疾病预防与控制杂志

目的 探讨 2 型糖尿病合并骨质疏松症患者的骨代谢特征及独立危险因素。方法 选取 2024 年高密市人民医院 128 例 30～60 岁 2 型糖尿病患者，按低密度脂蛋白胆固醇（LDL-C）水平分组（正常组 68 例：1.5～3.36 mmol/L；异常组 60 例：≥3.36 mmol/L）。检测两组糖化血红蛋白（HbA1c）及骨代谢指标：Ⅰ 型胶原氨基端延长肽（PINP）、骨钙素（BGP）、25- 羟维生素 D（25-OH VD）、甲状旁腺激素（PTH）、β 胶原降解产物（β-CTX）。结果 LDL-C 正常组与高 LDL-C 组在 PTH、PINP、BGP、β-CTX 与 HbA1c 指标上存在显著差异。其中，LDL-C 正常组的 PINP、BGP 水平显著高于高 LDL-C 组，而 PTH、β-CTX、HbA1c 则相对较低，差异在统计学上具有显著性（P＜0.05）。进一步分析相关性发现，LDL-C 和 HbA1c 均与 PINP、BGP、25-OH VD 水平呈负相关，与 β-CTX 水平呈正相关。多元线性回归分析显示，LDL-C 和 HbA1c 是影响 2 型糖尿病患者骨代谢指标的独立危险因素。结论 LDL-C 水平是影响 2 型糖尿病患者骨代谢的关键因素之一。另外，HbA1c 水平与骨代谢指标之间也显示出强烈的关联，进一步强调了糖尿病状况对骨骼健康的负面影响。LDL-C 和 HbA1c 是影响 2 型糖尿病患者骨代谢指标的独立危险因素，因此，临床医生和患者都应认识到 LDL-C 和 HbA1c 在 2 型糖尿病患者骨代谢中的重要性，并采取有效措施进行干预。

Objective To investigate the characteristics of bone metabolism and independent risk factors in type 2 diabetes patients with osteoporosis. Methods 128 patients with type 2 diabetes aged 30 to 60 years old in Gaomi People’ s Hospital in 2024 were selected and were grouped according to the low-density lipoprotein cholesterol (LDL-C) level (68 cases in the normal group: 1.5～3.36 mmol/L. 60 cases in the abnormal group: ≥3.36 mmol/L). Glycated hemoglobin A1c (HbA1c) and bone metabolism markers [procollagen I N - terminal propeptide (PINP), bonegla protein (BGP), 25-hydroxy-vitamin (25-OH VD), parathyroid hormone (PTH), β-cross-linked C-tetopeptide of type I collagen (β-CTX)] were measured in both groups. Results Significant differences in PTH, PINP, BGP, β-CTX, and HbA1c were observed between groups. Among them, the levels of PINP and BGP in the normal LDL-C group were significantly higher than those in the high LDL-C group, while PTH, β - CTX, and HbA1c were relatively lower, and the differences were statistically significant (P＜0.05). Further correlation analysis revealed that LDL-C and HbA1c were negatively correlated with PINP, BGP, and 25-OH VD levels, and positively correlated with β-CTX levels. Multiple linear regression analysis showed that LDL-C and HbA1c were independent risk factors affecting bone metabolism in type 2 diabetes patients. Conclusion LDL-C level is one of the key factors affecting bone metabolism in type 2 diabetes patients. In addition, HbA1c level also showed a strong correlation with bone metabolism indicators, further emphasizing the negative impact of diabetes on bone health. LDL-C and HbA1c are independent risk factors affecting bone metabolism in patients with type 2 diabetes. Therefore, clinicians and patients should recognize the importance of LDL-C and HbA1c in bone metabolism in patients with type 2 diabetes, and take effective measures to intervene.