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目的探讨骨代谢在2型糖尿病患者中的变化情况及2型糖尿病与25-羟维生素[25(OH)D3]、甲状腺旁激素(PTH)的关系。方法以350例2型糖尿病患者作为观察组进行研究,根据指标不同分为多个亚组:1将其按病程不同分为:观察A组(病程≤10年)190例、观察B组(病程>10年)160例;2根据糖化血红蛋白(Hb A1c)水平不同分为:观察C组(病程≤10年,Hb A1c<7%)205例、观察D组(病程>10年,Hb A1c>7%)145例;3根据骨量分为:骨密度正常组102例、骨量减少组161例、骨质疏松症组87例。另选同期进行健康体检者180例作为对照组进行分析。均采用双能X线骨密度仪测定其骨密度情况,同时检测其血钙、磷、镁、碱性磷酸酶、24 h尿钙、25(OH)D3、PTH水平情况。结果观察组25(OH)D3、血镁、股骨颈骨密度、全髋骨密度水平均低于对照组(P<0.05);观察A组、B组血钙、血镁、24 h尿钙、25(OH)D3、PTH水平与对照组比较,差异有统计学意义(P<0.05),观察A组血镁、PTH水平低于观察B组(P<0.05);观察C组、D组血钙、血镁、D3[25(OH)D3]、PTH水平与对照组比较,差异有统计学意义(P<0.05);骨质疏松组25(OH)D3、PTH、Hb A1c、病程与骨密度正常组、骨量减低组比较,差异有统计学意义(P<0.05)。结论 2型糖尿病患者均存在不同程度骨代谢异常情况,具体表现为维生素D水平降低,PHT水平明显偏高,骨密度下降等,其中以血糖水平控制差者和糖尿病病程长者最为显著。
Objective To investigate the changes of bone metabolism in type 2 diabetic patients and the relationship between type 2 diabetes and 25-hydroxyvitamin [25 (OH) D3] and thyroid hormone (PTH). Methods A total of 350 patients with type 2 diabetes mellitus as observation group were divided into several subgroups according to the different indexes: 1 The patients were divided into different groups according to their duration of disease: 190 patients in group A (duration ≤ 10 years) (Hb A1c> 10 years) in 160 cases; 2 According to the different levels of Hb A1c, 205 cases were observed in group C (duration of disease≤10 years, Hb A1c <7% 7%) 145 cases; 3 According to the bone mass were divided into: normal bone mineral density group of 102 cases, 161 cases of osteopenia group, 87 cases of osteoporosis group. In the same period, 180 healthy subjects were selected as the control group for analysis. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry. Levels of serum calcium, phosphorus, magnesium, alkaline phosphatase, 24 h urinary calcium, 25 (OH) D3 and PTH were also measured. Results The levels of 25 (OH) D3, blood magnesium, femoral neck BMD and total hip BMD in observation group were lower than those in control group (P <0.05) (P <0.05). The level of serum magnesium and PTH in group A was lower than that in group B (P <0.05), while the level of serum PTH in group C and D was significantly higher than that in group B The levels of calcium, magnesium, D3 [25 (OH) D3] and PTH in the osteoporosis group were significantly different from those in the control group (P <0.05) The density of normal group, osteopenia group, the difference was statistically significant (P <0.05). Conclusion Patients with type 2 diabetes mellitus have abnormal bone metabolism in varying degrees. The manifestations include decreased vitamin D levels, markedly elevated PHT levels, decreased bone mineral density, etc. Among them, those with poor control of blood glucose levels and diabetes duration are the most prominent.