骨代谢指标及骨密度检查在2型糖尿肾病中的临床应用

Clinic Application of Bone Metabolism Index and Bone Mineral Density Check in 2nd Diabetic Nephropathy

探讨血清骨代谢指标及骨密度检查在2型糖尿肾病中的临床应用。将诊断明确的44例2型糖尿病肾病(DN)组列为DN组,诊断明确的53例2型糖尿病(T2D)组列为T2D组,选40名查体健康者为对照(Con)组。用双能X线骨密度仪检查髋骨骨密度(BMD),罗氏全自动电化学发光分析仪检测血清骨Ⅰ型前胶原N端肽(P1NP)、Ⅰ型胶原羧基末端肽(β-CTX)、25-羟基维生素D[(25(OH)VD]、骨钙素(BGP)的水平,高效液相色谱法检测血浆糖化血红蛋白(HbA1C),统计结果并分析骨代谢指标与BMD、HbA1C间的相关性。结果显示,DN组及T2D组患者血清中HbA1C、β-CTX水平高于Con组,但BMD及血清BGP、P1NP、25(OH)VD水平低于Con组,有统计学意义(P<0.05);DN组BGP、P1NP、25(OH)VD、BMD水平下降和β-CTX增高的检出率较T2D组明显增多,有统计学意义(P<0.05)。Spearman分析发现DN组患者BMD与血清BGP、P1NP、25(OH)VD水平呈正相关,与血清β-CTX呈负相关;患者HbA1C水平与血清β-CTX呈正相关,与BGP呈负相关。结论提示DN患者血清骨代谢改变较T2D组和Con组明显,骨量减少更多,DN患者更容易发生骨质疏松症或骨折。

The clinic application of bone metabolism index and bone mineral density (BMD) check of serum in 2 nd diabetic nephropathy is discussed here.44 patients who have 2 nd diabetic nephropathy were in DN group,53 patients who have diabetes were in T2D group,and 40 healthy people were in Con group.Hip bone density was checked by dual energy X-ray bone density meter,bone 1 st type procollagen N peptide(P1NP) in serum,Ⅰtype collagen carboxyl terminal peptide(β-CTX),25-hydroxy vitamin D[(25(OH)-VD],the level of osteocalcin were checked by Roche automatic electrochemiluminescence analyzer.Plasma glycosylated hemoglobin(HbA 1C ) was checked by high efficiency liquid chromatography.Results were summarized and analyzed about the relationship between bone metabolic index and BMD,HbA 1C.The results show that HbA 1C,β-CTX level of patients in DN and T2D group were higher than that in Con,however,BMD and BGP,P1NP、25(OH)VD level in serum were less than that in Con,which has statistical significance( P <0.05).Level of BGP,P1NP,25(OH)VD and BMD in DN group were evidently higher than in T2D,as well as high β-CTX checked ratio,which has statistical significance( P <0.05) in Spearman analysis,in DN group,BMD was positive correlation to the level of BGP,P1NP and 25(OH)VD in serum,and negative correlation to β-CTX,HbA 1C level is positive correlation to β-CTX,negative correlation to BGP.As a result,the change of serum bone metabolism in patients of DN group were obvious than T2D and Con,and more bone are less,patients in DN are easily to have osteoporosis or fracture.