摘要
目的:骨质疏松症、糖尿病、动脉粥样硬化均为代谢性疾病,在同一个体常常合并存在。通过分析2型糖尿病患者下肢血管病变不同程度的骨密度变化,可探讨其可能的影响因素。方法:选取2006-03/10河北医科大学第三医院住院的2型糖尿病患者140例,男性71例,女性69例,年龄≥45岁(女性绝经1年以上)。患者对检测指标知情同意。按照下肢血管病变严重性进行评分,将入选病例分为正常组、轻度组、中度组和重度组,每组35例。全部受试者均检测正位腰椎及双侧股骨骨密度,并行双下肢动脉彩超。结果:①年龄、体质量指数、糖尿病病程、绝经年限、血糖水平、胰岛素水平、脂代谢指标控制、尿白蛋白、继发甲状旁腺激素水平、雌激素水平变化越大,腰椎、双侧股骨各部位骨密度差异越明显(P<0.05)。②腰椎、股骨骨密度与糖尿病病程、年龄、空腹血糖、餐后2h血糖、糖化血红蛋白、尿白蛋白、胆固醇、低密度脂蛋白胆固醇、女性绝经年限呈负相关,与体质量指数、高密度脂蛋白和雌二醇呈正相关,与三酰甘油和极低密度脂蛋白水平无明显相关。腰椎骨密度与甲状旁腺激素水平正相关,股骨骨密度与空腹胰岛素正相关。③下肢动脉彩色超声动脉硬化程度积分与糖尿病病程、年龄、空腹血糖、餐后2h血糖、糖化血红蛋白、尿白蛋白、胆固醇、低密度脂蛋白胆固醇、继发甲状旁腺激素水平呈正相关,与雌二醇水平呈负相关,与体质量指数、空腹胰岛素水平、三酰甘油、高密度脂蛋白胆固醇、极低密度脂蛋白胆固醇和绝经年限无明显相关。2型糖尿病下肢血管病变患者较2型糖尿病非下肢血管病变患者骨密度低,且动脉硬化程度越重,骨密度越低,尤以股骨骨密度最为显著。结论:①糖尿病下肢血管病变与骨密度密切相关。②年龄、血糖、血脂、糖尿病病程、糖尿病肾病、女性雌激素、血继发甲状旁腺激素水平是影响糖尿病患者骨密度及下肢血管病变的共同因素。
AIM： Diabetes, atherosclerosis, osteoporosis are metabolic diseases, often combined in the same individual existence. By analyzing degrees of bone mineral density in patients with type 2 diabetes combined with lower extremity vascular lesions, this study analyzed its possible influencing factors.
METHODS： 140 patients with type 2 diabetes, including 69 female cases, 71 male cases, aged at least 45 years （female menopause over a year） were enrolled from March to October 2006. Detection of indicators for patients with informed consent was obtained. According to a lower extremity vascular disease severity score, there were control, mild, moderate and severe groups, each comprising 35 cases. All of the subjects were detected in bilateral lumbar spine and femoral bone mineral density. Parallel double-lower extremity arterial color Doppler flow imaging （CDFI） was performed.
RESULTS： ①In age, body mass index, diabetes duration, duration of menopause, blood glucose levels, insulin levels and lipid metabolism in control, urinary albumin, secondary parathyroid hormone （PTH）, estrogen, the greater the levels changed, the more obvious differences were in lumbar, bilateral femur bone mineral density of the site （P 〈 0.05）. ②Lumbar vertebrae and femur bone mineral density were negatively correlated with diabetes duration, age, fasting blood glucose, postprandial two hour blood glucose, glycosylated hemoglobin, urinary albumin, cholesterol, low-density lipoprotein cholesterol and the female menopause age, and positively correlated with body mass index, high density lipoprotein and estradiol, as well as no significant difference with triglyceride and very low density lipoprotein levels. Lumbar spine bone mineral density was positively correlated with parathyroid hormone levels. Femur bone mineral density was positively related with fasting insulin. ③Lower extremity arterial atherosclerosis extent integral of color ultrasound were positively correlated with diabetes duration, age, fasting blood glucose, postprandial two hour blood glucose, glycosylated hemoglobin, urinary albumin, cholesterol, low-density lipoprotein cholesterol, secondary parathyroid hormone levels, negatively correlated with estradiol levels, as well as there were no significant difference with body mass index, fasting insulin levels, triglyceride, high-density lipoprotein, very low density lipoprotein and menopause duration. Bone mineral density was lower in type 2 diabetic patients with lower extremity vascular disease than in type 2 diabetic patients without lower extremity vascular disease. The more severe arteriosclerosis, the lower the bone mineral density was, especially in the most femur bone mineral density.
CONCLUSION： ①Diabetes and lower extremity vascular disease are closely related to bone mineral density. ②Age, blood glucose, blood lipids, diabetes duration, diabetic nephropathy, female hormones, blood parathyroid hormone levels affects bone mineral density and lower extremity vascular disease in patients with diabetes.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2008年第11期2099-2103,共5页
Journal of Clinical Rehabilitative Tissue Engineering Research
基金
河北省科技厅重大项目(06276106D)
河北省科技领军人才基金(06547008D-2)~~
