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目的探讨不同血糖水平对骨形成、骨吸收和骨密度的影响。方法对糖尿病组(DM)148例,葡萄糖耐量低减组(IGT)30例,空腹血糖受损组(IFG)30例,健康对照组(Control)50例,分别测定血浆葡萄糖(BG)、糖化血红蛋白(HbA1c)、血清骨钙素(BGP)、尿脱氧吡啶啉(DPD)/肌酐(Cr)、腰椎(L2、L3、L4)和髋部(股骨颈、Ward三角、大转子)骨密度(BMD),并对上述指标进行T检验和方差分析。结果四组间方差分析显示BMD在Ward三角、L4差异有统计学意义(P<0.05)。血清BGP水平在四组呈递增趋势,尿DPD/Cr水平在四组呈递减趋势,方差分析显示尿DPD/Cr水平差异有显著统计学意义(P<0.001)。尿DPD/Cr水平随HbA1c水平递增逐渐增高。结论糖尿病的前期阶段(IGT),骨吸收已呈现高于同龄正常人水平,糖尿病患者骨形成低于同龄正常人而骨吸收高于同龄正常人,骨平衡呈现负平衡,骨量逐渐丢失;IGT开始骨密度已较正常人低,良好的血糖控制对减少骨吸收和延缓骨量下降具有保护作用。应在糖调节受损的早期阶段对骨质疏松进行干预治疗。
Objective To investigate the effects of different blood glucose levels on bone formation, bone resorption and bone mineral density. Methods 148 diabetic patients (DM), 30 patients with impaired glucose tolerance (IGT), 30 patients with impaired fasting glucose (IFG) and 50 healthy controls were enrolled in this study. Plasma glucose (BG) Bone mineral density (HbA1c), serum BGP, DPD / Cr, lumbar (L2, L3, L4) and hip (femoral neck, Ward trigone, BMD), and T-test and variance analysis of the above indicators. Results ANOVA among the four groups showed that there was significant difference in L4 between BMD and Ward triangle (P <0.05). Serum BGP levels showed an increasing trend in four groups. The level of DPD / Cr in urine showed a decreasing trend in all four groups. The variance analysis showed that there was a significant difference in urinary DPD / Cr levels (P <0.001). Urinary DPD / Cr levels increased gradually with increasing HbA1c levels. Conclusion The levels of IGT and bone resorption in diabetic patients are higher than those in the same age group. The bone formation in diabetic patients is lower than that in normal people of the same age and the bone resorption is higher than that in normal people of the same age. The bone balance is negatively balanced and the bone mass is gradually lost. At the beginning of bone mineral density has been lower than normal, good blood sugar control to reduce bone resorption and delay bone loss has a protective effect. Osteoporosis should be treated at an early stage of impaired glucose regulation.