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目的 探讨老年2型糖尿病临床与不同骨密度(BMD)测定方法之间的关系和特点。方法 测定45例老年2型糖尿病患者的空腹(FBG)及餐后血糖(PBG)、糖化血红蛋白(HbAlc)、胆固醇(TC)、甘油三脂(TG)、骨钙素(BGP)、血清Ⅰ型胶原C端肽(CICP)、血清骨特异性碱性磷酸酶(B-ALP)、尿吡啶啉(Pyd)、脱氧吡啶啉(D-Pyd)、尿羟脯胺酸(Hyp),对同一病人同时行双能X线测定(DEXA)及定量CT测定(QCT),并进行分组比较。结果 本组45例病人中同时用DEXA及QCT测定骨密度均有骨质疏松者18例,占45％(18/40),其中男性4例,女性14例,女性占骨质疏松组的77.78％(14/18)。单用DEXA测量出骨质疏松者23例,单用QCT测量出骨质疏松者21例,其中5例有2例示QCT正常,而用DEXA测定有骨质疏松;3例用QCT测定已有腰椎骨质疏松,而DEXA示腰椎正常,但股骨颈部有骨质疏松。结论 老年2型糖尿病的骨质疏松与糖尿病病程、餐后血糖、胆固醇密切相关。骨形成指标(BGP、CICP)在骨质疏松组中非但不降,反比非骨质疏松组有明显升高。本研究显示老年2型糖尿病同时用DEXA及QCT测定骨密度有很好的相关性,r=0.770,P<0.01,故仅做腰椎QCT也可作为老年2型糖尿病骨质疏松的诊断依据。
Objective To explore the relationship between the clinical features of type 2 diabetes mellitus and the measurement of different bone mineral density (BMD). Methods The fasting blood glucose (FBG), postprandial blood glucose (PBG), HbAlc, cholesterol (TC), triglyceride (TG), osteocalcin (BGP) and serum type I in 45 elderly patients with type 2 diabetes mellitus CICP, B-ALP, Pyd, D-Pyd and Hyp were detected in the same patient Simultaneous dual-energy X-ray (DEXA) and quantitative CT (QCT) were performed and compared in groups. Results In this group of 45 patients, there were 18 cases of osteoporosis with DEXA and QCT, accounting for 45% (18/40), including 4 males and 14 females, 77.78 females in the osteoporosis group % (14/18). Twenty-three patients with osteoporosis were measured by DEXA alone. Twenty-one patients with osteoporosis were measured by QCT alone. Two of the five patients had QCT normal while the other two patients had osteoporosis by DEXA. Three patients had lumbar spine Osteoporosis, while DEXA showed normal lumbar spine, but femoral neck osteoporosis. Conclusion Osteoporosis in elderly type 2 diabetes is closely related to the course of diabetes, postprandial blood glucose and cholesterol. Bone formation index (BGP, CICP) in the osteoporosis group not only did not decrease, anti-osteoporosis group was significantly higher. This study shows that there is a good correlation between the type 2 diabetes mellitus and bone mineral density measured by DEXA and QCT at the same time, r = 0.770, P <0.01. Therefore, only QCT of the lumbar vertebrae can also be used as the diagnosis basis for type 2 diabetes mellitus with osteoporosis.