摘要
目的 探讨中老年2型糖尿病患者血尿酸水平与骨密度及骨折风险评估工具(FRAX)之间的关系.方法 选取2020年6月-2020年10月在新疆维吾尔自治区人民医院内分泌科住院的中老年2型糖尿病患者467例,测定桡骨远端1/3、腰椎L1-4及股骨颈骨密度,分别计算有或无股骨颈BMD的FRAX骨折风险,分析血尿酸水平与骨密度及FRAX评分的关系,并通过AUC曲线评价血尿酸预测绝经后T2DM女性骨质疏松症的灵敏度、特异度及血尿酸的最佳截止点.结果 随着SUA水平的升高,患者身高、体重、桡骨远端1/3BMD、L1-4BMD、Cr、BUN、TC均显著升高;随着SUA水平的升高,患者女性占比、HbA1c、桡骨远端1/3BMD(T)、L1-4BMD(T)均显著降低(均P＜0.05).男性SUA与骨密度及FRAX评分相关性均无统计学意义.绝经后女性SUA与桡骨远端1/3BMD、L1-4BMD显著正相关(r=0.132 & 0.155,P＜0.05),而与 股骨颈BMD、PMOF-FRAX无BMD、PHF-FRAX无BMD、PMOF-FRAX有BMD、PHF-FRAX有BMD相关性无统计学意义.多元线性回归分析显示校正年龄、HDL、Ca、P、25(OH)D混杂因素后,SUA仍为绝经后女桡骨远端1/3BMD及L1-4BMD保护因素(调整R2=0.035-0.205,P＜0.05).血尿酸预测绝经后T2DM女性骨质疏松症ROC曲线下面积AUC为0.569,SUA截点值为325/(µmol/L),灵敏度68％,特异度48％,不具有统计学意义.结论 血尿酸与绝经后2型糖尿病患者的骨密度正相关,稍高水平的血尿酸可能有助于绝经后2型糖尿病女性维持骨量.血尿酸既不是FRAX评分的保护因素也不是危险因素.
Abstract
Objective To investigate the relationship between serum uric acid level and bone mineral density and fracture risk as-sessment tool(FRAX)in middle-aged and elderly patients with type 2 diabetes mellitus(T2DM).Methods A total of 467 middle-aged and elderly patients with type 2 diabetes who were hospitalized in the Department of Endocrinology,Xinjiang Uygur Autonomous Region People's Hospital from June 2020 to October 2020 were selected.Bone mineral density(BMD)of the distal third of radius,lum-bar L1-4 and femoral neck were measured,and the fracture risk with or without femoral neck BMD was calculated.The relationship be-tween serum uric acid level and bone mineral density and FRAX score was analyzed,and the sensitivity and specificity of serum uric acid in predicting osteoporosis in postmenopausal women with T2DM and the optimal cut-off point of serum uric acid were evaluated by AUC curve.Results With the increase of SUA level,height,weight,distal radius 1/3BMD,L1-4BMD,Cr,BUN,TC were signifi-cantly increased.With the increase of SUA level,the female proportion,HbA1c,distal radius 1/3BMD(T)and L1-4BMD(T)were sig-nificantly decreased(all P＜0.05).There was no significant correlation between SUA and BMD and FRAX score in males.SUA was posi-tively correlated with distal radius 1/3BMD and L1-4BMD in postmenopausal women(r=0.132 & 0.155,P＜0.05).However,there was no significant correlation between BMD and femoral neck BMD,PMF-FRAXwithout BMD,PHF-FRAXwithout BMD,PMF-FRAXwith BMD,and PHF-FRAX with BMD.Multiple linear regression analysis showed that after adjusting for age,HDL,Ca,P,25(OH)D confounding factors,SUA was still a protective factor for 1/3BMD and L1-4BMD of postmenopausal female distal radius(adjusted R2=0.035-0.205,P＜0.05).The area under the ROC curve AUC of serum uric acid for predicting osteoporosis in postmenopausal women with T2DM was 0.569,the cut-off value of SUA was 325/(μmol/L),the sensitivity was 68％,the specificity was 48％,and there was no statistical sig-nificance.Conclusion Serum uric acid is positively correlated with bone mineral density in postmenopausal patients with type 2 dia-betes mellitus.A slightly higher level of serum uric acid may help postmenopausal women with type 2 diabetes mellitus maintain bone mass.Serum uric acid was neither a protective factor nor a risk factor for FRAX score.
基金项目
新疆维吾尔自治区科技支疆项目(2020E0281)
新疆维吾尔自治区人民医院院内项目(20200105)
NETL
NSTL
万方数据