目的 探讨航天职工2型糖尿病患者合并骨质疏松的危险因素。方法 选择航天职工中2型糖尿病患者211例,根据骨密度分为骨质疏松组和非骨质疏松组,对比各组患者年龄、糖尿病病程、体重指数、骨钙素、CTX、25-羟维生素D、甲状旁腺素、空腹血糖、糖化血红蛋白、C肽曲线下面积、HOMA-β、HOMA-CR、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇的差异,并进行Logistic回归分析。结果 单因素分析:骨质疏松组和非骨质疏松组比较,糖尿病病程、BMI、25(OH)D、HbA1c、HOMA-β、HOMA-CR差异有统计学意义(P<0.05)。多因素Logistic回归分析:糖尿病病程(OR=0.007,95%CI:0.000～0.182)、体重指数(OR=8.888,95%CI:1.646～47.998)、糖化血红蛋白(OR=0.497,95%CI:0.332～0.744)、HOMA-β(OR=27.433,95%CI:8.105～92.844)、25-羟维生素D(OR=1.169,95%CI:1.047～1.306)是独立影响因素。结论 长糖尿病病程、低体重、高血糖、胰岛功能差、25-羟维生素D缺乏是航天系统职工2型糖尿病合并骨质疏松的危险因素。
Abstract
Objective To explore the risk factors for type 2 diabetes mellitus (T2DM)complicated with osteoporosis among aerospace professional staff.Methods Two hundred and eleven T2DM patients among aerospace professional staff were included in this research.According to the bone mineral density,these patients were divided into the osteoporosis group and non-osteoporosis group.The differences in age,diabetes duration,body mass index,osteocalcin,CTX,25(OH)D,parathyroid hormone,fasting plasma glucose,glycosylated hemoglobin Alc, area under the curve of C-peptide,C peptide secretion index,C peptide resistance index,total cholesterol,triglyceride,high density lipoprotein cholesterol,and low density lipoprotein cholesterol were compared between the two groups. Logistic regression analysis was made.Results Single-factor analysis suggested that there was statistically significant difference between the two groups in terms of the course of disease,body mass index,25(OH)D ,HbA1c,HOMA-β and HOMA-CR(P<0.05).Multivariate Logistic regression analysis indicated that the course of disease(OR=0.007,95%CI:0.000-0.182),BMI(OR=8.888,95%CI:1.646-47.998),HbA1c(OR=0.497,95%CI:0.332-0.744), HOMA-β(OR=27.433,95%CI:8.105-92.844)and 25(OH)D(OR=1.169,95%CI:1.047-1.306)were independent risk factors for osteoporosis in patients with T2DM.Conclusions Long courses of diabetes, low weight,poor glycemic control,bad pancreas islet function and low 25(OH)D are the risk factors for osteoporosis in patients with T2DM among aerospace professional staff.
关键词
2型糖尿病 /
骨密度 /
骨质疏松 /
危险因素
Key words
type 2 diabetes mellitus /
bone mineral density /
osteoporosis /
risk factor
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参考文献
[1] Wang L, Gao P, Zhang M, et al. Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013[J] JAMA,2017,317(24):2515-2523.
[2] Irwin R,Lin H V,Motyl K J.et al.Normal hone density obtained in the absence of insulin receptor expression in bone[J].Endocrinology,2006,147(12):5760-5767.
[3] Siddappa R,Mulder W,Steeghs I,et al.cAMP／PKA signaling inhibits osteogenic differentiation and bone formation in rodent models[J].Tissue Eng Part A,2009,15(8):2135-2143.
[4] 李 霞,周智广,亓海英,等.用空腹C肽代替胰岛素改良HOMA公式评价胰岛素抵抗和胰岛β细胞功能 [J].中南大学学报,2004,29(4):419-423.
[5] 曹 晶,江 霞.2型糖尿病骨密度水平及其相关性的分析[J].医学综述,2014,20(11):2078-2080.
[6] 李晓宇,冯正平.糖尿病性骨质疏松发病机制的研究进展[J].中国骨质疏松杂志,2014,20(5):580-583.
[7] Saito M.Marumo K.Collagen CROSS-links as a determinant of bone quality:a possible explanation for bone fragility in aging,osteoporosis,and diabetes mellitus[J].Osteoporosis Int,2010,21(2):195-214.
[8] 张 洁,沈默宇,成金罗.2型糖尿病患者骨密度的相关因素[J].中国老年学杂志,2012;32(8):3186-3188.
[9] Jackuliak P,Payer J.Osteoporosis,fractures,and diabetes[J].Int J Endocrinol, 2014,2014:820615.
[10] Khosla S,Amin S,Orwoll E.Osteoporosis in men[J].Endocr Rev,2008,29(4):441-446.
[11] Bridges M J, Ruddick S A. Do frax/nogg guidelines predict fractures in post-menopausal women with Type 2 diabetes [J]. Diabet Med, 2012, 29(4): 555-556.
[12] Nimiphong H, Sritara C, Chailurkit L O, et al. Relationship of vitamin D status and bone mass according to vitamin D-binding protein genotypes[J]. Nutr J, 2015, 24(14):29-35.
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