老年男性2型糖尿病患者尿白蛋白排泄率及生长因子与骨质疏松的关系

The relationship between the urine albumin excretion rate, the growth factors and bone density in elderly male patients with type 2 diabetes mellitus

目的 观察老年 2型糖尿病患者尿白蛋白排泄率 (UAE)及血清胰岛素样生长因子 Ⅱ(IGF Ⅱ )、转化生长因子 β(TGF β)、表皮生长因子 (EGF)等细胞因子水平与骨质疏松的相关性。 方法 对照组 14例 ;老年 2型糖尿病患者 51例 ,根据UAE分成正常白蛋白尿组 (UAE <2 0 μg/min)、微量白蛋白尿组 ( 2 0 μg/min≤UAE <2 0 0 μg/min)和大量白蛋白尿组 (UAE≥ 2 0 0 μg/min)。使用双能X线骨密度仪测量前臂松质骨及皮质骨的骨密度 ,测定IGF Ⅱ、TGF β及白介素 6(IL 6)、肿瘤坏死因子(TNF)的血清水平。 结果 3组糖尿病患者松质骨骨密度分别为 ( 3 51 5± 65 3 )g/cm2 、( 3 72 0±66 4)g/cm2 、( 3 71 8± 76 7)g/cm2 ,较对照组 ( 4 76 7± 92 8)g/cm2 降低 (P <0 0 5) ,大量白蛋白尿组皮质骨骨密度 ( 62 1 3± 59 0 )g/cm2 低于对照组 ( 72 5 1± 3 5 9)g/cm2 (P <0 0 5)。糖尿病患者血清IGF Ⅱ、TGF β水平低于对照组 (P <0 0 5) ,IL 6、EGF及TNF与对照组比较 ,差异无显著性。IGF Ⅱ与松质骨T值呈负相关 ,与TGF β正相关。 结论 糖尿病肾病患者易并发骨质疏松 ,可能与IGF Ⅱ、TGF β因子下降有一定相关。

Objective To observe the relationship between urine albumin excretion rate (UAE), growth factors and the bone mineral density (BMD) in elderly patients with type 2 diabetes mellitus. Methods Fourteen controls and 51 elderly male patients with diabetes divided into three groups: normal albuminuria(UAE<20 μg/min),microalbuminuria (20 μg/min≤UAE<200 μg/min) and macroalbuminuria (UAE≥200 μg/min). Serum insulin like growth factor Ⅱ (IGF Ⅱ), transforming growth factor β(TGF β), epidermal growth factor (EGF), tumor necrosis factor (TNF) and IL 6 levels were examined. BMD was measured by dual energy X ray densitometer. Results BMD was significantly lower in diabetic patients than that in controls〔(351 5±65 3)g/cm 2, (372 0±66 4)g/cm 2, (371 8±76 7)g/cm 2 vs (476 7±92 8)g/cm 2, P <0 05〕, BMD of cortical bone was significantly lower in macroalbuminuria group 〔(621 3±59 0)g/cm 2 vs (725 1±35 9)g/cm 2, P <0 05〕. IGF Ⅱ and TGF β levels were lower in diabetic groups than in controls, while there were no significant changes of IL 6, EGF and TNF level among groups. There was a negative correlation between the IGF Ⅱ and T score of the BMD, while positive correlation between TGF β and IGF Ⅱ. Conclusions The diabetes is easily complicated with the osteoporosis. The occurrence of the diabetes mellitus might be correlated with the lowering of IGF Ⅱ and TGF β.