第一临床医学院知识库

目的：探讨老年2型糖尿病患者骨密度与血尿酸水平的相关性。方法 ：选择2015年6月-2016年10月于兰州大学第一医院内分泌科住院的老年2型糖尿病患者为研究对象。采用双能X线骨密度仪检测研究对象右侧跟骨骨密度，同期检测空腹血糖、血尿酸、糖化血红蛋白、血清钙、血清磷、25-羟化维生素D等指标，比较不同性别老年2型糖尿病患者骨密度、血尿酸等指标的差异。根据骨密度T值水平将研究对象分为骨量正常组（T≥-1）、骨量减少组（-1

结果：（1）最终共有263例纳入研究，其中男性141例（53.6%）、女性122例（46.4%）；男性和女性平均年龄无统计学差异（71.3±5.2岁 vs 71.7±4.9岁，P>0.05）；两组间BMI无统计学差异（P>0.05）；男性平均跟骨骨密度明显高于女性（0.574±0.145g/cm² vs 0.324±0.109 g/cm²，P<0.001）；男、女性平均血尿酸水平无统计学差异（P>0.05）；男性平均25-羟化维生素D浓度高于女性（43.22±16.36 ng/ml vs 37.61±17.27ng/ml，P<0.01）。（2）研究对象骨量正常、骨量减少、骨质疏松患者所占的比例分别为36.9%、30.8%、32.3%，女性骨质疏松所占比例明显高于男性（48.4% vs 18.4%，P<0.001）；骨质疏松组BMI显著低于骨量正常组（P<0.001）；不同骨密度组比较，去除混杂因素影响后，老年2型糖尿病患者骨量正常组的血尿酸水平高于骨质疏松组（345.38±76.96umol/L vs 317.02±99.71umol/L, P=0.042），男性骨量正常组血尿酸水平高于骨质疏松组（344.73±78.63umol/L vs 309.85±76.58umol/L, P=0.049），但女性血尿酸水平在各骨密度组间无统计学差异；同样在去除混杂因素影响后，不同血尿酸组进行比较，老年2型糖尿病患者组3骨密度明显高于组1（0.491±0.196 g/cm² vs 0.425±0.180 g/cm²，P<0.01），男性组3的平均跟骨骨密度高于组1（0.619±0.136g/cm² vs 0.543±0.167g/cm²，P<0.05），而女性骨密度在各组间无统计学差异；组3 平均BMI高于组1（P<0.05）。（3）老年男性2型糖尿病患者血尿酸与骨密度呈显著正相关（r = 0.227，P <0.01），而在女性患者中二者相关性并不显著。（4）多元线性回归分析结果示，去除混杂因素影响后，老年男性2型糖尿病患者血尿酸水平与骨密度仍呈正相关，调整R²为0.187（P<0.05）。

结论：老年2型糖尿病患者的骨密度随血尿酸水平升高而增加；老年男性2型糖尿病患者骨密度与血尿酸水平呈正相关，正常偏高的血尿酸水平可能对骨密度有保护作用, 血尿酸对骨密度的影响有待深入研究。

Objective：To investigate the relationship between bone mineral density and serum uric acid levels in elderly patients with type 2 diabetes.Methods：We selected elderly patients with type 2 diabetes admitted to Department of endocrinology in First Hospital Affilliated to Lanzhou University from June 2015 to October 2016. Bone mineral density was measured by dual energy X-ray absorptiometry in all subjects, fasting blood sample was taken to determine FPG, serum uric acid, HbA1c, serum calcium, serum phosphorus, 25OHD and other indexes, to compare the difference of bone mineral density, serum uric acid and other indexes between male and female. Bone mineral density status was divided into normal bone mass group (T≥-1), osteopenia group (-1

Results：(1) There were 263 cases in the study, 141 (53.6%) subjects were male and 122 (46.4%) sbjects were femal. There was no significant difference in mean age between male and female (71.5±5.1 years old vs 71.4±5.0 years old, P>0.05). There was no significant difference in BMI between male and female (P>0.05). The mean calcaneus BMD in male was significantly higher than that in female (0.574±0.145 g/cm² vs 0.324±0.109 g/cm², P<0.001). There was no significant difference in mean serum uric acid levels between male and female (P>0.05). The concentration of 25OHD in male was significantly higher than that in female (P<0.01). (2) The percents of type 2 diabetes with normal bone mass group, osteopenia group and osteoporosis group are 36.9%, 30.8%, 32.3%, respectively. The osteoporosis prevalence of female is higher than male (48.4% vs 18.4%, P<0.001). BMI in osteoporosis group is significantly lower than that in normal group (P<0.001). After adjusted confounding factors, the serum uric acid levels in the normal bone mass group was higher than that in the osteoporosis group among patients with type 2 diabetes (345.38±76.96 umol/L vs 317.02±99.71 umol/L, P=0.042); There was a statistical difference of serum uric acid levels between normal bone mass group and osteoporosis group in male patients (344.73±78.63 umol/L vs 309.85±76.58 umol/L, P=0.049); However, there was no statistical differences in female patients between groups. After removing the confounding factors, the mean bone mineral density of group 3 was significantly higher than that of group 1 among patients with type 2 diabetes (0.491±0.196 g/cm² vs 0.425±0.180 g/cm², P=0.004); The mean bone mineral density of group 3 was higher than that of group 1 among male patients with type 2 diabetes (0.619±0.136 g/cm² vs 0.543±0.167 g/cm², P=0.039); However, there was no statistical differences in female patients between the groups. The average BMI in group 3 was higher than group 1 (P=0.043). (3) There was a positive correlation between serum uric acid levels and calcaneus bone mineral density in male patients with type 2 diabetes mellitus, and the relative index was 0.227 (P<0.01). However, there was no significant correlation in female patients with type 2 diabetes. (4) Multiple linear regression analysis results showed that the calcaneus bone mineral density was positively correlated with serum uric acid levels in male patients with type 2 diabetes after adjusting the confounding factors, adjusted R² was 0.187 (P<0.05).

Conclusions：Bone mineral density was increased with the increase of serum uric acid levels in elderly patients with type 2 diabetes; The bone mineral density was positively correlated with serum uric acid levels in elderly male patients with type 2 diabetes, normal high serum uric acid may have a protective effect on bone mineral density, the effect of serum uric acid on bone mineral density needs further study.