摘要
目的 研究绝经后女性2型糖尿病(T2DM)患者血清性激素、甲状腺相关激素与骨密度和骨质疏松或骨量减少风险间的相关性.方法 回顾性将2019年3月至2022年3月安徽省安庆市第一人民医院收治的100例绝经后女性T2DM患者纳入本次研究.采用双能X线骨密度仪测定腰椎(L1-4)、股骨颈和全髋部的骨密度T值,将3个部位骨密度最小T值＞-1.0的患者设为正常骨密度组(n=22),T值≤-1.0为骨量减少,T值≤-2.5为骨质疏松,纳入骨质疏松或骨量减少组(n=78).检测并比较两组患者性激素[血清雌二醇、黄体生成素(LH)、卵泡刺激素(FSH)、孕酮、总睾酮、催乳素]、甲状腺相关激素[促甲状腺素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)、总三碘甲状腺原氨酸(TT3)和总甲状腺素(TT4)]、骨密度T值(L,-4、股骨颈、全髋关节)及3个部位的最小骨密度T值、骨折风险评估工具(FRAX)的主要部位骨折的概率(MOF)评分及FRAX髋部骨折的概率(HF)评分.采用多变量线性回归和Logistic回归分析绝经后女性T2DM患者的雌二醇、TSH与L1-4、股骨颈、全髋关节骨密度T值及3个部位最小T值、FRAX MOF和FRAX HF评分的相关性.结果 骨质疏松/骨量减少组的血清雌二醇、TSH分别为(18.45± 6.09)pmol/L 和(2.09±0.44)mU/L,均显著低于正常骨密度组[(23.95±6.85)pmol/L 和(2.77±0.514)mU/L],差异均有统计学意义(P＜0.05);两组其他性激素和甲状腺相关激素差异均无统计学意义(P＞0.05).骨质疏松或骨量减少组的腰椎L2-4、股骨颈、全髋关节骨密度T值及3个部位的最小骨密度T值分别为-3.25±0.75、-2.85±0.70、-2.48±0.61、-2.14±0.62,均显著低于正常骨密度组(-0.06±0.62、-0.12±0.51、0.15±0.51、-0.49±0.26),FRAX MOF评分及FRAX HF评分分别为(4.47±2.10)、(1.50±1.23)分,均显著高于正常骨密度组[(2.28±0.51)、(0.20±0.15)分],差异均有统计学意义(P＜0.05).多变量线性回归和Logistic回归分析显示,血清雌二醇、TSH与腰椎L1-4和3个部位的骨密度T值呈正相关(P＜0.05),与FRAX MOF和FRAX HF评分呈负相关(P＜0.05).结论 绝经后女性T2DM患者骨质疏松/骨量减少的患病率较高,其血清雌二醇、TSH较正常骨密度患者显著降低,雌二醇、TSH与骨密度T值、FRAX评分及骨质疏松或骨量减少的风险显著相关.
Abstract
Objective To investigate the correlation of serum sex-related hormones,thyroid-related hormones with bone mineral densi-ty and the risk of osteoporosis or osteopenia in postmenopausal women with type 2 diabetes mellitus(T2DM).Methods One hundred postmeno-pausal women with T2DM admitted to Anqing First People's Hospital of Anhui Province from March 2019 to March 2022 were retrospectively in-cluded in this study.The bone density T values of the lumbar spine(L1-4),femoral neck,and total hip were measured using a dual energy X-ray bone density instrument.Patients with the minimum T value of the three areas＞-1.0 were classified as the normal bone mineral density group(n=22),while those with T value ≤-1.0 were classified as the osteopenia,T value ≤-2.5 were classified as osteoporosis,included in oste-oporosis/osteopenia group(n=78).Serum sex-related hormones[including estradiol,luteinizing hormone(LH),follicle stimulating hormone(FSH),progesterone,total testosterone,prolactin],thyroid-related hormones[including thyroid stimulating hormone(TSH),free triiodothyro-nine(FT3),free tetraiodothyronine(FT4),total triiodothyronine(TT3),and total thyroxine(TT4)],bone density T-values(L1-4,femoral neck,total hip joint)and minimum bone density T-values for three locations,probability of major site fractures(MOF)score of fracture risk as-sessment tool(FRAX),and probability of hip fractures(HF)score of FRAX were detected and compared between two groups.Results Serum estradiol and TSH levels in the osteoporosis/osteopenia group were(18.45±6.09)pmol/L and(2.09±0.44)mU/L,respectively,which were significantly lower than those in the normal bone mineral density group[(23.95±6.85)pmol/L and(2.77±0.514)mU/L],respectively,the differences were statistically significant(P＜0.05).There was no statistically significant difference in other sex-related hormones and thyroid-related hormones between the two groups(P＞0.05).The bone density T values of the L1-4,femoral neck,and total hip joint,the minimum bone density T values in the three areas in the osteoporosis/osteopenia group were-3.25±0.75,-2.85±0.70,-2.48±0.61,and-2.14 ±0.62,respectively,which were significantly lower than those in the normal bone density group(-0.06±0.62,-0.12±0.51,0.15±0.51,and-0.49±0.26),the FRAX MOF scores and FRAX HF scores were(4.47±2.10)and(1.50±1.23)pionts,respectively,which were sig-nificantly higher than those in the normal bone density group[(2.28±0.51),(0.20±0.15)points],and the differences were statistically sig-nificant(P＜0.05).Multivariate linear regression and Logistic regression analysis showed positive correlation with serum estradiol,TSH,and T-values of bone density in the L1-4 and three sites of the lumbar spine(P＜0.05),while negative correlation with FRAX MOF and FRAX HF scores(P＜0.05).Conclusion The incidence of osteoporosis/bone loss is higher in postmenopausal female T2DM patients,with significantly lower serum estradiol and TSH compared to normal bone density patients.Estradiol and TSH levels are significantly correlated with bone density T-values,FRAX scores,and the risk of osteoporosis or bone loss.
维普
万方数据