中文摘要：

目的 探讨2型糖尿病患者的血清25-羟维生素D[25（OH）D]以及甲状旁腺激素（PTH）水平与骨密度之间的关系。方法 本研究为回顾性分析，共纳入2型糖尿病患者1 050例，采用双能X线吸收法骨密度仪检测腰椎2～4、股骨颈和全髋骨密度，同时测定血清PTH、25（OH）D以及血清钙、磷水平。结果 相关性分析提示血清PTH与腰椎（r=-0.072，P=0.034）、股骨颈（r=-0.112, P=0.001）和全髋 （r=-0.115, P=0.001）骨密度均呈明显负相关，且在校正年龄和体重指数后这种关系仍然存在。25（OH）D在校正了年龄和体重指数后，与股骨颈（r=0.099, P=0.007）和全髋（r=0.044, P=0.028）骨密度出现了显著的正相关。血清钙与磷水平与各部位骨密度之间无显著相关性。根据25（OH）D水平差异对2型糖尿病患者进行分组，其中维生素D缺乏者773例（73.5%）、不足者194例（18.5%）、充足者仅83例（8.0%），维生素D缺乏组的PTH水平显著高于充足组（P〈0.05），且维生素D缺乏组各部位骨密度均显著低于维生素D充足组（P〈0.05）。多元逐步回归分析结果提示，年龄、体重指数和PTH是影响2型糖尿病患者骨密度变异的主要因素。结论 2型糖尿病患者中普遍存在维生素D缺乏状况，同时存在继发性PTH的升高，而伴有PTH水平升高的2型糖尿病患者更容易发生骨密度的降低，从而增加骨质疏松症甚至是脆性骨折的发病风险。

英文摘要：

Objective To investigate the correlation between 25-hydroxyvitamin D [25（OH）D] and parathyroid hormone （PTH） with bone mineral density （BMD） in patients with type 2 diabetes mellitus. Methods The study is a retrospective analysis. 1 050 patients with type 2 diabetes mellitus were enrolled. BMDs at lumbar spine（2-4）, femoral neck, and total hip were measured by dual-energy X-ray absorptiometry. Serum PTH, 25（OH）D, Ca, and P levels were tested simultaneously. Results Pearson＇s correlation analysis revealed that PTH was negatively correlated with lumbar spine （r=-0.072, P=0.034）, femoral neck （r=-0.112, P=0.001）, and total hip （r=-0.115, P=0.001） BMD, partial correlation analysis showed that the relationship was still significant even after adjusted for age and body mass index; 25（OH）D had a significant positive correlation with femoral neck （r=0.099, P=0.007） and total hip （r=0.044, P=0.028） BMD after adjustment for age and body mass index. There was no correlation of Ca, P with BMD. Grouping according to differences in 25（OH）D levels in patients with type 2 diabetes mellitus, the number of cases with vitamin D deficiency was 773 （73.5%）, the number of cases with vitamin D insufficiency was 194（18.5%）, and the number of cases with adequate vitamin D was only 83（8.0%）. The level of PTH in cases with vitamin D deficiency was significantly higher than that in cases with adequate vitamin D （P〈0.05）; and BMD in cases with vitamin D deficiency was significantly lower than that with adequate vitamin D （P〈0.05）. Multiple stepwise regression analysis revealed that age, body mass index, and PTH were the main factors that influenced the change of BMDs in patients with type 2 diabetes mellitus. Conclusions There was prevalence of vitamin D deficiency in patients with type 2 diabetes mellitus, meanwhile there was secondarily raised PTH. Type 2 diabetic patients with raised PTH levels were more prone to develop lowered BMD, thus increasing the incidence of