老年男性2型糖尿病患者骨代谢标志物与骨质疏松的相关性研究

The study of correlation between bone metabolism markers and osteoporosis in old male type 2 diabetes patients

目的研究老年男性2型糖尿病（T2DM）患者骨代谢标志物与骨密度（BMD）的相关性，探讨其在评估2型糖尿病骨质疏松中的作用及意义。方法将179例老年男性2型糖尿病患者依据病程分为：T2DM-1组（病程〈20年）84例及T2DM-2组（病程≥20年）95例；依据尿白蛋白肌酐比值（UACR）分为：正常白蛋白尿组即单纯糖尿病组（UACR〈30mg／g）71例，微量白蛋白尿组即早期糖尿病肾病组（UACR30—299mg／g）49例，大量白蛋白尿组即临床糖尿病肾病组（UACRI〉300mg／g）59例。同时选取80例同年龄段健康体检者作为对照组。对所有研究对象进行骨代谢标志物和BMD测定及分析。结果与对照组比较，2型糖尿病组骨钙素（BGP）、总1型前胶原氨基端延长肽（T—P1NP）及总25-羟维生素D[25-（OH）D]显著降低（P均〈0．05），1型胶原羧基端肽B特殊序列（β—CTX）、甲状旁腺激素（PTH）显著升高（P均〈0．05），股骨颈BMD降低（P〈0．05）。在2型糖尿病组内，T2DM-2组BGP和T—P1NP水平明显低于T2DM．1组（P〈0．05），β-CTX显著升高（P〈0．05），股骨颈及腰椎BMD差异无统计学意义（P〉0．05）；在不同白蛋白尿组中，随着UACR的升高，血清BGP、T—P1NP、25-（OH）D逐渐降低，而β-CTX、PTH逐渐升高，各组间比较差异有统计学意义（P〈0．05），大量白蛋白尿组股骨颈BMD明显低于正常白蛋白尿组（P〈0．05）。股骨颈处BMD与BGP、β-CTX之间存在显著相关性。结论随着老年男性2型糖尿病患者病程延长及肾功能逐渐下降，骨代谢标志物BGP、β-CTX及股骨颈处BMD能够更敏感地反映早期骨代谢变化，可作为评定患者骨质疏松的临床标志。

Objective To investigate the significance of bone metabolism markers in old male type 2 diabetes mellitus（T2DM） patients by measuring the correlation of bone metabolism markers and bone mineral density（BMD）. Methods 179 elderly male patients with T2DM were divided into T2DM-1 Stoup（ duration 〈 20 years ,84 cases） and T2DM-2 group（ duration 〉/20 years ,95 cases） according to the duration of diabetes. According to urinary albumin-creatinine ratio （ UACR）, patients were divided into normal albuminuria group （ pure DM group, UACR 〈 30 mg/g, 71 cases ）, microalbuminuria group （ early diabetic nephropathy group, UACR 30-299 mg/g,49 cases） and macroalbuminuria group （ clinical diabetic nephropathy group, UACR ≥ 300 mg/g, 59 cases）. Meanwhile, 80 healthy people were selected as the normal control group. Markers of bone metabolism and BMD of all subjects were detected for further assessments. Results Compared with the control group, BGP, T-P1NP and 25-（OH） D in patients were significantly lower （ P 〈 0.05 ）, 13-CTX and PTH were obviously higher（ P 〈 0.05 ）, and BMD of femoral neck were evidently lower（ P 〈 0.05 ）. BGP and T-P1NP in T2DM-2 group were significantly lower than those in T2DM-1 group while 13-CTX was obviously higher （ P 〈 0.05 ）. Whereas, there were no significant differences of femoral neck and lumbar spine BMD between the two groups. BGP,T-P1NP and 25-（OH） D were gradually lower with the increase of UACR in patients while β-CTX and PTH were gradually higher （P 〈 0.05）. The BMD of femoral neck in macroalbuminuria group were significantly lower than those in the normal albuminuria group（P 〈 0.05）. BMD of femoral neck was significantly related to BGP and β-CTX. Conclusion Along with the long course and gradual decline of renal function in T2DM patients, bone metabolism markers including BGP, β-CTX and BMD of femoral neck were sensitive in detecting the early variety of bone metabolism,which can be used as clinical markers for evaluating patients with osteoporosis.