2型糖尿病患者骨转换标志物和尿白蛋白/肌酐比的关系

The relationship of bone conversion markers and urinary albumin creatinine ratio in type 2 diabetes

目的探讨2型糖尿病(T2DM)患者尿白蛋白/肌酐比(UACR)与骨转换标志物的关系。方法纳入2019年1月至2020年7月合肥市第一人民医院滨湖院区内分泌科收治住院的87例T2DM患者,收集患者一般资料以及血尿标本,检测N端-骨钙素(N-MID)、总Ⅰ型胶原氨基端延长肽(PINP)和I型胶原羧基端Beta特殊序列(β-CTX)和UACR等项目。根据UACR分成3组:正常组(38例),UACR≤30 mg/g;微量白蛋白组(37例),30 mg/g<UACR<300 mg/g;临床蛋白尿组(12例),UACR≥300 mg/g。对组间资料和N-MID、β-CTX、PINP等指标进行统计学分析。结果三组间患者N-MID、β-CTX、PINP和糖化血红蛋白(HbA1c)差异有统计学意义(P<0.05);临床蛋白尿组和微量白蛋白组的N-MID、β-CTX和PINP的水平较正常组低(P<0.05);临床蛋白尿组的N-MID水平较微量白蛋白组低(P<0.05);与正常组比较,临床蛋白尿组的HbA1c水平升高(P<0.05)。Pearson相关性分析提示UACR与N-MID、β-CTX呈负相关(r=-0.272、r=-0.483,P值均<0.05)。结论T2DM患者在出现微量白蛋白和临床蛋白尿时,存在明显的骨转换指标降低,N-MID和β-CTX是糖尿病肾病患者早期提示低骨转换的状态较为敏感的实验室检测指标。

Objective To investigate the relationship between urinary albumin creatinine ratio and bone conversion markers in patients with type 2 diabetes.Methods A total of 87 patients with T2DM who admitted to the department of Endocrinology in the First People′s Hospital of Hefei from January 2019 to July 2020 were included.General information and blood and urine samples of 87 patients were collected.Detection of N-terminal osteocalcin,typeⅠprocollagen amino-terminal peptide,β-carboxyl-terminal peptide and UACR,etc.According to UACR,total 87 patients with T2DM were divided into 3 groups:the normal group(n=38),UACR≤30 mg/g;the microalbumin group(n=37),30 mg/g<UACR<300 mg/g;the Clinical proteinuria group,UACR≥300 mg/g(n=12).The data between the three groups and the indexes of N-MID,β-CTX and PINP were analyzed statistically.Results There were statistically significant differences of N-MID,β-CTX,PINP和HbA1c(P<0.05).The levels of N-MID,β-CTX and PINP in clinical proteinuria group were lower than those in normal group(P<0.05).The levels of N-MID,β-CTX and PINP in microalbumin group were lower than those in normal group(P<0.05).The level of N-MID in clinical proteinuria group was lower than that in microalbumin group(P<0.05).Compared with normal group,HbA1c level in clinical proteinuria group was increased(P<0.05).Pearson correlation analysis showed that UACR was negatively correlated with N-MID andβ-CTX(r=-0.272,r=-0.483,P<0.05).Conclusion The presence of microalbumin uria and clinical proteinuria in T2DM patients has significantly reduced bone conversion indexes.N-MID andβ-CTX are sensitive laboratory indicators for early indication of low bone conversion status in diabetic nephropathy patients.