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目的:观察绝经后2型糖尿病患者(T2DM)骨密度(BMD)的变化,及其与胰岛素抵抗和体质成分的关系。方法:以26例绝经后2型糖尿病女性患者为研究对象,26例年龄、绝经年限、体重指数(BMI)相匹配的绝经后健康女性为正常对照组。应用双能X线骨密度仪测定腰1-4(L1-4)各腰椎骨密度和全身体肌肉、脂肪组织含量,以稳态模型HOMA-IR指数评估胰岛素抵抗。结果:①绝经后T2DM患者L1部位BMD值高于对照组(P<0.05),胰岛素抵抗明显高于对照组(P<0.01)。②多元逐步回归分析显示:T2DM组L1、L2、L3各腰椎BMD均与胰岛素抵抗呈明显正相关(r=0.42,0.45,0.41;P均<0.05),L1部位BMD与肌肉含量正相关(r=0.44,P<0.05)。结论:绝经后2型糖尿病患者腰椎骨密度高于对照组;胰岛素抵抗、肌肉含量可能是T2DM患者BMD的保护因素。
Objective: To observe the changes of bone mineral density (BMD) in postmenopausal type 2 diabetic patients (T2DM) and its relationship with insulin resistance and body composition. Methods: Twenty-six women with postmenopausal type 2 diabetes mellitus were enrolled in this study. Twenty-six healthy women with age, menopause and body mass index (BMI) matched normal controls. The lumbar BMD of lumbar 1-4 (L1-4) and whole body muscle and adipose tissue were measured by dual energy X-ray absorptiometry. The homeostasis model HOMA-IR index was used to evaluate the insulin resistance. Results: ① The BMD of L1 in T2DM patients after menopause was significantly higher than that in control group (P <0.05), insulin resistance was significantly higher than that in control group (P <0.01). ② Multiple stepwise regression analysis showed that the BMDs of L1, L2 and L3 in T2DM group were positively correlated with insulin resistance (r = 0.42,0.45,0.41, P <0.05 respectively), and BMD in L1 group was positively correlated with muscle mass (r = 0.44, P <0.05). Conclusion: BMD of lumbar vertebrae in type 2 diabetic patients is higher than that in control group. Insulin resistance and muscle content may be the protective factors of BMD in T2DM patients.