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| 绝经后2型糖尿病患者LDL/HDL比值与骨强度以及骨折风险的相关性研究 |
| Relationship between LDL/HDL ratio and stiffness index and fracture risk in postmenopausal women with type 2 diabetes mellitus |
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| DOI：10.3969/j.issn.1006-7108.2020.02.006 |
| 中文关键词: 2型糖尿病；绝经后；LDL/HDL值；骨强度指数 骨折风险；骨代谢标志物 |
| 英文关键词:type 2 diabetes mellitus postmenopausal women LDL/HDL ratio SI fracture risk bone turnover markers |
| 基金项目:安徽省卫生厅医学科研课题项目（13ZC003） |
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| 中文摘要: |
| 目的 探讨LDL/HDL比值与绝经后女性2型糖尿病患者骨强度以及骨折风险的相关性。方法 选取2014年1月至2018年1月在我院内分泌科就诊的女性2型糖尿病（type 2 diabetes mellitus,T2DM）患者226例，其中113例已绝经，将患者分为未绝经组与已绝经组。运用超声骨密度仪(QUS)分别测量受试者的骨强度指数(stiffness index,SI)，同时收集患者一般资料如年龄、体质量指数（bone mass index, BMI）、糖尿病病程等，测定血脂、糖化血红蛋白、骨钙素(BGP)、血清I型原胶原N-端前肽(PINP)、血清1型胶原交联β- C-末端肽（β-CTX），并计算TC/HDL比值(THR)、LDL/HDL比值（LHR）。采用骨折风险预测工具模型(FRAX)计算患者10年任何重要部位骨质疏松性骨折 (PMOF)、髋部骨折 (PHF) 概率。采用线性回归分析不同血脂指标与SI相关性，进一步评估LHR与骨代谢、PMOF和PHF等的相关关系。结果 (1) 与未绝经组相比，已绝经组SI[（79.96±11.35） VS (92.50±15.95), P＜0.001）]、BGP[（13.47±4.11）VS (21.00±10.90), P= 0.039）]、PINP[（34.59±16.16）VS (56.70±37.33), P=0.016 ]降低，β-CTX[（590.71±263.24）VS (423.07±198.04), P=0.021]、LHR[（2.16±0.76）VS (1.89±0.81), P=0.040）]、PMOF[（3.67±1.28）VS (1.50±0.14）, P=0.009]、PHF[（1.44±0.61）VS (0.65±0.12）, P=0.005]升高，差异有统计学意义； (2) Pearson相关性分析结果提示SI与PMOF、PHF呈负相关(β= -0.749;β= -0.681, P均＜0.001)；(3)分别校正年龄与BMI（β= -0.245, P=0.006），Hba1c与病程（β= -0.240, P=0.009），年龄、BMI、Hba1c、病程和肌酐（β=-0.248, P=0.005）,绝经后2型糖尿病患者LHR与SI均有显著负相关；(4)LHR与PMOF、PHF、β-CTX呈正相关(β=0.336;β=0.319; β=277, P均＜0.05),与BGP、PINP呈负相关（β= -0.310; β= -0.298 , P均＜0.05）。结论 绝经后2型糖尿病患者LHR与SI、FRAX骨折风险评分以及骨代谢指标相关，高LHR可能引起SI下降、骨折风险增高，其机制可能与成骨减少、破骨增加有关。 |
| 英文摘要: |
| Objective To study the relationship between LDL/HDL ratio (LHR) and stiffness index and fracture risk in postmenopausal women with type 2 diabetes mellitus (T2DM). Methods From 2014 to 2017, in the Endocrinology Department of Anhui Provincial Hospital a total of 113 postmenopausal women with T2DM were selected as the postmenopausal group, and 113 premenopausal women with T2DM were selected as the premenopausal group. Bone strength index (SI) based on QUS were measured. General information such as age and body mass index (BMI), T2DM history, blood lipids, glycosylated hemoglobin (HbA1c), osteocalcin (BGP), serum type I procollagen N-terminal propeptide (PINP), serum type 1 collagen cross-linking β-C-terminal peptide (β-CTX), and calculation of TC/HDL ratio (THR) and LDL/HDL ratio (LHR) of the two groups were record and compared. Fracture Risk Assessment Tool (FRAX) was utilized to estimate the 10-year probability of a major osteoporotic fracture (PMOF) and the probability of hip fracture (PHF). Linear regression analysis was used to analyze the correlation between different blood lipids and SI, and evaluate the relationship between LHR and bone metabolism, PMOF and PHF. Results (1) Compared with the premenopausal group, the postmenopausal group had significantly lower SI [(79.96±11.35) VS (92.50±15.95), P<0.001], BGP [(13.47±4.11) VS (21.00±10.90), P= 0.039], PINP [(34.59±16.16) VS (56.70±37.33), P=0.016], and significantly higher β-CTX [(590.71±263.24) VS (423.07±198.04), P=0.021], LHR [(2.16±0.76) VS (1.89±0.81), P=0.040], PMOF [(3.67±1.28) VS (1.50±0.14), P=0.009] and PHF [(1.44±0.61) VS (0.65±0.12), P=0.005]. (2) Pearson correlation analysis showed that SI was negatively correlated with PMOF and PHF (β = -0.749; β = -0.681, both P<0.001). (3) In models adjusted age, BMI, HbA1c, duration of diabetes and Cr, a negative association was found between LHR and SI (β= -0.248, P=0.005). (4) Regression analyses showed that LHR was positively associated with PMOF, PHF and β-CTX (β=0.336; β=0.319; β=277, P<0.05), and negatively associated with BGP and PINP (β= -0.310; β= -0.298, P<0.05). Conclusions Our study showed that LHR has a close relationship with SI, risk of osteoporotic fracture and bone turnover markers. High LHR may cause the decrease of SI and the increase of osteoporotic fracture risk by promoting bone turnover. |
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