2型糖尿病肾病患者血清骨转换标志物的表达水平和临床价值探讨

Expression and clinical value of serum bone turnover markers in patients with type 2 diabetic nephropathy

目的探讨2型糖尿病肾病患者血清转换标志物(BTMs)的表达水平和临床价值。方法选择2016年1月-2020年2月住院2型糖尿病患者195例(分为正常白蛋白尿组、微量白蛋白尿组、大量白蛋白尿组),另选取同期健康体检者40例为正常对照组,检测血清总I型胶原氨基端延长肽(tPINP)和β-胶原特殊序列(β-CTX)以及其他实验室指标,并进行统计学分析。结果正常对照组、正常白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组血清t PINP和β-CTX浓度的总体差异均有统计学意义(P均<0.01);两两比较显示正常白蛋白尿组血清t PINP和β-CTX浓度显著低于正常对照组(P均<0.05),而大量蛋白尿组显著高于其他组别(P<0.05),特别是血清β-CTX浓度随着T2DM肾病进展逐渐显著升高(P<0.05)。多因素Logistic回归分析显示,血清β-CTX是2型糖尿病患者发生蛋白尿的独立危险因素,其水平与Urea和t PINP呈正相关,与Ca呈负相关。结论血清骨转换标志物与2型糖尿病肾病密切相关,特别是血清β-胶原特殊序列可作为蛋白尿发生的独立危险因素。

Objective To investigate the expression and clinical value of serum bone turnover markers(BTMS)in patients with type 2 diabetic nephropathy.Methods From January 2016 to February 2020,195 patients with type 2 diabetes mellitus(divided into normal albuminuria,microalbuminuria and macroalbuminuria groups)were selected,and 40 healthy persons were selected as the control group.The serum total procollagen typeⅠamino-terminal propeptide(tPINP),β-Cross Laps(β-CTX)and other laboratory indexes were detected and analyzed statistically.Results There was statistical significance on the differences in serum tPINP andβ-CTX levels among the control,normal albuminuria,microalbuminuria and macroalbuminuria groups(P<0.01);the serum levels of tPINP andβ-CTX in the normal albuminuria group were significantly lower than those in the control group(P<0.05),while the levels in the macroalbuminuria group were significantly higher than those in other groups(P<0.05),especially the serumβ-CTX level increased with the progression of T2DM nephropathy(P<0.05).Multivariate Logistic regression analysis showed that serumβ-CTX was an independent risk factor for proteinuria in patients with type 2 diabetes mellitus.The serum level ofβ-CTX was positively correlated with Urea and tPINP,but negatively correlated with Ca.Conclusion Serum bone turnover markers are closely related to type 2 diabetic nephropathy,especially serumβ-CTX can be used as an independent risk factor for proteinuria.