Correlation Analysis Between MHR, MLR And Bone Mineral Density In Hospitalized Patients With Type 2 Diabetes Mellitus

Objective:To explore the correlation between monocyte-to-HDLcholesterol Ratio(MHR),monocyte to lymphocyte ratio(MLR)and bone mineral density(BMD)in patients with type 2 diabetes mellitus(T2DM),and to analyze the clinical value of MHR and MLR in predicting osteoporosis(OP)in patients with T2 DM.Methods: A total of 1551 inpatients with T2 DM diagnosed in the third affiliated Hospital of Nanchang University from January 1,2020 to August31,2022 were collected.The sex,body mass index(BMI),age,duration of diabetes,arteriosclerosis,hypertension,diabetic peripheral neuropathy(DPN),diabetic retinopathy(DR),diabetic nephropathy(DN)and other complications were recorded.Fasting and 2-hour postprandial blood glucose,fasting and postprandial 2h C peptide,glycosylated hemoglobin(Hb A1c),urea(BUN),creatinine(SCr),uric acid(SUA),monocyte(Mono),high density lipoprotein cholesterol(HDL-C),lymphocytes(Lym),total cholesterol(TC),Ca,P,bone derived alkaline phosphatase(BALP)were measured,and the values of MHR and MLR were calculated.Bone mineral density(BMD)of L1-L4,left femoral neck and left hip were measured.According to the diagnostic criteria of WHO,1551 patients were divided into three groups: normal bone mass,low bone mineral density and osteoporosis.The main results were as follows: 1)the differences of general data,biochemical indexes and complications among the groups were compared.2)to analyze the correlation between MHR,MLR and bone mineral density in patients with T2 DM.3)to explore the influencing factors of OP in patients with T2 DM.4)the value of ROC curve analysis of MHR and MLR in predicting the occurrence of OP in patients with T2 DM.Results:(1)There was no significant difference in hypertension history,DR,DPN,Hb A1 c,FBG,2h PBG,2h C peptide and Ca,P,BALP,TC,HDL-C among the three groups.There were significant differences in age,course of disease,bone mineral density of MLR,FCP,BMI,MHR,SUA,L1-4,left femoral neck and left hip among the three groups.Compared with the normal bone mass group,there were significant differences in sex,urea nitrogen and arteriosclerosis between the osteoporosis group and the low bone mass group(p < 0.05).Compared with normal bone mass group and osteopenia group,the creatinine value of osteoporosis group was higher,and there was statistical difference(p=0.03).The morbidity of diabetic nephropathy in low bone mass group was higher than that in normal bone mass group(p= 0.033).(2)Correlation analysis showed that MHR,MLR was negatively correlated with bone mineral density(BMD)of L1-4,left femoral neck and left hip.II correlation was found.(3)Multiple stepwise regression analysis showed that MHR,MLR,female and arteriosclerosis were risk factors for BMD at L1-4,left femoral neck and left hip(p < 0.005),and BMI was a protective factor for BMD at the three sites(p < 0.001).Age was a risk factor for bone mineral density of left femoral neck and left hip(p < 0.01).BUN was a risk factor for bone mineral density of the left hip.SUA is the protective factor of bone mineral density of L1-4(p < 0.01).(4)Univariate Logistic regression analysis was performed with OP as dependent variable.The results showed that age,female,course of disease,BUN,MHR,MLR and arteriosclerosis were risk factors for OP in T2 DM patients,and BMI,FCP,SUA was protective factor(p < 0.001).After correcting the above confounding factors,multivariate Logistic regression analysis showed that MHR and MLR were independent risk factors for OP(p < 0.001).(5)In the quartile of MHR,there was a significant difference in the prevalence of osteoporosis between the first quartile and the second,third and fourth quartile of osteoporosis.In the quartile of MLR,there was a significant difference in the prevalence of osteoporosis between the first quartile and the second,third and fourth quartile.(6)Through the analysis of ROC curve,the ROC working curve area of MHR is 0.706,and the approximate value is 0.5%.The best critical value is 0.374,the sensitivity is 77.3%,and the specificity is 54.8%.The ROC working curve area of MLR is 0.725,the approximate value is 0.331,the optimal critical value is 0.244,the sensitivity is 61.2%,and the specificity is 71.9%.Conclusion:In patients with T2 DM,MHR and MLR were significantly correlated with bone mineral density,which were independent risk factors for OP in patients with T2 DM.MHR and MLR are expected to be used as simple and feasible indexes to predict the occurrence of OP in patients with T2 DM.