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2型糖尿病患者VSR与骨质疏松及骨折的相关性分析

Correlation of VSR with osteoporosis and fractures in patients with type 2 diabetes mellitus

    摘要
  • 摘要:
    目的  探讨2型糖尿病（T2DM）患者内脏脂肪面积与骨骼肌质量比值（VSR）与骨质疏松（OP）及骨折风险的关系。
    方法  本研究对象为2022年1月至2023 年3月在兰州大学第一医院内分泌科住院的549例T2DM患者。采用双能X线骨密度仪（DXA）测量腰椎及髋部BMD。采用生物电阻抗分析仪测量内脏脂肪面积（VFA）和四肢骨骼肌质量（ASM），计算VSR。根据OP诊断标准，将患者分为骨量正常组、骨量减少组和OP组；根据VSR四分位，将患者分为Q1～Q4组。比较4组BMD、OP患病率和椎体骨折风险。采用多因素Logistic回归分析VSR与OP及骨折风险的关系。
    结果 OP组VSR较骨量正常组和骨量减少组升高（均P ＜ 0.05）。青年组、中年组和老年组患者的BMD、VSR差异有统计学意义（均P ＜ 0.05）。BMD随VSR增加呈现先升后降的倒U型变化，在Q2组达到最高，而在Q4组降至最低。高VSR水平与较高的腰椎OP患病率相关，且女性OP患病率在各组中均高于男性（均P ＜ 0.05）。多因素Logistic回归分析显示，患者VSR与OP、骨折风险无关（P ＞ 0.05）；中年组中，VSR与OP患病风险呈正相关（均P ＜ 0.05）。
    结论  中年T2DM患者中，VSR升高与OP患病风险相关，可作为该特定人群骨退化与代谢失衡的早期预警指标。

     

    Abstract:
    Objective  To investigate the relationship of the visceral fat area to skeletal muscle mass ratio (VSR) with osteoporosis (OP) and fracture risk in patients with type 2 diabetes mellitus (T2DM).
    Methods  A total of 549 patients with T2DM who were hospitalized in the Department of Endocrinology, the First Hospital of Lanzhou University, from January 2022 to March 2023 were included in this study. Lumbar spine and hip bone mineral density (BMD) were measured by dual-energy X-ray absorptiometry (DXA). Visceral fat area (VFA) and appendicular skeletal muscle mass (ASM) were measured by bioelectrical impedance analysis, and VSR was calculated. According to the diagnostic criteria for OP, the patients were divided into the normal bone mass group, osteopenia group and OP group. According to VSR quartiles, the patients were divided into Q1 to Q4 groups. BMD, the prevalence of OP and the risk of vertebral fracture were compared among the four groups. Multivariable Logistic regression analysis was used to examine the relationship of VSR with OP and fracture risk.
    Results  VSR was higher in the OP group than those in the normal bone mass group and osteopenia group (both P ＜ 0.05). Differences in BMD and VSR among the young, middle-aged and elderly groups were statistically significant (all P ＜ 0.05). With increasing VSR, BMD showed an inverted U-shaped trend, reaching the highest level in the Q2 group and the lowest level in the Q4 group. A high VSR level was correlated with a higher prevalence of lumbar OP, and the prevalence of OP in women was higher than that in men across all groups (all P ＜ 0.05). Multivariable Logistic regression analysis showed that VSR was not correlated with OP or fracture risk in the overall population (P ＞ 0.05). In the middle-aged group, VSR was positively correlated with the risk of OP (all P ＜ 0.05).
    Conclusion  In middle-aged patients with T2DM, an increased VSR is correlated with the risk of OP and may serve as an early warning indicator of bone degeneration and metabolic imbalance in this specific population.

     

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