茹志成 杜凌超 郭彩霞

[摘要]目的 研究2型糖尿病（T2DM）与骨质疏松的关系。方法 选取2015年9月～2017年2月在我院接受治疗的T2DM患者96例，以阶段性的血糖控制是否达标作为分组依据，分为血糖控制达标组（n=48）和血糖控制未达标组（n=48），另择选同一时期在我院体检健康者48例，作为对照组。同时，将96例糖尿病（DM）患者以骨质疏松的程度，划分为骨质疏松组（n=37）、正常組（n=13）、和骨密度减低（n=46）三组，对三组25羟维生素D3（25（OH）D3、血钙、尿钙、血镁及甲状旁腺激素（PTH）、DM病程及糖化血红蛋白（HbA1c）指标进行比较分析。结果 ①血糖控制达标组的25（OH）D3、血镁低于对照组，尿钙高于对照组，差异均有统计学意义（P<0.05）；血糖控制未达标组的25（OH）D3、碱性磷酸酶（ALP）、血镁低于对照组，尿钙高于对照组，差异均有统计学意义（P<0.05）。②骨质疏松组的PTH、DM病程以及HbA1c高于对照组和骨密度减低组，差异有统计学意义（P<0.05）；③DM骨密度减低的独立危险因素有PTH、DM病程以及HbA1c和25（OH）D3。结论 T2DM与骨质疏松存在明显的相关性；PTH、DM程以及HbA1c和25（OH）D3对选取患者的骨密度水平产生影响。

[关键词]骨质疏松；2型糖尿病；骨密度

[中图分类号] R587.1 [文献标识码] A [文章编号] 1674-4721（2018）8（c）-0053-03

[Abstract] Objective To study the relationship between type 2 diabetes （T2DM） mellitus and osteoporosis. Methods From September 2015 to February 2017， 96 patients with T2DM mellitus who were treated in our hospital were divided into two groups： blood glucose control group （n=48） and blood glucose control substandard group （n=48）. In addition， 48 healthy patients in the same period were selected as the control group. At the same time， 96 patients with diabetes mellitus were divided into osteoporosis group （n=37）， normal group （n=13）， and bone mineral density decrease （n=46） according to the degree of osteoporosis three groups were divided into three groups：25（OH）D3 （25 hydroxyvitamin D3）， blood calcium， Urine calcium， serum magnesium and PTH （parathyroid hormone）， course of diabetes and HbA1c （glycosylated hemoglobin） were compared. Results ①25（OH）D3 in blood glucose control group was lower than that in control group， serum magnesium was lower than that in control group and the urinary calcium index was higher than that in control group. The differences were statistically significant （P<0.05）， 25（OH）D3， ALP， serum magnesium in blood glucose control substandard group were lower than those in the control group， and the urinary calcium index was higher than that in the control group. The differences were statistically significant （P<0.05）. ②PTH， course of diabetes and HbA1c in osteoporosis group were significantly higher than those in control group and BMD decrease， the differences were statistically significant （P<0.05）. ③The independent risk factors for the decrease of bone mineral density in diabetes mellitus were significan PTH， the course of diabetes and HbA1c and 25（OH）D3. Conclusion There was a significant correlation between T2DM and osteoporosis. The course of diabetes and the effect of HbA1c and 25（OH）D3 on the bone mineral density of type 2 diabetes mellitus.

[Key words] Osteoporosis type； 2 diabetes mellitus； Bone mineral density

糖尿病（DM）患者可出现一系列的慢性并发症，其中骨质疏松对骨代谢的影响主要表现为骨形成减少、缓慢及骨吸收增加，骨微结构破坏，骨量低下。伴随着人们生活方式的改变，肥胖、DM呈高发状态，而骨质疏松患病率同步上升，成为很多T2DM患者的合并症。T2DM并慢性并發症的出现和发生，主要是由于患者血糖持续性升高得不到较好的控制导致的，而对患者的血糖波动情况进行积极控制和治疗，对糖尿病痛性神经病变的治疗具有重要的作用和价值[1-2]。本研究择选在我院接受治疗的T2DM患者96例和健康体检者48例作为研究主体，旨在研究T2DM与骨质疏松的相关性，为疾病的诊断和预防提供可借鉴的参考价值。

1资料与方法

1.1一般资料

选取2015年9月～2017年2月在我院接受治疗的T2DM患者96例，以阶段性的血糖控制是否达标（HbA1c<6.5%为血糖控制达标）作为分组依据，分为血糖控制达标组（n=48）和血糖控制未达标组（n=48）；……