摘要目的 探讨2型糖尿病(T2DM)患者心血管自主神经病变(CAN)与骨密度的关系.方法 选取2016年1月至2017年12月于南京鼓楼医院内分泌科住院的T2DM患者564例,采用心血管反射试验(Ewing试验)将467例50岁以上男性和绝经期女性患者和97例小于50岁男性和育龄期女性患者分别分为CAN组和非CAN组.采用双能X线骨密度仪测量受试者全髋、腰椎(L1～L4)、股骨颈骨密度,50岁以上男性和绝经期女性患者记录相应部位T值,小于50岁男性及育龄期女性患者记录Z值.比较各组年龄、病程、空腹血糖等一般资料和骨密度T或Z值.根据数据类型,组间比较采用独立样本t检验和χ2检验,骨密度间比较采用协方差分析或秩和检验.采用Pearson相关分析探讨骨密度值和CAN评估参数的相关性,多元线性回归分析探讨骨密度T值和Z值的影响因素.结果 在50岁以上男性和绝经期女性患者中,与非CAN组相比,CAN组全髋骨密度T值[-0.300(-0.900,0.500)比0.100(-0.400,0.800),Z=-4.937,P<0.01]、腰椎骨密度T值(0.07±1.42比0.51±1.37,t=3.384,F=5.602,P<0.05)、股骨颈骨密度T值(-0.75±0.91比-0.40±0.92,t=4.069,F=4.484,P<0.05)均显著降低.在小于50岁男性及育龄期女性患者中,与非CAN组相比,CAN组全髋骨密度Z值(0.20±0.81比0.57±0.79,t=2.228,F=7.324,P<0.01)、股骨颈骨密度Z值[-0.200(-0.600,0.400)比0.250(-0.300,1.025),Z=-2.248,P<0.05]均显著降低.校正病程、年龄、雌二醇等影响因素后,CAN仍是全髋骨密度T值(β=-0.256、SE=0.106、β'=-0.142、t=-2.414,P<0.05)及Z值(β=-0.554、SE=0.206、β'=-0.355、t=-2.687,P<0.05)的影响因素.结论 CAN是T2DM患者骨密度降低的重要影响因素.

abstractsObjective To explore the association between cardiovascular autonomic neuropathy (CAN) and bone mineral density in patients with type 2 diabetes mellitus (T2DM). Method A total of 564 patients with T2DM admitted to the Department of Endocrinology, Drum Tower Hospital of Nanjing University Medical School between Jan. 2016 and Dec. 2017 were recruited. According to the Ewing test method, 467 patients (males over 50 years and menopausal females) and 97 patients (males younger than 50 years and females in childbearing age) were divided into CAN groups and non-CAN group. Dual-energy X-ray absorptiometry was used to measure bone densities in locations of the total hip, lumbar vertebrae (L1-L4) and femoral neck. T values of corresponding site were recorded in males over 50 years and menopausal females, and Z values were recorded in males younger than 50 years and females in childbearing age. The T/Z value, age, disease duration, fasting blood glucose were compared between these two groups. Independent sample t-test and chi-square test were used for comparison, and covariance analysis and rank sum test were used for bone mineral density analysis. Pearson correlation analysis was used to investigate the correlation between bone mineral density and CAN evaluation parameters. Multiple linear regression analysis was used to investigate the influencing factors of bone density T and Z values. Result In males over 50 years and menopausal females, T-value of the total hip bone density [-0.300(-0.900, 0.500) vs 0.100 (-0.400, 0.800), Z=-4.937, P<0.01], T-value of lumbar spine bone density (0.07 ± 1.42 vs 0.51 ± 1.37, t=3.384, F=5.602, P<0.05), and T-value of femoral neck bone density (-0.75±0.91 vs-0.40±0.92, t=4.069, F=4.484, P<0.05) were significantly lower in the CAN group than those in the non-CAN group. In males younger than 50 years and females in childbearing age, Z-value of the total hip bone density (0.20 ± 0.81 vs 0.57 ± 0.79, t=2.228, F=7.324, P<0.01) and femoral neck bone mineral density [-0.200(-0.600, 0.400) vs 0.250(-0.300, 1.025), Z=2.248, P<0.05] were significantly lower in the CAN group than those in the non-CAN group. After adjusting for the influencing factors such as duration of disease, age, and estradiol, CAN was still a factor influencing the T value (β=-0.256, SE=0.106,β'=-0.142, t=-2.414, P<0.05) and Z value (β=-0.554, SE=0.206,β'=-0.355, t=-2.687, P<0.05) of total hip bone density. Conclusion CAN is an important factor to decrease bone density in patients with T2DM.