中国骨质疏松杂志

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 LHR and stiffness index and fracture risk in postmenopausal women with type 2 diabetes mellitus.

投稿时间：2018-11-02 修订日期：2019-03-04

DOI：

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 LHR 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)

作者	单位	邮编
黄斌	安徽省立医院	230001
宁珂	安徽省立医院南区
陈超^*	安徽省立医院南区	230001
叶山东	安徽省立医院南区

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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 -2018年1月我院内分泌科就诊的女性 2型糖尿病(T2DM)患者226例,其中113例已绝经。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(年龄、身体质量指数(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 VS21.00±10.90,P= 0.039)、PINP(34.59±16.16 VS 56.70±37.33,P=0.016 )降低,β-CTX(590.71±263.24VS 423.07±198.04,P=0.021)、LHR(2.16±0.76 VS 1.89±0.81,P=0.040)、PMOF(3.67±1.28VS 1.50±0.14,P=0.009)、PHF(1.44±0.61VS 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,均P＜0.001)；(3)分别校正年龄、BMI(β=-0.245,p=0.006)；Hba1c、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,均P＜0.05),与BGP、PINP负相关(β=-0.310;β=-0.298 ,均P＜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 Relationship between LHR and stiffness index and fracture risk in postmenopausal women with type 2 diabetes mellitus . Methods A total of 113 T2DM postmenopausal women from Endocrinology Department of Anhui provincial Hospital 2014 to 2017 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. The general information,T2DM history, lipid profile(include LHR and THR), and bone turnover markers between the 2 groups were record and compared．Fracture Risk Assessment Tool ( FRAX) was utilized to predict the risk of osteoporotic fracture. The 10-year probability of a major osteoporotic fracture (PMOF) and the probability of hip fracture (PHF) were calculated automatically by the system in postmenopausal group. Results Compared with premenopausal group ,there was significant difference in SI(79.96±11.35 VS 92.50±15.95,P＜0.001),BGP(13.47±4.11 VS21.00±10.90,P= 0.039)、PINP(34.59±16.16 VS 56.70±37.33,P=0.016 )、β-CTX(590.71±263.24VS 423.07±198.04,P=0.021)、LHR(2.16±0.76 VS 1.89±0.81,P=0.040)、PMOF(3.67±1.28VS 1.50±0.14,P=0.009)、PHF(1.44±0.61VS 0.65±0.12,P=0.005)．Models were adjusted age、BMI、HbA1c 、duration of diabetes and Cr. A negative association was found between LHR and SI(β=-0.248,p=0.005).Pearson correlation analysis revealed that LHR was positively correlated with PMOF、PHF、β-CTX(β=0.336;β=0.319,β=277, P＜0.05), and LHR was negatively correlated with BGP、PINP(β=-0.310;β=-0.298 ,P＜0.05) as well. Conclusions Study had shown that LHR have a close relationship between SI、risk of osteoporotic fracture and bone turnover markers. High LHR may case the decreasing of SI and the increasing of risk of osteoporotic fracture by promoting bone turnover.

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