中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (31): 5009-5014.doi: 10.12307/2023.526

• 骨科植入物相关临床实践 Clinical practice of orthopedic implant • 上一篇    下一篇

绝经后2型糖尿病患者新骨骼肌肉减少指数与骨密度的关系

古  鹏1,蒲  彬1,陈俊邦1,岳  丹2,辛  俏3,曾展鹏4,郑晓辉4   

  1. 1广州中医药大学第一临床医学院,广东省广州市  510405;2西南医科大学中西医结合学院,四川省泸州市  646000;3江西中医药大学临床医学院,江西省南昌市  330000;4广州中医药大学第一附属医院,广东省广州市  510405
  • 收稿日期:2022-07-16 接受日期:2022-09-02 出版日期:2023-11-08 发布日期:2023-01-31
  • 通讯作者: 郑晓辉,主任医师,广州中医药大学第一附属医院,广东省广州市 510405
  • 作者简介:古鹏,男,1997年生,江西省赣州市人,汉族,广州中医药大学在读硕士,主要从事创伤骨科及骨质疏松方面的研究。
  • 基金资助:
    广州中医药大学第一附属医院高水平医院建设项目(211010010729),项目负责人:郑晓辉

Correlation between new sarcopenia index and bone mineral density in postmenopausal patients with type 2 diabetes mellitus

Gu Peng1, Pu Bin1, Chen Junbang1, Yue Dan2, Xin Qiao3, Zeng Zhanpeng4, Zheng Xiaohui4   

  1. 1First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China; 2School of Integrated Traditional Chinese and Western Medicine, Southwest Medical University, Luzhou 646000, Sichuan Province, China; 3School of Clinical Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang 330000, Jiangxi Province, China; 4The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • Received:2022-07-16 Accepted:2022-09-02 Online:2023-11-08 Published:2023-01-31
  • Contact: Zheng Xiaohui, Chief physician, The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • About author:Gu Peng, Master candidate, First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • Supported by:
    High-level Hospital Construction Project of the First Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 211010010729 (to ZXH)

摘要:


文题释义:

新骨骼肌肉减少指数:是一种由血清肌酐、胱抑素C估计的肾小球滤过率、时间常数计算得来的评估肌少症的新指标。已被证实与晚期癌症患者、结直肠癌患者术后骨骼肌质量存在相关性,可能也与骨骼质量存在相关。
骨质疏松症:是一种以骨量减少、骨组织微结构破坏、骨强度下降、骨脆性增加,从而导致患者骨折风险显著增加为特征的全身性骨骼疾病。骨质疏松症可发生于任何年龄,但多见于绝经后女性和老年男性。

背景:2型糖尿病合并骨质疏松的患病率逐年增加,骨质疏松的早期预防、早期发现及早期治疗被认为在绝经后2型糖尿病患者中至关重要。
目的:探讨绝经后2型糖尿病患者新骨骼肌肉减少指数与骨密度及骨质疏松的相关性。
方法:选择2021年1月至2022年3月广州中医药大学第一附属医院收治的绝经后2型糖尿病住院患者,根据是否合并骨质疏松分为骨质疏松组(93例)和非骨质疏松组(121例)。收集患者一般资料及骨密度信息、血常规、糖代谢、脂代谢、肾功能指标等,计算得到新骨骼肌肉减少指数。多因素线性回归分析各临床指标和腰椎、左侧股骨颈和左侧髋部骨密度的相关性,多因素logistic回归分析绝经后2型糖尿病患者骨质疏松的危险因素,受试者工作特征曲线分析新骨骼肌肉减少指数、胱抑素C、肌酐/胱抑素C对绝经后2型糖尿病患者合并骨质疏松的预测效能。

结果与结论:①骨质疏松组患者新骨骼肌肉减少指数、胱抑素C、肌酐/胱抑素C均低于非骨质疏松组(P < 0.05);②调整协变量后的多因素线性回归显示,肌酐/胱抑素C、新骨骼肌肉减少指数与腰椎、股骨颈及髋部骨密度呈显著正相关(β肌酐/胱抑素C=0.003,0.001,0.002,P < 0.05;β新骨骼肌肉减少指数=0.002,0.001,0.002,P < 0.05),胱抑素C与腰椎骨密度存在正相关(β胱抑素C=0.09,P < 0.05);③调整协变量后的多因素logistics回归显示胱抑素C、肌酐/胱抑素C、新骨骼肌肉减少指数是绝经后糖尿病患者患骨质疏松的保护因素(OR=0.149,0.957,0.941,P < 0.05);④新骨骼肌肉减少指数预测绝经后2型糖尿病患者出现骨质疏松的受试者工作特征曲线下面积最大(曲线下面积=0.756),灵敏度为67.8%,特异性为72.0%;⑤提示肾功能和骨骼健康存在内在联系,新骨骼肌肉减少指数升高与绝经后2型糖尿病患者骨密度升高存在相关性,绝经后2型糖尿病患者通过新骨骼肌肉减少指数可及时预测骨质疏松的发生风险。

https://orcid.org/0000-0002-2501-2564(古鹏)

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 2型糖尿病, 骨质疏松症, 骨密度, 新骨骼肌肉减少指数, 绝经后妇女

Abstract: BACKGROUND: The prevalence of type 2 diabetes mellitus complicated with osteoporosis is increasing yearly. Early prevention, detection, and treatment of osteoporosis are considered essential in postmenopausal patients with type 2 diabetes mellitus.
OBJECTIVE: To investigate the correlation of new sarcopenia index (SI) with bone mineral density and osteoporosis in patients with type 2 diabetes mellitus complicated with osteoporosis.  
METHODS: Postmenopausal patients with type 2 diabetes mellitus hospitalized in the First Affiliated Hospital, Guangzhou University of Chinese Medicine from January 2021 to March 2022 were selected and divided into osteoporosis group (n=93) and non-osteoporosis group (n=121) according to whether type 2 diabetes mellitus is combined with osteoporosis. The demographic data, bone mineral density, blood routine, glucose metabolism, lipid metabolism, and renal function indexes were collected and the SI was calculated. The correlation between clinical indexes and bone mineral density of the lumbar spine, left femoral neck and left hip was analyzed by multivariate linear regression, and the risk factors of osteoporosis in postmenopausal patients with type 2 diabetes mellitus were analyzed by multivariate logistic regression. The predictive values of new SI, serum cystatin C level, and creatinine/serum cystatin C ratio (CCR) in predicting osteoporosis in postmenopausal patients with type 2 diabetes mellitus were analyzed by the receiver operating characteristic curve.  
RESULTS AND CONCLUSION: (1) The new SI, serum cystatin C level, and CCR value in the osteoporosis group were lower than those in the non-osteoporosis group (P < 0.05). (2) Multivariate linear regression analysis with adjusted covariates showed that the new SI and CCR were significantly positively correlated with bone mineral density of the lumbar spine, left femoral neck and left hip (βCCR=0.003, 0.001, 0.002, P < 0.05; βSI=0.002, 0.001, 0.002, P < 0.05). The cystatin C level was significantly correlated with bone mineral density of the lumbar spine (βcystatin C=0.09, P < 0.05). (3) Multivariate Logistic regression analysis with adjusted covariates showed that serum cystatin C level, CCR, and new SI were protective factors for osteoporosis in postmenopausal patients with type 2 diabetes mellitus (odds ratio=0.149, 0.957, 0.941; P < 0.05). (4) The area under the receiver operating characteristic curve of the new SI for predicting osteoporosis in such patients was the largest (the area under the curve=0.756), with a sensitivity of 67.8% and a specificity of 72.0%. (5) To conclude, renal function is intrinsically related to bone health. An increased new SI is related to the increase of bone mineral density in postmenopausal patients with type 2 diabetes mellitus, and the risk of osteoporosis can be predicted by the new SI in such patients.

Key words: type 2 diabetes mellitus, osteoporosis, bone mineral density, new sarcopenia index, postmenopausal woman

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