摘要
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.
出处
《临床内科杂志》
CAS
2016年第7期469-471,共3页
Journal of Clinical Internal Medicine
关键词
2型糖尿病
骨代谢标志物
骨密度
Type 2 diabetes mellitus
Bone metabolism markers
Bone mineral density