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目的观察体成分对正常糖耐量(NGT)及2型糖尿病(T2DM)绝经后女性骨密度(BMD)的影响及差异。方法收集中南大学湘雅二医院2005—2008年长沙地区152名绝经后女性志愿者及门诊就诊者,经OGTT检测41例诊为T2DM,111名糖耐量正常,年龄45～81岁。采用双能X线骨密度仪测定腰椎前后位腰1至腰4(AP)、左侧股骨颈(FN)、左髋部总体(T-hip)及全身骨密度(TBMD),同时测定体成分,计算出瘦体重(LTM)、体脂量(FTM)、躯干体脂比(Tru-fat%)及总体脂比(Fat%)。分析体成分对两组研究对象BMD的影响。结果体成分对不同糖耐量绝经后女性BMD的影响存在差异。NGT组:瘦体重与各部位BMD均呈正相关,是各部位BMD的独立预测因素(β=0.199～0.455,R2C=0.027～0.200,P<0.01或0.05),体脂比与全身BMD呈负相关,体脂为全身BMD(β=-0.237,P<0.05)的独立影响因素。T2DM组:瘦体重仅与股骨颈及髋部BMD呈正相关,总体脂比与股骨颈及髋部BMD呈正相关,体脂为股骨颈及髋部BMD(β=0.427～0.475,R2C=0.166～0.182,P<0.01)的独立影响因素,而瘦体重与各部位BMD均无独立相关。结论绝经后女性中,相对于NGT组,T2DM组的瘦体重对BMD的保护作用减弱,体脂对股骨颈及髋部起到保护作用;糖尿病超重或肥胖患者减重过程中,需要加强肌肉力量的锻炼,并保持适当的体重,以防止骨量丢失。
Objective To observe the effect of body composition on bone mineral density (BMD) in postmenopausal women with normal glucose tolerance (NGT) and type 2 diabetes mellitus (T2DM). Methods A total of 152 postmenopausal female volunteers and outpatients from Changsha Second Hospital of Central South University from 2005 to 2008 were collected. Twenty-one patients were diagnosed as T2DM by OGTT, and 111 were normal glucose tolerance patients (45-81 years old). The lumbar spine 1 to 4 (AP), left femoral neck (FN), T-hip and whole body bone mineral density (TBMD) were measured by dual energy X-ray absorptiometry. LTM, FTM, Tru-fat% and Fat% were calculated. The effects of body composition on BMD of two groups were analyzed. Results Body composition had different effects on BMD in postmenopausal women with different glucose tolerance. NGT group: lean body mass was positively correlated with BMD of each site, which was an independent predictor of BMD in each site (β = 0.199 ~ 0.455, R2C = 0.027 ~ 0.200, P <0.01 or 0.05) Body fat was an independent factor affecting systemic BMD (β = -0.237, P <0.05). In T2DM group, lean body mass was only positively correlated with femoral neck and hip BMD. Total fat ratio was positively correlated with femoral neck and hip BMD. Body fat was femoral neck and hip BMD (β = 0.427-0.475, R2C = 0.166-0.1821 , P <0.01). However, lean body mass had no independent correlation with BMD in different parts. Conclusions In postmenopausal women, lean body mass of T2DM group is weaker than that of NGT group, and body fat has a protective effect on the femoral neck and hip. Diabetic patients with overweight or obesity need to strengthen their muscle strength Exercise and maintain proper weight to prevent loss of bone mass.