目的 探讨2型糖尿病(T₂DM)患者并发骨质疏松的危险因素。方法 将334例T₂DM患者根据骨密度(BMD)值分为骨量正常组、骨量减少组和骨质疏松组,对比各组患者年龄、DM病程、体重指数(BMI)、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、C肽分泌指数(HOMA-β)、C肽曲线下面积(C-PAUC)、C肽抵抗指数(HOMA-CR)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、尿微量白蛋白(mALb)、肾小球滤过率(GFR)及慢性并发症发生的差异,并进行Logistic回归分析。结果 334例T₂DM患者中骨量正常者116例,男75例(64.66%),女41例(35.34%);骨量减少者110例,男50例(45.45%),女60例(54.55%);骨质疏松者108例,男46例(42.59%),女62例(57.41%)。与骨量正常组比较,骨质疏松组和骨量减少组年龄大,DM病程长,HbA1c高,HOMA-β、C-PAUC低、下肢动脉硬化发生率高(P<0.05)。骨质疏松组BMI、HOMA-CR低于骨量正常组(P＜0.05),mALb、中重度下肢动脉硬化、视网膜病变及周围神经病变发生率高于骨量正常组(P＜0.05)。高龄(OR=1.123,P=0.019)、长病程(OR=1.052,P=0.028)、低HOMA-β(OR=0.706,P=0.016)及高mALb(OR=1.289,P=0.006)是骨质疏松的独立危险因素。结论 高龄、长病程、胰岛功能差、糖尿病肾病是T₂DM并发骨质疏松的危险因素,糖尿病慢性并发症与骨质疏松密切相关。

Objective To study the relative clinical risk factors of osteoporosis in patients with type 2 diabetes mellitus(T₂DM). Methods 334 T₂DM patients were included in this research. According to their bone mineral density(BMD) values, the patients were divided into normal bone mass group, osteopenia group and osteoporosis group. The three groups were compared for differences in age, diabetes duration, body mass index (BMI), fasting plasma glucose (FPG), glycosylated hemoglobin A₁c (HbA₁c), C peptide secretion index(HOMA-β), area under the curve of C-peptide (C-PAUC), C peptide resistance index(HOMA-CR), triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), microalbuminuria(mALb), glomerular filtration rate(GFR) and chronic complications, then logistic regression analysis was made. Results Of 334 T₂DM patients, 116 patients had normal bone mass, including 75 males(64.66%)and 41 females(35.34%).110 patients had osteopenia, including 50 males(45.45%)and 60 females(54.55%). And the other 108 patients had osteoporosis, including 46 males(42.59%) and 62 females(57.41%). Compared with normal bone mass group, osteopenia group and osteoporosis group had older age, longer disease course, lower HOMA-β and C-PAUC, higher HbA₁c and incidence of lower limb arteriosclerosis(P＜0.05). Osteoporosis group had lower BMI and HOMA-CR(P＜0.05), but mALb, the incidence of moderate to severe lower limb arteriosclerosis, retinopathy and peripheral neuropathy were higher (P＜0.05).Logistic regression analyses showed that older age (OR=1.123,P=0.019), longer disease course(OR=1.052, P=0.028),lower HOMA-β(OR=0.706, P=0.016), higher mALb(OR=1.289, P=0.006) were the independent factors associated with BMD. Conclusions Older age, long disease duration,bad pancreas islet function, diabetic nephropathy are the risk factors of osteoporosis in T₂DM. Osteoporosis is closely related to chronic diabetic complications.