Valerio Giuliana, del Puente Antonio, Esposito-del Puente Antonella, Buono Pietro, Mozzillo E, Franzese Adriana
Faculty of Motoric Science, Parthenope University, Naples, Italy.
Horm Res. 2002;58(6):266-72. doi: 10.1159/000066441.
To analyze whether bone mineral density (BMD) and bone resorption status are influenced by long-term metabolic control and duration of disease in adolescents with long-standing type 1 diabetes mellitus.
Twenty-seven adolescents (age 13.1 +/- 1.7 years, duration of diabetes 6.9 +/- 3.0 years) were studied. The BMD, expressed as z score, was measured at the lumbar spine (L1-L4) using dual-energy X-ray absorptiometry, while the urinary excretion of total deoxypiridinoline (Dpyd), a marker of bone resorption, was measured by immunoassay and was corrected by creatinine (Cr). Linear and multivariate correlations between lumbar BMD z score or Dpyd/Cr excretion and age and disease variables [short-term (Hb A(1c latest)) or long-term (Hb A(1c whole duration)) metabolic control, duration, 'diabetes impact index' (mean Hb A(1c whole duration) x duration of disease in months)] were sought.
In diabetic subjects the mean BMD z score was -0.44 +/- (SD) 1.02 (95% CI: -0.03; -0.84), and the Dpyd/Cr excretion was not increased. A negative correlation was found between lumbar BMD z score and age (r -0.59; p = 0.001), duration (r -0.39; p = 0.04), and the diabetes impact index (r -0.4; p = 0.04). The Dpyd/Cr ratio correlated negatively with age (r -0.40; p = 0.04) and positively with height velocity (r 0.42; p = 0.04). By using multiple linear regression, age showed a significant inverse correlation with lumbar BMD z score (beta = -0.39; p = 0.0005). A negative correlation was found between lumbar BMD z score and Hb A(1c whole duration) (beta = -0.40; p = 0.02) or diabetes impact index (beta = -0.001; p = 0.01).
Poor metabolic control may expose adolescents with long-standing type 1 diabetes to the risk of developing osteopenia in adult age. Optimization of metabolic control in growing diabetic children may prevent osteoporosis in later life.
分析长期代谢控制及病程对长期患1型糖尿病青少年的骨密度（BMD）和骨吸收状态的影响。
对27名青少年（年龄13.1±1.7岁，糖尿病病程6.9±3.0年）进行研究。采用双能X线吸收法测量腰椎（L1-L4）的骨密度，以z值表示，同时采用免疫分析法测量骨吸收标志物总脱氧吡啶啉（Dpyd）的尿排泄量，并通过肌酐（Cr）进行校正。研究腰椎骨密度z值或Dpyd/Cr排泄量与年龄及疾病变量[短期（最新糖化血红蛋白A1c）或长期（整个病程糖化血红蛋白A1c）代谢控制、病程、“糖尿病影响指数”（整个病程平均糖化血红蛋白A1c×疾病病程月数）]之间的线性和多变量相关性。
糖尿病患者的平均骨密度z值为-0.44±（标准差）1.02（95%置信区间：-0.03；-0.84），Dpyd/Cr排泄量未增加。腰椎骨密度z值与年龄（r=-0.59；p=＜0.001）、病程（r=-0.39；p=0.04）和糖尿病影响指数（r=-0.4；p=0.04）呈负相关。Dpyd/Cr比值与年龄呈负相关（r=-0.40；p=0.04），与身高增长速度呈正相关（r=0.42；p=0.04）。通过多元线性回归分析，年龄与腰椎骨密度z值呈显著负相关（β=-0.39；p=＜0.0005）。腰椎骨密度z值与整个病程糖化血红蛋白A1c（β=-0.40；p=0.02）或糖尿病影响指数（β=-0.001；p=0.01）呈负相关。
代谢控制不佳可能使长期患1型糖尿病的青少年在成年后患骨质减少的风险增加。优化正在成长的糖尿病儿童的代谢控制可能预防其晚年发生骨质疏松症。
