Page 46 - 2022-06-中国全科医学

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Yiyang，using multistage stratified random sampling. All the assessment examinations were conducted in Yiyang Central
Hospital，specifically，BMD at lumbar spine，femoral neck and total hip was measured by dual-energy X-ray absorptiometry，
subcutaneous and visceral fat areas were measured by DUALSCAN HDS-2000 visceral fat analyzer（Omron，Japan），and 10-
year major osteoporotic fracture（clinical spine，forearm，hip or shoulder fracture） or 10-year hip osteoporotic fracture risk was
assessed by FRAX questionnaire. T2DM inpatients who completed a FRAX questionnaire in which the item of rheumatoid arthritis
was substituted by diabetes，namely，diabetes was considered as a risk factor for osteoporotic fractures，whose assessment
results were expressed by FRAX2，otherwise，their assessment results were expressed by FRAX1. Results Type 2 diabetic
men had higher average weight and BMI，and greater average areas of visceral and subcutaneous fat，and lower average FRAX1
（major osteoporotic fracture） than non-diabetic men （P<0.05）. Type 2 diabetic women had greater average age and visceral
fat area，lower femoral neck and total hip BMD，and higher average FRAX1 （hip osteoporotic fracture） and FRAX2 （major
osteoporotic fracture） and FRAX2 （hip osteoporotic fracture） than non-diabetic women （P<0.05）. After adjusting for
age and weight，total hip BMD in type 2 diabetic women were lower than those in non-diabetic women （P<0.05）. Pearson
correlation analysis results showed that visceral fat area was positively correlated with weight，BMI，subcutaneous fat area，
BMD at lumbar spine，femoral neck and total hip in non-diabetic men and postmenopausal women （P<0.05）. Visceral fat
area was positively correlated with weight，BMI，subcutaneous fat area and total hip BMD in non-diabetic women （P<0.05）.
Visceral fat area was positively correlated with weight，BMI，subcutaneous fat area，lumbar spine BMD and total hip BMD in
T2DM men （P<0.05）. Visceral fat area was positively correlated with weight，BMI，subcutaneous fat area and total hip BMD
in women or postmenopausal women with T2DM （P<0.05）. Partial correlation analysis results showed that after adjusting for age
and weight，visceral fat area was negatively correlated with femoral neck BMD，and total hip BMD in T2DM women （P<0.05）.
Visceral fat area was negatively correlated with femoral neck BMD，but positively correlated with FRAX1 （hip osteoporotic
fracture） or FRAX2 （hip osteoporotic fracture） in T2DM postmenopausal women （P<0.05）. Conclusion T2DM patients
had higher weight，BMI and visceral fat area than those without diabetes. T2DM women had lower femoral neck BMD and hip
BMD，and may be at higher risk of 10-year hip osteoporotic fracture. Visceral fat area was negatively correlated with femoral neck
BMD and total hip BMD in T2DM women. The risk of 10-year hip osteoporotic fracture may increase as visceral fat area increases
in postmenopausal women with or without T2DM.
【Key words】 Diabetes mellitus，type 2；Intra-abdominal fat；Bone density；Fractures，bone；Osteoporotic
fractures；Correlation of data

近年来 2 型糖尿病、骨质疏松及骨质疏松性骨折发 本研究价值：
病率逐渐增高 ［1］ 。肥胖与 2 型糖尿病关系密切，其是 （1）本研究通过比较糖尿病与非糖尿病人群内
2 型糖尿病发生的独立危险因素 ［2］ 。既往研究认为肥 脏脂肪面积、骨密度及未来 10 年骨质疏松性骨折发
胖是骨密度的保护因素，但也有研究显示内脏脂肪增多 生风险，得出女性 2 型糖尿病较非糖尿病人群有较高
可能导致骨密度下降 ［3-4］ 。2 型糖尿病合并肥胖与骨质 的内脏脂肪面积，有较低的股骨颈骨密度及总髋骨密
疏松及骨质疏松性骨折的关系尚存争议。因此，本研究 度；通过偏相关分析发现校正年龄、体质量后内脏脂
测量了 2 型糖尿病患者与社区人群内脏脂肪与骨密度、 肪面积与股骨颈骨密度及总髋骨密度呈负相关。
骨折风险评分，以探讨 2 型糖尿病患者内脏脂肪对骨密 （2）目前绝经后 2 型糖尿病女性骨质疏松患病
度及骨质疏松性骨折的影响。 率高，且骨质疏松性骨折因防治困难带来严重的社会
1 对象与方法 负担，本研究通过简易的 FRAX 问卷评估 2 型糖尿病
1.1 研究对象 选取 2019 年 7—12 月在益阳市中心医 未来 10 年骨质疏松性骨折风险，并进一步了解绝经
院内分泌科住院的 2 型糖尿病患者 202 例，年龄 40~75 后 2 型糖尿病女性内脏脂肪面积与未来 10 年髋部骨
岁；男 90 例，平均年龄为（57.5±9.6）岁；女 112 例， 质疏松性骨折风险呈正相关，为更好地防治女性 2 型
平均年龄为（59.7±8.8）岁；女性中绝经女性 75 例。 糖尿病骨质疏松及骨质疏松性骨折提供依据。
参照《中国 2 型糖尿病防治指南（2020 年版）》 ［5］ 中
2 型糖尿病诊断标准：空腹血糖≥ 7.0 mmol/L，随机血 准。排除标准：（1）1 型糖尿病、特殊类型糖尿病（如
糖或口服葡萄糖耐量试验 2 h 血糖≥ 11.1 mmol/L，糖化 胰腺损伤所致糖尿病、皮质醇增多症或生长激素增多引
血红蛋白≥ 6.5%；有“三多一少”症状加任意血糖达标， 起的糖尿病等）；（2）合并失代偿性心功能不全〔纽
“无三多一少” 症状非同日检测 2 次血糖均达上述标 约心功能分级（NYHA 分级）为Ⅲ或Ⅳ级〕、不稳定型