中国骨质疏松杂志

绝经后糖尿病骨质疏松症患者的DXA与QCT诊断及临床分析

Diagnosis and clinical analysis of DXA and QCT in osteoporosis in patients with postmenopausal diabetes

DOI：10.3969/j.issn.1006-7108.2026.06.014

英文关键词:Type 2 diabetes osteoporosis dual-energy X-ray absorption meter quantitative CT

基金项目:安徽省卫生健康适宜推广项目（SYJS202123）

作者	单位
申金付1* 钱学雯2 张梦洁1 王静宇1 宁海玉1 王霞1 霍琴琴1 张学辉1 张琴1	1.安徽医科大学附属阜阳市人民医院内分泌科,安徽阜阳 236000 2.阜阳市肿瘤医院内科,安徽阜阳 236000

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中文摘要:

目的探讨绝经后2型糖尿病(T2DM)患者腰椎骨质疏松症(OP)的双能X线吸收法(DXA)、定量计算机断层扫描法(QCT)的诊断，及影响因素分析。方法选取2021年1月至2023年6月于本院收治的绝经后T2DM患者156例，均做DXA和QCT检测腰椎骨密度(BMD)，以T值≤?2.5 或≤?2.0 为OP诊断切点的DXA分为DXA1组、DXA2组，及QCT诊断OP为QCT组。收集并比较患者一般临床资料、生化、骨转换标志物、DXA检测的面积骨密度(aBMD)、QCT检测的体积骨密度(vBMD)结果等，使用SPSS软件对收集的数据进行统计学分析。结果 ①绝经后T2DM患者腰椎OP检出率：DXA1组检出率32.7 %(51/156)低于DXA2检出率46.8 %(73/156)及QCT组的检出率45.5 %(71/156)(P<0.05)；QCT与T≤?2.5的DXA共同检出腰椎OP患者有44例(86.3)，QCT与T≤?2.0的DXA共同检出腰椎OP患者有62例(84.9 %)。②相关分析显示，绝经后T2DM患者的L1~4 DXA T值、L1~4 aBMD值、髋关节DXA T值、髋关节aBMD值与L1~2 vBMD值正相关(P<0.05)。线性回归分析显示，年龄、病程、糖化血红蛋白(HbA1 c)、血磷与血肌酐是L1~4 aBMD值的影响因素；年龄、病程、体重指数(BMI)、HbA1c、血钙、白蛋白、碱性磷酸酶及β-胶原特殊序列(β-CTX)是L1~2 vBMD值的影响因素(P< 0.05)。③二元回归分析示，绝经后T2DM患者腰椎OP诊断的影响因素：病程、BMI、HbA1c、β-CTX是以T≤?2.5为切点的DXA诊断影响因素；年龄、病程、BMI、HbA1c、β-CTX、25-羟基维生素D(25OHD)是以T≤?2.0为切点的DXA诊断影响因素；年龄、病程、BMI、β-CTX是QCT诊断的影响因素(P<0.05)。结论绝经后T2DM患者腰椎OP以T≤?2.0为诊断切点DXA与QCT的检出率及一致性高，或许有更高的诊断价值。

英文摘要:

Objective To investigate the diagnosis of lumbar osteoporosis(OP) in postmenopausal patients with type 2 diabetes mellitus(T2DM) using dual-energy X-ray absorptiometry(DXA) and quantitative computed tomography(QCT), and to analyze influencing factors. Methods A total of 156 postmenopausal T2DM patients in our hospital from January 2021 to June 2023 were enrolled. All patients underwent DXA and QCT to measure lumbar bone mineral density(BMD).Diagnostic thresholds for OP were defined as T-score ≤-2.5 SD (DXA1 group) or ≤-2.0 SD(DXA2 group) for DXA,and QCT-based criteria for the QCT group.General clinical data,biochemical parameters, bone turnover markers(BTMs), DXA-derived areal BMD (aBMD),and QCT-derived volumetric BMD(vBMD) were collected and compared.The collected data were statistically analyzed using SPSS software. Results ①The OP detection rates in postmenopausal T2DM patients were 32.7% (51/156) for DXA1 group,46.8% (73/156) for DXA2 group,and 45.5% (71/156) for QCT group (P<0.05 for DXA1 group vs DXA2/QCT group). Concordance rates between DXA1 group and QCT group, and DXA2 group and QCT group were 86.3%(44/51) and 84.9%(62/73), respectively. ②Correlation analysis revealed positive associations between L1-4 DXA T-scores, L1-4 aBMD, hip DXA T-scores, hip aBMD, and L1-2vBMD(P<0.05). Linear regression identified age, disease duration, HbA1c, serum phosphorus, and creatinine as influencing factors for L1-4 aBMD, while age, disease duration, body mass index(BMI),HbA1c,serum calcium, albumin,alkaline phosphatase,and β-CTX influenced L1-2vBMD(P<0.05). ③Binary regression analysis showed disease duration,BMI, HbA1c,and β-CTX were predictors for DXA-based OP diagnosis at T≤? 2.5; age, disease duration, BMI, HbA1c, β-CTX, and 25-hydroxyvitamin D(25OHD) influenced DXA diagnosis at T≤?2.0; age, disease duration, BMI, and β-CTX were predictors for QCT-based diagnosis(P<0.05). Conclusion Using T≤?2.0 as the diagnostic threshold, DXA demonstrated high consistency and detection rates with QCT for lumbar OP in postmenopausal T2DM patients, suggesting superior diagnostic value at this cutoff.

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