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(L_(1-4))、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_(1-4)、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L_(1-4)、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L_(1-4)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。
Objective To investigate the correlation of serum sex-related hormones,thyroid-related hormones with bone mineral density and the risk of osteoporosis or osteopenia in postmenopausal women with type 2 diabetes mellitus(T2DM).Methods One hundred postmenopausal women with T2DM admitted to Anqing First People's Hospital of Anhui Province from March 2019 to March 2022 were retrospectively included in this study.The bone density T values of the lumbar spine(L_(1-4)),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 osteoporosis/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 triiodothyronine(FT3),free tetraiodothyronine(FT4),total triiodothyronine(TT3),and total thyroxine(TT4)],bone density T-values(L_(1-4),femoral neck,total hip joint) and minimum bone density T-values for three locations,probability of major site fractures(MOF) score of fracture risk assessment 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 L_(1-4),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 significantly higher than those in the normal bone density group [(2.28±0.51),(0.20±0.15) points],and the differences were statistically significant(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 L_(1-4) 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.
作者
刘珍
郑海兰
江斓
丁维
金娜
LIU Zhen;ZHENG Hai-lan;JIANG Lan(Department of Endocrinology,Anqing First People's Hospital of Anhui Province,Anqing Anhui 246001,China)
出处
《临床和实验医学杂志》
2024年第3期277-281,共5页
Journal of Clinical and Experimental Medicine
基金
安徽省医学会研究项目(编号:202000301945)。
关键词
性激素
甲状腺激素
骨密度
骨质疏松
骨量减少
2型糖尿病
Sex hormone
Thyroid hormone
Bone density
Osteoporosis
Osteopenia
Type 2 diabetes mellitus
