糖尿病肾脏疾病患者尿白蛋白水平对骨代谢异常的意义

Significance of urinary albumin in patients with diabetic kidney disease for abnormal bone metabolism

目的探讨分析糖尿病肾脏疾病(DKD)患者不同尿白蛋白水平对骨代谢异常的影响。方法回顾性分析2016年1月~2018年10月四川省人民医院510例确诊为糖尿病肾脏疾病的患者资料,另选取170例体检健康成人(健康对照组)。按照尿白蛋白排泄率(UAER)将观察组分为3个亚组:A组为正常尿白蛋白组(UAER<30 mg/g)180例,B组为微量尿白蛋白组(UAER 30~300 mg/g)170例,C组为大量尿白蛋白组(UAER>300 mg/g)160例,对各组的骨代谢标志物进行比对分析。结果尿白蛋白亚组比较,血磷(Pi)从A组开始升高(P<0.05),血25羟基维生素D[25(OH)D]从A组即有明显下降(P<0.05),C组的血甲状旁腺素(iPTH)、血骨钙素(OT)、血β-胶原特殊序列(β-CTX)较前明显升高,差异有统计学意义(P<0.05);与健康对照组比较,糖尿病肾脏疾病各组跟骨超声传导速度、振幅衰减和骨硬度指数均显著较低,差异有统计学意义(P<0.01),其中C组明显低于A组及B组,差异有统计学意义(P<0.05)。单因素相关性分析显示,尿白蛋白与OT(r=0.186)、iPTH(r=0.192)成正相关,与25(OH)D(r=-0.324)成负相关。结论DKD患者普遍存在骨代谢异常,且与尿白蛋白有关,骨代谢生化指标如βCTX、25(OH)D、OT能较好地反映骨代谢状态。

Objective To investigate the effect of different urinary albumin levels on bone metabolism in patients with Diabetic kidney disease.Methods 510 patients with type 2 diabetic kidney disease were selected as observation.170 healthy adults were selected as control group.According to urinary albumin excretion rate(UAER),the observation group was divided into three subgroups:180 cases with normal urinal albumin(UAER<30 mg/g)were in Group A;170 cases with microalbuminuria(UAER 30~300 mg/g)were in group B;and 160 cases with massive urinary albumin(UAER>300 mg/g)in the group C.The bone metabolic markers were compared and analyzed.Results Blood phosphorus(Pi)began to increase from group A(P<0.05),blood 25-hydroxyvitamin D[25(OH)D)]began to decrease from group A(P<0.05),parathyroid hormone(iPTH),osteocalcin(OT)and blood beta-collagen specific sequence(beta-CrossLaps,beta-CTX)were increased in group C(P<0.05).Compared with the control group,the calcaneal ultrasound conduction velocity,amplitude attenuation and bone hardness index in each group of Diabetic kidney disease were lower in the observation group(P<0.01).Univariate correlation analysis showed that urinary albumin was positively correlated with OT(r=0.186),iPTH(r=0.192)and negatively correlated with 25(OH)D(r=0.324).Conclusion DKD is generally associated with abnormal bone metabolism and is related to urinary albumin.Biochemical indicators of bone metabolism such as beta CTX,25(OH)D and OT can reflect the state of bone metabolism well.