早发2型糖尿病骨密度、骨代谢变化及影响因素分析

高晶晶; 李聪; 高磊; 包鹏; 费爱华; 高艳虹

doi:10.16766/j.cnki.issn.1674-4152.002803

早发2型糖尿病骨密度、骨代谢变化及影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002803

高晶晶^{1, 2},
李聪¹,
高磊¹,
包鹏^{1, 2},
费爱华²,
高艳虹^1, ,

1.
上海交通大学医学院附属新华医院老年医学科, 上海 200092
2.
上海交通大学医学院附属新华医院全科医学科

基金项目:

国家自然科学基金项目 82071575

上海市科技计划项目 20ZR1435100

详细信息

通讯作者:
高艳虹，E-mail：gaoyanhong@xinhuamed.com.cn

中图分类号: R587.1
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- 被引次数: 0
出版历程
- 收稿日期: 2022-03-24
- 网络出版日期: 2023-04-07

Changes in bone mineral density, bone metabolism and its influencing factors in early-onset type 2 diabetes mellitus

GAO Jing-jing^{1, 2},
LI Cong¹,
GAO Lei¹,
BAO Peng^{1, 2},
FEI Ai-hua²,
GAO Yan-hong^{1
, ,}

1.
Department of Geriatrics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China

摘要

摘要: 目的研究早发2型糖尿病(T2DM)骨密度、骨代谢水平改变并探讨其影响因素。方法选取2018年1月—2021年12月在上海交通大学医学院附属新华医院内分泌科住院的初诊年龄≤40岁的2型糖尿病患者201例为早发组，另以本院与早发组年龄、性别相匹配的非糖尿病患者107例为对照组。比较2组一般临床资料及腰椎L_1~4平均骨密度(BMD)、骨代谢水平差异。结果 (1)校正BMI后，早发组与对照组BMD比较差异无统计学意义(F=1.004，P>0.05)，早发组1型原胶原氨基端前肽(P1NP)、骨钙素、25(OH)D₃、甲状旁腺激素均低于对照组(t=3.941、6.556、7.123、4.620，均P＜0.05)，2组1型胶原羧基端肽β特殊序列(β-CTX)比较差异无统计学意义(t=1.684，P>0.05)。(2)影响因素分析结果显示，BMD与年龄呈独立负相关关系(95% CI：-0.007~-0.001，P=0.012)，与BMI(95% CI：0.004~0.014，P=0.001)、糖化血红蛋白(95% CI：0.002~0.021，P=0.014)呈独立正相关关系；β-CTX与年龄(95% CI：-0.013~-0.003，P=0.001)、TC(95% CI：-0.079~-0.015，P=0.004)呈独立负相关关系，女性(95% CI：-0.177~-0.020，P=0.014)是β-CTX降低的独立危险因素；P1NP与年龄(95% CI：-0.831~-0.137，P=0.007)、空腹血糖(95% CI：-1.815~-0.333，P=0.005)、TG(95% CI：-0.635~-0.508，P=0.004)呈独立负相关关系。结论早发2型糖尿病患者的骨密度与非糖尿病人群相比未见明显差异，但骨形成标志物降低，年龄、性别、BMI、血糖、血脂水平是其骨密度、骨代谢水平改变的独立影响因素。
- 早发2型糖尿病 /
- 骨质疏松 /
- 骨密度 /
- 骨代谢
Abstract: Objective To analyse the changes in bone mineral density, bone metabolism and its influencing factors in early-onset type 2 diabetes mellitus (T2DM). Methods We performed a retrospective analysis of 201 patients with T2DM who were diagnosed with diabetes aged ≤ 40 years old in the Department of Endocrinology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2018 to December 2021. These subjects were classified as the early-onset group. In addition, we selected 107 non-diabetic patients matched with the early-onset group with regard to age and sex ratio as the control group. The general clinical data, biochemical indexes, mean bone mineral density (BMD) of lumbar spine L_1-4 and bone metabolism markers were compared between the two groups. Results (1) After correcting the BMI, no statistically significant difference in BMD was observed between the early-onset group and control group (F=1.004, P>0.05). The levels of type Ⅰ procollagen amino-terminal peptide, osteocalcin, 25(OH)D₃ and parathyroid hormone of the early-onset group were lower than those in the control group (t=3.941, 6.556, 7.123, 4.620, all P < 0.05), whereas no significant difference in β-carboxyl terminal peptide (β-CTX) was found between the two groups (t=1.684, P>0.05). (2) Correlation analysis results showed that BMD was independently and negatively correlated with age (95% CI: -0.007 to -0.001, P=0.012) but was independently and positively correlated with BMI (95% CI: 0.004 to 0.014, P=0.001) and HbA1c (95% CI: 0.002 to 0.021, P=0.014). β-CTX was independently and negatively correlated with age (95% CI: -0.013 to -0.003, P=0.001) and TC (95% CI: -0.079 to -0.015, P=0.004). In addition, the female gender was an independent risk factor for decreased β-CTX (95% CI: -0.177 to -0.020, P=0.014). P1NP was independently and negatively correlated with age (95% CI: -0.831 to -0.137, P=0.007), FPG (95% CI: -1.815 to -0.333, P=0.005) and TG (95% CI: -0.635 to -0.508, P=0.004). Conclusion There is no significant difference in BMD amongst patients with early-onset type 2 diabetes compared with non-diabetic people, but the markers of bone formation decrease. The age, gender, BMI, blood glucose and blood lipid levels are independent influencing factors of changes in BMD and bone metabolism in patients.
- Early-onset type 2 diabetes mellitus /
- Osteoporosis /
- Bone mineral density /
- Bone metabolism

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表 1 2组研究对象一般临床资料比较

Table 1. Comparison of general clinical data between two groups

组别	例数	性别(男/女, 例)	年龄(x±s, 岁)	BMI(x±s)	SBP(x±s, mm Hg)	DBP(x±s, mm Hg)	吸烟[例(%)]
早发组	201	146/55	38.13±7.10	27.11±4.53	129.04±15.66	83.33±11.56	46(22.89)
对照组	107	77/30	38.93±5.87	24.94±3.24	124.81±12.66	77.90±9.44	16(14.95)
统计量		0.016^a	-1.057^b	5.072^b	2.564^b	4.658^b	2.733^a
P值		0.900	0.291	＜0.001	0.011	＜0.001	0.098

组别	例数	饮酒[例(%)]	高血压[例(%)]		心脑血管疾病[例(%)]	动脉粥样硬化斑块[例(%)]	脂肪肝[例(%)]
早发组	201	16(7.96)	55(27.36)		30(14.92)	76(37.81)	128(63.68)
对照组	107	8(7.48)	20(18.69)		9(8.41)	37(34.58)	34(31.78)
统计量		0.023^a	2.850^a		2.679^a	0.314^a	28.510^a
P值		0.880	0.091		0.528	0.575	＜0.001
注：1 mm Hg=0.133 kPa；^a为χ²值，^b为t值。

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表 2 2组研究对象生化指标比较

Table 2. Comparison of biochemical indexes between two groups

组别	例数	ALT [M(P₂₅, P₇₅)，U/L]	AST [M(P₂₅, P₇₅)，U/L]		尿酸[M(P₂₅, P₇₅)，μmol/L]	TC (x±s，mmol/L)		TG[M(P₂₅, P₇₅)，mmol/L]
早发组	201	26.00(16.00, 41.00)	20.00(15.00, 32.00)		353.00(294.00, 425.00)	4.91±1.10		2.00(1.27, 3.25)
对照组	107	22.00(13.00, 37.00)	20.00(16.00, 26.50)		360.00(276.50, 431.00)	4.58±0.99		1.53(0.97, 2.33)
t值		-2.356^a	-0.192^a		-0.252^a	2.583^b		-3.581^a
P值		0.018	0.847		0.801	0.010		＜0.001

组别	例数	LDL-C (x±s, mmol/L)	HDL-C[M(P₂₅, P₇₅)，mmol/L]	Scr (x±s, μmol/L)	eGFR[x±s, mL/(min·1.73m²)]	Ca (x±s, mmol/L)	Mg (x±s, mmol/L)	P (x±s, mmol/L)
早发组	201	2.97±0.91	0.95(0.83, 1.15)	58.64±17.56	135.57±40.69	2.21±0.10	0.85±0.09	1.26±0.18
对照组	107	2.72±0.82	1.15(1.00, 1.37)	63.18±14.80	113.07±21.12	2.23±0.12	0.91±0.07	1.15±0.16
t值		2.433^b	-5.254^a	-2.274^b	6.302^b	-1.205^b	-7.227^b	5.362^b
P值		0.016	＜0.001	0.024	＜0.001	0.230	＜0.001	＜0.001
注：^a为Z值，^b为t值。

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表 3 2组研究对象骨密度、骨代谢指标比较(x±s)

Table 3. Comparison of bone mineral density and bone metabolism between two groups(x±s)

组别	例数	BMD^a(g/cm³)	β-CTX(ng/mL)	P1NP(ng/mL)	OC(ng/mL)	25(OH)D₃(nmol/L)	PTH(pmol/L)
早发组	201	1.189±0.010	0.46±0.27	42.64±18.68	11.18±5.86	33.98±11.88	3.86±1.48
对照组	107	1.170±0.014	0.51±0.27	52.01±22.40	15.75±5.68	48.53±19.27	4.76±1.87
统计量		1.004^b	1.684^c	3.941^c	6.556^c	7.123^c	4.620^c
P值		0.317	0.093	＜0.001	＜0.001	＜0.001	＜0.001
注：^a为校正BMI后；^b为F值，^c为t值。

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表 4 早发T2DM患者骨密度和骨代谢指标与各因素的相关性分析

Table 4. Correlation analysis of bone mineral density and bone metabolism indexes with various factors in patients with early-onset T2DM

项目	BMD		β-CTX		P1NP
项目	r值	P值	r值	P值	r值	P值
病程(年)	-0.007	0.919	-0.103	0.146	0.010	0.883
年龄(岁)	-0.249	＜0.001	-0.243	0.001	-0.165	0.019
BMI	0.314	＜0.001	0.046	0.518	0.011	0.876
HbA1c(%)	0.218	0.002	0.074	0.298	-0.148	0.036
FPG(mmol/L)	0.090	0.203	-0.089	0.211	-0.226	0.001
TC(mmol/L)	0.030	0.677	-0.226	0.001	-0.228	0.001
TG(mmol/L)	0.179	0.011	-0.164	0.020	-0.242	0.001
LDL-C(mmol/L)	-0.097	0.171	-0.110	0.120	-0.077	0.279
HDL-C(mmol/L)	-0.135	0.055	-0.139	0.049	0.010	0.890
Ca(mmol/L)	0.078	0.269	0.075	0.290	0.049	0.490
Mg(mmol/L)	-0.102	0.152	-0.003	0.969	0.092	0.193
P(mmol/L)	0.094	0.183	-0.037	0.605	-0.030	0.676

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表 5 早发2型糖尿病患者骨密度、骨代谢指标与各因素的多元线性回归分析

Table 5. Multiple linear regression analysis of bone mineral density, bone metabolism indexes and various factors in patients with early-onset type 2 diabetes mellitus

因变量	自变量	B	β	SE	t值	P值
BMD	年龄	-0.004	-0.172	0.002	-2.526	0.012
	BMI	0.009	0.238	0.003	3.476	0.001
	HbA1c	0.012	0.164	0.005	2.470	0.014
β-CTX	年龄	-0.008	-0.223	0.003	-3.335	0.001
	女性	-0.099	-0.166	0.040	-2.487	0.014
	TC	-0.047	-0.196	0.016	-2.921	0.004
P1NP	年龄	-0.484	-0.184	0.176	-2.749	0.007
	TG	-1.572	-0.200	0.539	-2.914	0.004
	FPG	-1.074	-0.197	0.376	-2.858	0.005
注：性别赋值女性=1、男性=0；其余连续变量均以实际值赋值。

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