本文選題：2型糖尿病 + 骨密度減低�。� 參考：《華北理工大學(xué)》2015年碩士論文

【摘要】：目的探討影響2型糖尿病患者骨密度減低的相關(guān)因素,為預(yù)防2型糖尿病患者骨密度減低、發(fā)生骨質(zhì)疏松癥,并降低病理性骨折風(fēng)險(xiǎn)提供相關(guān)理論依據(jù)。方法選取河北聯(lián)合大學(xué)附屬醫(yī)院內(nèi)分泌科住院的2型糖尿病(T2DM)患者216例,依據(jù)骨密度(BMD)測(cè)定結(jié)果分為骨密度正常組(76例,52.78±6.61歲)、骨密度減低組(68例,53.82±8.02歲)、骨質(zhì)疏松癥組(72例,56.96±7.49歲)。入組患者均測(cè)定腰椎前后位總體(L1-4)面積BMD,分析T2DM患者BMD與性別、年齡、糖尿病病程、體重指數(shù)(BMI)、糖化血紅蛋白(Hb A1c)、堿性磷酸酶(ALP)、甲狀旁腺激素(PTH)、降鈣素(CT)、血鈣、血磷的相關(guān)性,以及T2DM患者BMD與糖尿病并發(fā)癥(早期糖尿病腎病、糖尿病視網(wǎng)膜病變、糖尿病周圍神經(jīng)病變、糖尿病周圍血管病變)的相關(guān)性。結(jié)果三組間經(jīng)單因素方差分析顯示,骨質(zhì)疏松癥組與骨密度正常組比較,年齡、BMI、Hb Alc較高,差異有統(tǒng)計(jì)學(xué)意義(P值分別為0.001、0.002、0.000);骨質(zhì)疏松癥組與骨密度減低組比較,年齡、BMI、Hb Alc較高,差異有統(tǒng)計(jì)學(xué)意義(P值分別為0.013、0.007、0.000);骨密度減低組與骨密度正常組比較,Hb Alc較高,差異有統(tǒng)計(jì)學(xué)意義(P=0.004)。三組間經(jīng)卡方檢驗(yàn)顯示,性別構(gòu)成比、糖尿病周圍神經(jīng)病變構(gòu)成差異有統(tǒng)計(jì)學(xué)意義(P0.05),其中骨質(zhì)疏松癥組女性、合并糖尿病周圍神經(jīng)病變所占比例高,而三組間是否合并早期糖尿病腎病、糖尿病視網(wǎng)膜病變、糖尿病周圍血管病變的差異無統(tǒng)計(jì)學(xué)差異(P0.05)。將單因素方差分析及卡方檢驗(yàn)有統(tǒng)計(jì)學(xué)差異的變量作為自變量,以是否合并骨質(zhì)疏松癥為因變量進(jìn)行二分類Logistic回歸分析,結(jié)果顯示,年齡(OR=1.050)、Hb A1c(OR=1.531)、并發(fā)糖尿病周圍神經(jīng)病變(OR=2.149)、性別(女)(OR=2.084)為T2DM患者合并骨質(zhì)疏松癥的危險(xiǎn)因素,而高BMI(OR=0.868)為T2DM患者骨質(zhì)疏松癥的保護(hù)因素。Pearson相關(guān)分析結(jié)果顯示,年齡、糖尿病病程、BMI、Hb A1c、PTH、性別構(gòu)成比及并發(fā)糖尿病周圍神經(jīng)病變比例與骨密度減低嚴(yán)重程度存在相關(guān)性(P0.05),將上述相關(guān)分析有統(tǒng)計(jì)學(xué)意義的變量納入多元線性回歸分析,結(jié)果顯示,性別(女)(r=-0.056,P=0.001)、年齡(r=-0.004,P=0.000)、Hb A1c(r=-0.029,P=0.000)、糖尿病周圍神經(jīng)病變(r=-0.054,P=0.002)與T2DM患者骨密度呈獨(dú)立負(fù)相關(guān),而BMI值(r=0.005,P=0.048)與T2DM患者骨密度呈獨(dú)立正相關(guān)。結(jié)論女性患者、年齡增長(zhǎng)、Hb A1c水平升高、合并糖尿病周圍神經(jīng)病變?yōu)門2DM患者骨密度降低的獨(dú)立相關(guān)因素,而一定程度上的高BMI對(duì)T2DM患者骨密度減低具有保護(hù)作用。
[Abstract]:Objective to investigate the related factors affecting the decrease of bone mineral density in patients with type 2 diabetes, and to provide relevant theoretical basis for preventing the decrease of bone mineral density, developing osteoporosis and reducing the risk of pathological fracture in type 2 diabetes mellitus. Methods 216 patients with type 2 diabetes mellitus (T2DM) were selected from Endocrinology Department of affiliated Hospital of Hebei Union University. According to the results of BMD, 76 patients with normal bone mineral density (BMD) were divided into normal BMD group (n = 76), BMD group (n = 68), BMD group (n = 68) and osteoporosis group (n = 72) (56.96 鹵7.49 years old). The total L1-4) area of lumbar spine was measured in all patients with T2DM. The correlation between BMD and sex, age, diabetes course, BMI, HbA1cP, ALP, PTH, calcitonin, serum calcium and phosphorus were analyzed. And the correlation between BMD and diabetic complications (early diabetic nephropathy, diabetic retinopathy, diabetic peripheral neuropathy, peridiabetic vascular disease) in patients with T2DM. Results the univariate analysis of variance showed that the age of BMIHb Alc in osteoporosis group was higher than that in normal BMD group (P = 0.001 鹵0.002), and that in osteoporosis group was higher than that in BMD group (P < 0.05), and the age of BMIHb Alc was higher in osteoporosis group than that in BMD reduction group. The difference was statistically significant (P = 0.013 ~ 0.007 ~ 0.000 ~ 0.000), and HB Alc was higher in BMD reduction group than that in normal BMD group, and the difference was statistically significant (P = 0.004). Chi-square test showed that there were significant differences in sex composition and diabetic peripheral neuropathy among the three groups (P 0.05). In osteoporosis group, the proportion of diabetic peripheral neuropathy was high in female. However, there was no significant difference between the three groups in early diabetic nephropathy, diabetic retinopathy and peridiabetic vascular disease (P 0.05). The univariate ANOVA and chi-square test variables with statistical differences were taken as independent variables, and the two classification Logistic regression analysis was carried out with the dependent variables of osteoporosis. The results showed that, The age of T2DM patients was 1.050 HbA1cP 1.531D, and the incidence of diabetic peripheral neuropathy was 2.149%. Sex (female) was the risk factor of osteoporosis in patients with T2DM, while high BMIA OR1 (0.868) was the protective factor of osteoporosis in T2DM patients. Pearson correlation analysis showed that age, and sex were the risk factors of osteoporosis in patients with T2DM, and the results of Pearson correlation analysis showed that age, and sex were the risk factors of osteoporosis in T2DM patients. There was a correlation between the ratio of sex composition and the proportion of peripheral neuropathy complicated with diabetes mellitus and the severity of bone mineral density reduction (P 0.05). The variables with statistical significance were included in the multivariate linear regression analysis. There was an independent negative correlation between the sex (RV -0.056, P = 0.001), age (n = 0.004), HbA1cn (n = 0.029), and diabetic peripheral neuropathy (n = 0.054, P ~ (0.002), but an independent and positive correlation between the BMI value and the bone mineral density (BMD) in patients with T2DM (P = 0.048, P = 0.048, P = 0.048, P = 0.048, P = 0.048, P = 0.048, P = 0.048, P = 0.048, P = 0.048, P = 0.048, P = 0.048, P = 0.048, P = 0.048, P = 0.048). Conclusion the increase of HbA1c level in female patients with age and diabetic peripheral neuropathy is an independent correlation factor of BMD decrease in T2DM patients, while high BMI has protective effect on BMD in T2DM patients to a certain extent. [WT5HZ] [WT5 "BZ] [WT5" BZ] [WT5 "BZ] [WT5" BZ]
【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R587.1;R580

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本文編號(hào)：1877780