本文關(guān)鍵詞：住院2型糖尿病患者的骨密度變化及其與代謝指標(biāo)的相關(guān)性分析　出處：《南昌大學(xué)》2016年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 2型糖尿病 骨質(zhì)疏松 骨密度

【摘要】：目的:研究住院2型糖尿病(T2DM)患者的骨密度(BMD)變化及合并骨質(zhì)疏松的相關(guān)因素,為糖尿病性骨質(zhì)疏松(DOP)的早期診斷與防治提供依據(jù)。方法:將入選的733例住院2型糖尿病患者按照平均骨密度值分為骨量正常組(A組)、骨量減低組(B組)和骨質(zhì)疏松組(C組),對(duì)比三組患者的性別、年齡、體重指數(shù)(BMI)、病程、空腹血糖(FPG)、餐后1h血糖(1h PG)、餐后2h血糖(2h PG)、空腹胰島素(FINS)、餐后1h胰島素(1h INS)、餐后2h胰島素(2h INS)、胰島素抵抗指數(shù)(Homa-IR)、胰島素敏感指數(shù)(ISI)、糖化血紅蛋白(Hb A1c)、尿微量白蛋白定量、血脂、尿酸、甲狀旁腺素(PTH)、血鈣(Ca)、血磷(P)和骨堿性磷酸酶(BALP)等指標(biāo)之間的差異,并進(jìn)行相關(guān)性分析。結(jié)果:1、住院T2DM患者中骨量減少的檢出率為49.7%,骨質(zhì)疏松(OP)的檢出率為12.4%,其中女性患者OP的檢出率大于男性,有明顯統(tǒng)計(jì)學(xué)差異(P0.05)。2、在一般臨床資料的對(duì)比中,C組的年齡和病程均明顯大于A、B兩組(P0.05),且B組的年齡明顯大于A組(P0.05),但是病程在A、B兩組間則無(wú)明顯差異(P0.05);而A、B組的BMI均明顯大于C組(P0.05),A組的BMI明顯大于B組。3、在血糖及胰島素水平的比較中,C組的FPG、2h PG均明顯大于A、B兩組(P0.05),且B組的2h PG明顯大于A組(P0.05),但是FPG在A、B兩組間無(wú)統(tǒng)計(jì)學(xué)差異(P0.05);A組的Homa-IR明顯小于B、C兩組(P0.05),A組的ISI明顯大于B、C兩組(P0.05),但Homa-IR、ISI在B、C兩組間均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05);而1h PG、FINS、1h INS、2h INS、Hb A1c在三組中均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。4、在代謝指標(biāo)的對(duì)比中,C組的HDL-C水平明顯高于A、B兩組(P0.05);A、B組的尿酸水平明顯高于C組(P0.05),且A組的尿酸明顯高于B組(P0.05);而尿微量白蛋白、TC、TG、LDL-C在三組間無(wú)明顯差異(P0.05)。5、在骨代謝指標(biāo)及BMD值的對(duì)比中,A、B組的腰椎L1-L4及雙側(cè)股骨頸的BMD值均明顯大于C組(P0.05),且A組各部位的BMD值均大于B組(P0.05);A、B組的BALP、PTH均明顯小于C組(P0.05),且A組的BALP明顯小于B組(P0.05),但PTH在A、B組間無(wú)統(tǒng)計(jì)學(xué)差異(P0.05);而血鈣、磷在三組間無(wú)明顯差異(P0.05)。6、T2DM患者的BMI、FINS、ISI、尿酸與各部位BMD值呈正相關(guān)(P0.05),年齡、FPG、2h PG、Homa-IR、HDL-C與各部位BMD值呈負(fù)相關(guān)(P0.05)。7、進(jìn)一步進(jìn)行多元逐步回歸分析后,年齡(β=-0.041,P=0.000)、BMI(β=0.063,P=0.005)、FPG(β=-0.236,P=0.000)、HDL-C(β=-0.649,P=0.005)、尿酸(β=0.002,P=0.047)仍與骨密度獨(dú)立相關(guān)。結(jié)論:1、住院的50歲以上2型糖尿病患者中骨量減少及OP的發(fā)生率占60%以上,其中絕經(jīng)后女性較男性更易患OP。2、高齡、低體重、糖尿病病程長(zhǎng)、空腹血糖控制不佳、胰島功能差、胰島素抵抗、高高密度脂蛋白膽固醇、低尿酸均是2型糖尿病合并骨質(zhì)疏松的高危因素。
[Abstract]:Objective: to study the changes of bone mineral density (BMD) and the related factors of osteoporosis in patients with type 2 diabetes mellitus (T2DM). Methods: 733 inpatients with type 2 diabetes mellitus were divided into two groups according to the average bone mineral density (BMD). Sex, age, body mass index (BMI), course of disease, fasting blood glucose (FPG), postprandial blood glucose (1 h) and postprandial blood glucose (1 h) were compared between group B (group B) and group C (group C). 2 h postprandial blood glucose, 2 h PGN, fasting insulin, 1 h insulin, 1 h insulin, 2 h postprandial insulin, 2 h ins). Insulin resistance index (ISI), insulin sensitivity index (ISI), glycosylated hemoglobin (HbA1cN), urinary albumin, serum lipids and uric acid. The differences of PTH, Ca, P) and BALP (bone alkaline phosphatase) were analyzed. Results: 1. The detectable rate of osteopenia and osteoporosis OPO in T2DM patients was 49.7 and 12.4respectively. The detection rate of op in female patients was higher than that in men. The age and course of disease in group C were significantly larger than those in group A and B (P 0.05). The age of group B was significantly larger than that of group A (P 0.05), but there was no significant difference in the course of disease between group A and group B (P 0.05). The BMI of group A was significantly higher than that of group C (P 0.05). The BMI of group A was significantly larger than that of group B (0.3), and the level of blood glucose and insulin in group C was significantly higher than that of group C (FPG). 2 h PG was significantly higher than that of Agna B group (P 0 05), and 2 h PG in B group was significantly higher than that in A group (P 0 05), but FPG was higher in A group than that in A group (P 0 05). There was no statistical difference between group B and group B (P 0.05). The Homa-IR of group A was significantly lower than that of group A (P 0.05), but the ISI of group A was significantly higher than that of group B (P 0.05), but Homa-IRI was higher than that of group B (P 0.05). There was no statistical difference between group C and group C (P 0.05). However, there was no significant difference in HbA1c between the three groups in 1h PGN FINSN 1h and 1h INS1c, and there was no significant difference among the three groups (P0.05A1c) in the comparison of metabolic indexes. The level of HDL-C in group C was significantly higher than that in group A and B (P 0.05). The level of uric acid in group A was significantly higher than that in group C (P 0.05), and the level of uric acid in group A was significantly higher than that in group B (P 0.05). However, there was no significant difference in LDL-C between the three groups in urine microalbuminuria (TCX) and TGG. 5. There was no significant difference between the three groups (P < 0. 05), and there was no significant difference between the three groups in bone metabolism index and BMD value. The BMD values of L1-L4 and bilateral femoral neck in group B were significantly higher than those in group C (P 0.05), and the BMD values in group A were higher than those in group B (P 0.05). The BALP of group A was significantly lower than that of group B (P 0.05), but that of group A was lower than that of group B (P 0.05), but the PTH of group A was lower than that of group A. There was no statistical difference between group B and group B (P 0.05). However, there was no significant difference in serum calcium and phosphorus among the three groups. There was a positive correlation between uric acid and BMD value in all parts of BMI-FINSISI. There was a negative correlation between HDL-C and BMD value in two hours of PGHA-IRL. Further multivariate stepwise regression analysis was carried out. Age (尾 -0.041) and BMI0.000 (尾 -0.063 / P0. 005 / FPG (尾 -0.236 / P0. 000)). HDL-C (尾 -0.649) and uric acid (尾 -0.002) were still independent of BMD. Conclusion: 1. The incidence of osteopenia and op accounted for more than 60% in the hospitalized patients over 50 years old with type 2 diabetes mellitus. Postmenopausal women were more likely to develop OP.2than men, the elderly, low body weight and long course of diabetes. Poor control of fasting blood glucose, poor islet function, insulin resistance, high density lipoprotein cholesterol and low uric acid were all high risk factors for type 2 diabetes mellitus with osteoporosis.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R587.1;R580

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