcium， serum calcium， magnesium，PTH，25（OH）D3 and ALP in group B were significantly lower than those in the control group（P<0.05）.The urinary calcium in group B was significantly higher than that in group A（P<0.05）.The BMD of the femoral neck in group B was significantly lower than that in group A（P<0.05）.The osteoporosis group had higher HbAlc and PTH than the control group（P<0.05）.The course of disease，HbAlc and PTH were the risk factors of bone mineral density decrease in diabetic patients. Conclusion The level of bone mineral density in T2DM patients is lower than that in patients with type 2 diabetes mellitus.There is correlation between T2DM and OP.Course of disease，HbAlc，PTH are factors affecting the level of bone mineral density in T2DM patients.

[Key words] Type 2 diabetes；Osteoporosis；Bone mineral density

糖尿病（diabetes mellitus，DM）患者可出现一系列的慢性并发症，其中骨质疏松（osteoporosis，OP）

对骨代谢的影响主要表现为骨形成减少、缓慢，骨吸收增加，骨微结构破坏，骨量低下[1-2]。伴随着人们生活方式的改变、肥胖、糖尿病呈高发状态。而骨质疏松患病率同步上升，成为很多T2DM患者的合并症[3]。本文通过观察T2DM患者糖化血红蛋白（HbAlc）、血磷、尿钙、血钙、血镁、甲状旁腺激素（PTH）、25羟维生素D3（25（OH）D3）及碱性磷酸酶（ALP）等临床生化指标的变化情况，旨在探讨T2DM与骨密度之间的关系。

1 资料与方法

1.1 一般资料

本研究资料来自于2015年9月～2017年2月我院收治的2 型糖尿病患者180例，患者均符合1999年WHO制定的诊断标准[4]；排除3月内因依从性差，不接受胰岛素治疗，饮食控制不良、运动治疗不理解等原因造成血糖控制不达标的难治性2型糖尿病患者。……