胰岛素抵抗与绝经后2型糖尿病患者股骨颈强度指数的相关性分析

Association of insulin resistance with femoral neck strength indexes in postmenopausal T2DM patients

摘要:

目的 研究胰岛素抵抗（IR）与绝经后T2DM患者股骨颈强度指数的相关性。方法 选取2017年9月—2020年12月在南京医科大学附属常州第二人民医院内分泌科住院的绝经后T2DM患者217例，收集患者一般资料、生化指标、左侧股骨颈骨密度（BMD）、几何结构参数，计算稳态胰岛素评价指数（HOMA-IR）、左侧股骨颈强度指数等，并按HOMA-IR数值分为低、中、高IR组。结果 ①与低IR组相比，中、高IR组BMI升高（P <0.05），糖尿病病程缩短（P <0.05），CSI、BSI降低（P <0.05）。②HOMA-IR与BMI呈正相关（r =0.233，P <0.05），与糖尿病病程、糖化血红蛋白呈负相关（r =-0.315和-0.143，均P <0.05）。③在校正糖化血红蛋白和糖尿病病程前后，HOMA-IR与CSI、BSI、ISI均呈负相关（r =-0.238、-0.237、和-0.189，均P <0.05）。④在校正了糖化血红蛋白、糖尿病病程、BMI后，HOMA-IR与CSI、BSI的相关性减弱，但仍呈负相关（r =-0.135和-0.155，均P <0.05），HOMA-IR与ISI无相关性（r =-0.081，P >0.05）。⑤空腹C肽与CSI、BSI、ISI呈负相关（r =-0.192、-0.210和-0.960，均P <0.05）。在校正了糖化血红蛋白、糖尿病病程、BMI后，空腹C肽仅与BSI呈负相关（r =-0.148，P <0.05）。结论 绝经后T2DM患者IR与股骨颈强度指数低有关，尤其是股骨颈对弯曲的抵抗力。该研究为评估绝经后T2DM、IR患者个体的骨骼健康提供了一个新的思路。

Abstract:

Objective To explore the associations of insulin resistance with femoral neck strength indexes in postmenopausal type 2 diabetes mellitus (T2DM) patients.Methods A total of 217 postmenopausal T2DM patients were selected from the Department of Endocrinology in Changzhou Second People's Hospital between September 2017 and December 2020. The general clinical data, biochemical indicators, bone mineral density (BMD) and geometric parameters of the left femoral neck were collected, and insulin resistance index (HOMA-IR) and the strength indexes of the left femoral neck were calculated. The patients were further divided into 3 groups according to HOMA-IR.Results Compared with the mild insulin resistance group, the body mass index (BMI) was higher, the disease duration of T2DM was shorter, and the compression strength index (CSI) and bending strength index (BSI) were lower in the moderate and severe insulin resistance groups (P < 0.05). HOMA-IR was positively correlated with BMI (r = 0.233, P < 0.05), but negatively correlated with the disease duration of T2DM and the level of glycosylated hemoglobin (r = -0.315 and -0.143, both P < 0.05). HOMA-IR showed an inverse relationship with CSI, BSI and impact strength index (ISI) both before and after adjusting for the level of glycosylated hemoglobin and the disease duration of T2DM (P < 0.05). After adjusting for the level of glycosylated hemoglobin, the disease duration of T2DM and BMI, HOMA-IR was still negatively correlated with CSI and BSI though the correlations were weakened (r = -0.135 and -0.155, both P < 0.05), while ISI had no correlation with HOMA-IR (r = -0.081, P > 0.05). The fasting C-peptide level was negatively correlated with CSI, BSI and ISI (P < 0.05). After adjusting for the level of glycosylated hemoglobin, the disease duration of T2DM and BMI, the fasting C-peptide level was only negatively correlated with BSI (r = -0.148, P < 0.05).Conclusions Insulin resistance in postmenopausal T2DM patients is associated with the low femoral neck strength, especially the bending strength. These findings suggest a better approach to evaluating bone health in postmenopausal T2DM patients with insulin resistance.