中文摘要：

目的 探讨2型糖尿病（T2DM）围绝经期妇女骨密度（BMD）、骨形成及骨吸收指标的变化及其机制，了解其与糖、脂代谢的相关性，为防治糖尿病患者发生骨质疏松提供依据。方法 选取266例T2DM围绝经期妇女（研究组），排除影响骨、脂代谢疾病患者，按照脂蛋白（Lp）（a）水平分为高Lp（a）组[Lp（a）≥300mg／L，162例，平均年龄为（58．32±4．87）岁]和正常Lp（a）组[104例，平均年龄为（60．41±3．92）岁]，同时选取40例年龄相匹配的健康妇女作对照组。采用双能X线骨密度仪（DXA）检测研究对象腰椎正、侧位及股骨的BMD，收集相关生化指标，并将BMD及骨代谢指标与糖、脂代谢指标的关系作统计学分析。结果 研究组的BMD较对照组有不同程度下降，糖化血红蛋白（HbA1c）与L2～4（r=0．0118，P=0．0007）、Ward’s三角（r=-0．0103，P=0.0001）、股骨颈（Neck）（r=-0.2187，P=0．0001）、股骨大转子（Troch）部位（r=-0.0142，P=0．0007）的BMD呈负相关；餐后2h血糖（2hPG）与L2～4（r=-0．0217，P=0．0001）、Ward’s三角部位（r=-0．0253，P=0．0001）的BMD呈负相关；空腹胰岛素（FINS）、餐后2hC肽（2hCP）水平与L2～4（r=0.0137、0.0274，P=0．0001）、Ward’s三角（r=0．0172、0．0068，P〈0．05）、Neck部位（r=0．0323、0．0183，P〈0.01）的BMD呈正相关；Lp（a）与Ward’s三角（r=0．659，P=0．001）、Neck（r=-0．642，P=0．001）、Troeh（r=-0，627，P=0，001）部位的BMD呈负相关。结论 T2DM围绝经期妇女比健康者容易引起BMD下降，除了雌激素的影响外，可能与胰岛功能受损有关，较好地控制血糖和保护胰岛细胞功能对预防骨质疏松症有益。Lp（a）也是影响围绝经期妇女骨代谢的一个因素，其可能通过影响骨转换而影响骨质量。

英文摘要：

Objective To investigate the relationship between bone mineral density （BMD）, indexes of bone metabolism and metabolism of carbohydrate, lipid in peri-menopausal women with type 2 diabetes mellitus, with attempt and to provide the evidence for prevention of osteoporosis. Methods The subjects included 266 peri-menopausal women with type 2 diabetes mellitus and 40 normal controls. The 266 type 2 diabetes patients were divided into two groups： high Lp（a） group[-n=162, Lp（a）≥300 mg/L] and normal Lp（a） group （n=104）. BMD was measured by dual energy X-ray absorptionmetry and collected the relevant biochemistry indexes. The correlations between bone mineral density, indexes of bone metobolism and metabolism of carbohydrate, lipid were analyzed by SPSSll. 0. Results BMD was decreased in all 266 peri-menopausal period women with type 2 DM. HbA1c was significantly in negative correlation with BMD of L2～4 , Ward＇s triangle Neck and Trochanter respectively; 2hPG was negatively correlated with BMD of L2～4 , Ward＇s triangle neck＇ respectively Meanwhile the changes in BMD of L2～4 , Ward＇s triangle, Neck were positively correlated with FINS, 2hCP, respectively. Lp（a） was significantly in negative correlation with BMD of Ward＇s tniangle, Neck, Trochanter. Conclusion The decrease of BMD in the peri- menopausal women with type 2 diabetes mellitus is associated with the level of estrogen, and pancreatic islet cell hypofunction. Control of blood glucose and protection of islet cells are beneficial to osteoporotic patients. Lp（a） is also a factor affecting bone metabolism with influence on BMD. （Shanghai Med J, 2006, 29： 203-206）