[1]郭丽婷,郝帅,高志红.2型糖尿病患者骨代谢生化指标和钙调激素 与骨密度关系的研究[J].国际内分泌代谢杂志,2015,(02):88-92.[doi:10.3760/cma.j.issn.1673-4157.2015.02.005]
　Guo Liting,Hao Shuai,Gao Zhihong..Research on the relationship between bone mineral density and biochemical index of bone metabolism ,calmodulin hormone in type 2 diabetic patients[J].International Journal of Endocrinology and Metabolism,2015,(02):88-92.[doi:10.3760/cma.j.issn.1673-4157.2015.02.005]
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2型糖尿病患者骨代谢生化指标和钙调激素 与骨密度关系的研究()
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《国际内分泌代谢杂志》[ISSN:1673-4157/CN:12-1383/R]

卷:
期数:
2015年02
页码:
88-92
栏目:
论著
出版日期:
2015-03-20

文章信息/Info

Title:
Research on the relationship between bone mineral density and biochemical index of bone metabolism ,calmodulin hormone in type 2 diabetic patients
作者:
郭丽婷; 郝帅; 高志红
300052　天津医科大学总医院内分泌科
Author(s):
Guo Liting; Hao Shuai; Gao Zhihong.
Department of Endocrinology，Ｔｈｅ General Hospital of Tianjin Medical University，Tianjin 300052，China Corresponding author：Gao Zhihong，Email：zhg2931@163.com
关键词:
糖尿病; 骨质疏松; 骨密度; 25羟维生素D3; 甲状旁腺激素
Keywords:
Type 2 diabetes mellitus; Osteoporosis; Bone mineral density; 25-hydroxy vitamin D3; Parathyroid hormone
DOI:
10.3760/cma.j.issn.1673-4157.2015.02.005
摘要:
目的　观察2型糖尿病（T2DM）患者骨代谢生化指标、血清25-羟维生素D3[25（OH）D3] 和甲状旁腺激素（PTH）水平，分析其对骨密度的影响并探讨T2DM患者骨量的变化。方法　选择天津医科大学总医院T2DM患者127例（男57例，女70例）作为糖尿病组；另选年龄、性别相匹配的健康体检者68名作为对照组。按糖尿病病程或HbA1c将糖尿病组分为4个亚组，A组：病程≤10年，B组：病程＞10年，C组：HbA1c≤8%，D组：HbA1c＞8%；按骨量不同分为3个亚组：骨密度正常组（T值＞-1.0 SD）；骨量减少组（-2.5 SD ＜T值≤-1.0 SD）；骨质疏松组（T值≤-2.5 SD）。测定所有受试者血钙、磷、镁、碱性磷酸酶（ALP）、24 h尿钙、25（OH）D3和PTH，采用双能X线骨密度仪对所有受试者进行骨密度测定。结果　糖尿病组血钙、血镁、25（OH）D3、股骨颈和全髋骨密度较对照组显著降低（t = 0.235~ 1.884，P均＜0.05），PTH较对照组显著升高（t =1.067，P＜0.01）；A组、B组血钙、血镁、25（OH）D3较对照组显著降低，且B组血镁低于A组（P均＜0.05），PTH显著高于对照组，且B组高于A组（P＜0.01）；C组、D组血钙、血镁、25（OH）D3较对照组显著降低（P均＜0.05），PTH显著高于对照组（P ＜0.01）；A组、B组股骨颈、全髋骨密度较对照组显著下降（P均＜0.05）；D组股骨颈、全髋骨密度较对照组和C组均明显降低（P均＜0.01）,全身骨密度低于对照组（P＜0.05）；C组各部位骨密度较对照组差异均无统计学意义；糖尿病组骨质疏松和骨量减低[39.37%（50/127），47.24%（60/127）]的比例显著高于对照组[26.47%（18/68），32.35%（22/68），X2=3.852，4.708，P均＜0.05）]，并且糖尿病骨质疏松组糖尿病病程、HbA1c、PTH也均较骨密度正常组和骨量减低组明显升高 （P均＜0.05）；Logistic回归分析显示糖尿病病程、HbA1c、PTH是糖尿病患者骨密度降低的危险因素。结论　T2DM患者存在骨代谢紊乱，维生素D水平下降，PTH水平升高和骨密度的下降，以糖尿病病程长和血糖控制差者为著。
Abstract:
Objective　To observe the levels of biochemical index of bone metabolism，25-hydroxy vitamin D3[25（OH）D3] and parathormone（PTH） in patients with type 2 diabetes mellitus（T2DM），and ana-lyze their effects on bone mineral density（BMD） and discuss the changes of bone mass in T2DM patients. Methods　One hundred and twenty-seven patients with T2DM were selected，including 57 male cases and 70 female cases as diabetes group；68 healthy people（sex and age matched） were choosed as control group. Diabetes group was divided into 4 subgroup according to diabetic duration or HbA1c，group A：diabetic duration ≤10 years，group B： diabetic duration＞10 years，group C：HbA1c≤8%，group D：HbA1c ＞ 8%；meanwhile diabetes group was divided into 3 subgroup according to BMD，normal BMD group：T＞-1.0 SD；osteopenia group：-2.5 SD＜T≤-1.0 SD；osteoporosis group：T≤-2.5 SD. Blood calcium，phosphorus，magnesium，alkaline phosphatase（ALP），24 h urinary calcium，25（OH）D3 and PTH were measured. BMD was determined by using dual-energy X-ray absorptiometry （DEXA） . Results　Compared with control group，blood calcium，magnesium，25（OH）D3，femoral neck and total hip BMD in diabetes group were significantly decreased （t = 0.235-1.884，all P ＜0.05），PTH was significantly increased（t = 1.067，P ＜ 0.01）. Blood calcium，magnesium，25（OH） D3 in group A，group B were significantly decreased than those in control group， and blood magnesium in group B was also lower than that of group A（all P ＜0.05），the level of PTH in group A，group B was significantly increased than that in control group，and its value in group B was also higher than that in group A（P ＜0.01）. Compared with control group，blood calcium，magnesium，25（OH） D3 in group C，group D were significantly decreased（all P ＜0.05）， the level of PTH was significantly increased（P ＜0.01）. Femoral neck and total hip BMD in group A，group B were declined significantly than those in control group（all P ＜ 0.05）. Femoral neck and total hip BMD in group D were declined significantly than those in control group and group C（all P ＜ 0.01），the whole body BMD was significantly lower than that in control group（P＜0.05）. Each part of BMD in group C had no significant difference compared with control group. The rate of osteoporosis and osteopenia in diabetes group[39.37%（50/127），47.24%（60/127）] were significantly higher than those in control group [26.47%（18/68），32.35%（22/68），X2=3.852，4.708，all P＜0.05]，and diabetic duration，HbA1c，and PTH in osteoporosis group were significantly higher than those in normal BMD group and osteopenia group（all P＜0.05）. Logistic regression analysis showed that diabetic duration，HbA1c，PTH and were the risk factors of decease of BMD in diabetic patients. Conclusions　Patients with T2DM have bone metabolic disorders，decrease of vitamin D levels，increase of PTH and reduction of BMD. It would be more significant in patients with longer diabetic duration and poor glycemic control.

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备注/Memo

备注/Memo:
通信作者：高志红，Email: zhg2931@163.com
更新日期/Last Update: 2015-03-20