老年女性2型糖尿病肾病的骨密度及相关因素分析

Analysis of bone minernal density and related factors in old women with type 2 diabetic nephropathy

目的探讨老年女性2型糖尿病(T2DM)患者尿白蛋白排泄率(UAER)与骨密度(BMD)的关系,并分析相关因素。方法采用双能X线骨密度仪测定114例老年女性T2DM患者和47例健康体检者的BMD,收集相关生化指标。结果老年女性T2DM患者股骨颈BMD正常白蛋白尿组(A组)明显高于微量白蛋白尿组(B组)(P<0.01),B组高于临床白蛋白尿组(C组)(P<0.05);B组Ward三角BMD明显高于C组(P<0.01)。空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)和尿钙/肌酐(Ca/Cr)A组低于B组(P<0.01和P<0.05),空腹胰岛素(FIns)、餐后2h胰岛素(2hIns)、骨钙素(BGP)A组高于B组(P<0.01),FPG和2hPG、尿Ca/CrB组低于C组(P<0.01和P<0.05),2hIns、BGPB组高于C组(P<0.05、P<0.01)。结论老年女性T2DM患者随着UAER增高,肾脏损害的加重,BMD下降,可能与胰岛功能受损、血糖增高有关,良好血糖控制、保护胰岛细胞功能对预防骨质疏松有益。

Objective To investigate the relationship between urinary albumin excretion and bone minernal density （BMD） in old women with type 2 diabetes mellitus,and to analyse related factors. Methods BMD of 114 old women with type 2 diabetes mellitus and 47 normal controls were measured by dual energy X-ray absorptiometry. Related biochemical parameters were measured. Results BMD of femur neck in nomal albuminuria group（ group A）was higher than that in microalbuminuria group（ group B） （P 〈0. 01 ） ,and this parameter in group B was higher than that in clinical albuminuria group（ group C） （P 〈 0. 05 ）. BMD of Ward in group B was higher than that in group C （ P 〈 0. 01 ）. FPG,2hPG, HbA1 c and Urine Ca/Cr in group A were lower than those in group B（P 〈0. 01 ,P 〈0. 05）. Flns,2hlns,BGP in group A were higher than those in group B（P 〈 0. 01 ）. FPG and 2hPG, urine Ca/Cr in group B were lower than those in group C （P 〈 0. 01 ,P 〈 0. 05 ）. 2hIns, BGP in group B were higher than those in group C （ P 〈 0. 05, P 〈 0. 01 ）. Conclusions The reduction of BMD of old women with type 2 diabetes mellitus is associated with urinary albumin excretion, and may be related with the islet cell hypofunction and high blood glucose. Controlling blood glucose and protecting islet cell are beneficial to preventing osteoporosis.