肾功能正常的2型糖尿病肾病患者血清尿酸与骨密度的关系

Relationship between serum uric acid and bone mineral density in patients with type 2 diabetic nephropathy and normal renal function

目的探讨肾功能正常的2型糖尿病肾病患者血清尿酸(serumuricacid,SUA)与骨密度(bonemineraldensity,BMD)的关系。方法选取2017年8月至2018年8月就诊于青岛市城阳区人民医院内分泌科和肾内科的115例肾功能正常的2型糖尿病肾病患者,收集患者临床资料进行回顾性分析。按照三分位数原理将SUA的结果分为低SUA组(n=39)、中SUA组(n=38)、高SUA组(n=38)3组。检测血常规、血清白蛋白、血肌酐、尿素氮、SUA、血钙、血磷、腰椎1~4BMD、股骨BMD、股骨Wards三角区BMD等指标,观察3组患者上述指标的变化,分析SUA与各指标的相关性。结果低、中、高3组患者的SUA(F=211.355,P<0.001)、总胆固醇(F=3.678,P=0.028)、三酰甘油(F=4.397,P=0.015)、腰椎1~4BMD(F=3.124,P=0.048)、股骨BMD(F=5.038,P=0.008)、股骨Wards三角区BMD(F=3.339,P=0.039)、股骨脂肪含量(F=3.374,P=0.038)、股骨肌肉含量(F=3.413,P=0.036)比较,差异有统计学意义。相关性分析结果显示,SUA与总胆固醇(r=0.248,P=0.008)、三酰甘油(r=0.341,P<0.001)、腰椎1~4BMD(r=0.220,P=0.018)、股骨BMD(r=0.227,P=0.015)呈正相关。多元线性逐步回归分析结果显示,SUA是腰椎1~4BMD(β=4.54×10^-4,P=0.018)、股骨BMD(β=4.52×10^-4,P=0.015)、股骨Wards三角区BMD(β=0.001,P=0.019)的独立保护因素。结论SUA可以增加肾功能正常的2型糖尿病肾病患者的BMD值。

Objective To retrospectively investigate the relationship between serum uric acid(SUA)and bone mineral density(BMD)in patients with type 2 diabetic nephropathy and normal renal function.Methods A total of 115 patients with type 2 diabetic nephropathy and normal renal function visiting Department of Endocrinology and Department of Nephropathy of Shandong Province Qingdao Chengyang People’s Hospital were recruited.Their clinical data were collected to conduct retrospective analysis.The patients were divided into three groups according to the tertile principle and SUA levels:low SUA group(n=39),medium SUA group(n=38)and high SUA group(n=38).Routine blood biochemical parameters,serum albumin,creatinine,urea nitrogen,SUA,calcium,phosphorus,BMD in lumbar vertebra 1-4,BMD in the femur and BMD in the Wards triangular zone of the femur were assayed.Changes of the above parameters in the 3 groups were observed to analyze the correlations of SUA with the other indices.Results SUA(F=211.355,P<0.001),total cholesterol(F=3.678,P=0.028),triglyceride(F=4.397,P=0.015),lumbar 1-4 BMD(F=3.124,P=0.048),femoral BMD(F=5.038,P=0.008),femur wards triangle BMD(F=3.339,P=0.039),femur fat content(F=3.374,P=0.038)and femur muscle content(F=3.413,P=0.036)have statistically significant differences among the low,middle and high SUA groups.Correlation study revealed that SUA level was positively correlated with total cholesterol(r=0.248,P=0.008),triglyceride(r=0.341,P<0.001),lumbar 1-4 BMD(r=0.220,P=0.018)and femoral BMD(r=0.227,P=0.015).Multivariate regression analysis results showed that SUA was an independent protective factor for lumbar1-4 BMD(β=4.54×10^-4,P=0.018),femoral BMD(β=4.52×10^-4,P=0.015)and femur Wards triangle BMD(β=0.001,P=0.019).Conclusions SUA can increase the BMD value in patients with type 2 diabetic nephropathy and normal renal function patients,which may reduce bone loss via the inhibition of oxidative stress.