中文摘要：

目的探讨男性2型糖尿病患者性激素水平与骨密度之间的关系。方法本研究为回顾性分析，共纳入男性2型糖尿病患者673例，采用双能x线骨密度仪检测腰椎2-4（L2-4）、股骨颈和全髋骨密度，同时测定其HbA1c、血清卵泡刺激素（FSH）、黄体生成素（LH）、催乳素、雌二醇、睾酮、游离睾酮（FT）以及性激素结合球蛋白（SHBG）水平。结果相关性分析提示FSH与股骨颈（r=-0．122，P=0．005）和全髋骨密度（r=-0．109，P=0．012）呈明显负相关，LH与股骨颈骨密度（r=-0．086，P=0．048）呈负相关，上述关系在校正年龄及体重指数（BMI）后均消失；雌二醇与L2-4（r=0．114，P=0．011）和全髋骨密度（r=0．091，P=0．043）呈明显正相关，且这种正相关关系不受年龄的影响，但校正BMI后相关性消失；睾酮仅与L2-4骨密度存在微弱正相关，在校正BMI后这种关系仍然存在；FT和催乳素与各部位骨密度均不存在相关性；SHBG与上述3个部位骨密度均存在明显负相关关系，且在校正年龄后相关性依然存在，但经过BMI校正后相关性消失。多元逐步回归分析结果提示，SHBG、雌二醇和睾酮是影响男性2型糖尿病患者骨密度变异的主要因素。结论男性2型糖尿病患者骨密度的变异受性激素和SHBG的影响，而伴有SHBG水平升高的男性2型糖尿病患者更容易发生骨密度的降低。

英文摘要：

Objective investigate the correlation between serum levels of sex steroid hormones and bone mineral density （ BMD ） in men with type 2 diabetes mellitus （ T2DM ）. Methods The study is a retrospective analysis. A total of 673 men with T2DM were enrolled. BMDs of lumbar spine 2-4 （ L2-4 ） , femoral neck （ FN）, and total hip （TH） were measured by dual-energy X-ray absorptiometry. Serum HbA1c, follicle-stimulating hormone （FSH）, luteinizing hormone （LH）, prolactin, estradiol, testosterone, free testosterone （FT）, and sex hormone binding globulin （SHBG） levels were tested simultaneously. Results Pearson＇s correlation analysis revealed that FSH was negatively correlated with FN （ r= -0. 122, P=0. 005 ） and TH （ r= -0. 109, P=0. 012）, and LH was also negatively correlated with FN （ r= -0. 086, P =0.048 ）. However, all these negative relationships were lost after the adjustment of age and body mass index （BMI）. Estradiol had a significantly positive correlation with L2-4 （ r = 0.114, P = 0.011 ） and TH （r = 0.091, P = 0. 043 ） B MD, and this relationship was not influenced by age, but disappeared after adjustment for BMI. Testosterone showed a weakly positive correlation with L2-4 BMD, which still remained even after adjustment for BMI. There was no correlation of FT and prolactin with BMD. SHBG showed significantly negative correlations with three BMDs. Partial correlation analysis showed that the relationship remained significant even after adjusting for age, but disappeared after the adjustment for BMI. Multiple stepwise regression analysis revealed that SHBG, estradiol, and testosterone were the main factors that influenced the change of BMDs in men with T2DM. Conclusions Serum concentrations of sex steroid hormones and SHBG were correlated with the variation of BMDs in male patients with T2DM, and the subjects with higher SHBG concentrations were more likely to have low BMD.