摘要
目的研究社区老年2型糖尿病(type 2 diabetes mellitus,T2DM)对骨密度(bone mineral density,BMD)、下肢肌功能、跌倒及骨折的影响。方法选取上海市5家社区卫生服务中心的60岁以上老年人9 584例,其中T2DM组1 201例,对照组8 383例;T2DM患者分为骨折组184例,非骨折组1 017例。分别记录受试者的年龄、性别、身高及体质量,计算出体质量指数(body mass index,BMI),起立行走计时测试(the timed up and go,TUG)评估下肢肌力情况,询问受试者骨折史,吸烟、饮酒情况,1年内跌倒及骨折情况,父母发生髋部骨折史,并询问T2DM患者的病程,药物治疗情况。利用跟骨超声骨密度仪(quantitative ultrasound system-bone mineral density,QUS-BMD)测量骨密度值。比较T2DM与对照组的一般基础资料及发生跌倒和骨折情况,比较T2DM患者骨折组与非骨折组各临床指标。结果 T2DM组吸烟率20.4%明显高于对照组17.8%(P=0.030),完成TUG所需中位数时间10.75 s明显高于对照组10.12 s(P=0.000),BMD(0.920±0.040)g/cm^2高于对照组(0.790±0.030)g/cm^2(P=0.000),1年内跌倒发生率10.1%高于对照组7.1%(P=0.000),1年内骨折发生率15.3%高于对照组12.1%(P=0.080);T2DM患者中,与非骨折组相比,骨折组女性的比例高(89.1%vs.52.1%,P=0.000)、糖尿病病程长[(11.6±0.6)年vs.(9.6±0.2)年,P=0.000]、吸烟比率高(95.1%vs.67.9%,P=0.000)、饮酒比率高(93.5%vs.80.7%,P=0.000)、使用胰岛素比率高(23.9%vs.14.9%,P=0.002)、父母髋部骨折史高(9.2%vs.3.7%,P=0.001)、1年内发生跌倒率高(20.7%vs.8.3%,P=0.000)、跌倒风险评分高[(2.98±0.01)分vs.(1.8±0.01)分,P=0.000]、TUG高(10.92 s vs.10.34 s,P=0.000)、骨密度低[(0.635±0.026)g/cm^2vs.(0.780±0.030)g/cm^2,P=0.000]。结论与对照组相比,患T2DM的老年人虽然BMD高,但是下肢肌功能降低、跌倒及骨折的发生率明显增高,揭示T2DM降低了老年人肌肉功能,增加了跌倒和骨折的发生,且该作用独立于BMD以外。
j Objective To study the effects of type 2 diabetes mellitus （T2DM） on bone mineral density （ BMD）, lower limb muscle function, fall and fracture in community elderly population. Methods A total of 9 584 residents aged ≥ 60 years were enrolled who underwent medical examination from 5 communities in Shanghai. The residents were divided into T2DM group （n= 1 201 ） and control group （n= 8 383） according to medical history, and diabetes patients were divided into fracture （n= 184） and non-fracture （n= 1 017） group. Each participant completed questionnaire. Bone mass was assessed by quantitative ultrasound, and limb muscle function was evaluated by timed up and go （TUG） test. Bone mass, TUG test, and situation of falls and fractures were compared between T2DM group and control group, and also compared between fracture and non-fracture group with diabetes. Results The smoking rate in T2DM group was 20. 4% which was significantly higher than control （ 17. 8%, P=0. 030）. TUG in T2DM group was 10. 75 （by median number） seconds which was significantly higher than control group （ 10. 12 seconds, P=0. 000）. BMD of T2DM group [ （0. 92±0. 04） g/cm^2 ] was significantly higher than control group [ （0. 79±0. 03） g/cm^2, P=O. 0001. Fall rate within 1 year of T2DM group （ 10. 1%） was higher than control group （7. 1%, P=0. 000）. The fracture rate within 1 year of T2DM group （15. 3%） was higher than control group （ 12. 1%, P = 0. 080）. In T2DM, compared with non-fracture group, ratio of female in fracture group was significantly higher （89. 1% vs. 52. 1%） （P=0. 000）, duration of diabetes was longer [ （ 11.6±0. 6） years vs. （9.6±0. 2） years, P=0.0003, smoking rate was higher （95.1% vs. 67.9%, P=0.000）, alcohol ratio was higher （93.5% vs. 80. 7%, P=0. 000）, rate of insulin use was higher （23.9% vs. 14. 9%, P= 0. 002）, family history of hip fracture was higher （9.2% vs. 3.7%, P=0. 001）, rate of fall per year was higher （20. 7% vs. 8.
作者
王小冬
肖峰
杜艳萍
乌日娜
程群
WANG Xiao-dong1 , XIAO Feng1 , DU Yah-ping2, WU Ri-na1 , CHENG Qun2(1. Medical Science, Zhou Jiaqiao Street Community Health Service Center of Changning District, Shanghai 200051, China ; 2. Department of Osteoporosis and Bone Disease, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, Chin)
出处
《中华骨质疏松和骨矿盐疾病杂志》
CSCD
北大核心
2018年第2期120-125,共6页
Chinese Journal Of Osteoporosis And Bone Mineral Research
基金
上海申康医院发展中心临床科技创新项目(SHDC12016201)
上海市科学技术委员会支持项目(16411954600)
上海市长宁区科学技术委员会课题(CNKW2014S02)
关键词
2型糖尿病
起立行走计时测试
下肢肌功能
骨密度
跌倒
骨折
type 2 diabetes mellitus
timed up and go
lower limb muscle function
bone mineral density
fall
fracture
