老年男性2型糖尿病肝肾阴虚证患者尿酸排泄分数与骨质疏松症的相关性

Correlation between Fractional Excretion of Uric Acid and Osteoporosis in Elderly Male Patients of Yin Deficiency of Liver and Kidney Syndrome with Type 2 Diabetes Mellitus

目的:探讨老年男性2型糖尿病肝肾阴虚证患者尿酸排泄分数(FEUA)与骨质疏松症(OP)的相关关系。方法:选取2018年1月至2022年1月就诊的老年男性2型糖尿病肝肾阴虚证患者208例,根据骨密度(BMD)将入组患者分为骨量正常组(73例)、骨量减少组(69例)和骨质疏松组(66例)。收集患者的一般临床资料、生化指标、25-羟维生素D(25-(OH)VitD)、甲状旁腺激素、甲状腺功能、24 h尿尿酸、尿肌酐。采用方差分析、卡方检验、Pearson相关分析、多因素逐步回归模型和受试者操作特征(ROC)曲线分析进行统计学分析。结果:三组患者的HbA1c、FPG、UA、Cr、TG、Ca、25-(OH)VitD、FN骨密度、L1~L4骨密度差异有统计学意义(P<0.05)。随着尿酸排泄分数的增加,患者L1~L4、股骨颈、Wards三角、大粗隆骨密度呈下降趋势(P<0.05)。患者尿酸排泄分数水平由低到高依次为骨量正常组、骨量减少组和骨质疏松组(P<0.05)。尿酸排泄分数水平与L1~L4、股骨颈、Wards三角、大粗隆骨密度均呈负相关(r=-0.721,-0.762,-0.795,-0.776;P=0.019,0.001,P<0.001,P<0.001)。HbA1c、UA、Cr、TG、25-(OH)VitD、尿酸排泄分数是骨密度的影响因素(t=2.957,3.072,1.337,3.001,1.702,2.435,均P<0.05)。受试者操作特征曲线分析提示尿酸排泄分数对骨质疏松症有一定的预测价值(曲线下面积为0.71,P=0.01),Youden指数最大对应的尿酸排泄分数为12.65%。结论:老年男性2型糖尿病肝肾阴虚证患者尿酸排泄分数水平与骨质疏松症负相关,尿酸排泄分数>12.65%对骨质疏松症有一定的预测价值,其机制可能与尿酸排泄分数反映机体的氧化应激状态有关。

Objective:To explore the correlation between fractional excretion of uric acid(FEUA) and osteoporosis in elderly male patients of Yin deficiency of liver and kidney syndrome with type 2 diabetes mellitus.Methods:208 elderly male patients of Yin deficiency of liver and kidney syndrome with type 2 diabetes were selected from January 2018 to January 2022.The patients were divided into normal bone mass group(73 cases),osteopenia group(69 cases) and osteoporosis group(66 cases) according to bone mineral density(BMD).The general clinical data, biochemical indexes, 25 hydroxyvitamin D(25-(OH)VitD),parathyroid hormone, thyroid function, 24-hour uric acid and creatinine were collected.The statistics were compared and analyzed by variance analysis, Chi-square test, Pearson correlation analysis, multivariate stepwise regression model and receiver operator characteristic(ROC) curve analysis.Results:There were significant differences in HbA1 c, FPG,UA,Cr, TG, Ca, 25-(OH) VitD,FN BMD,L1to L4BMD among the three groups(P<0.05).With the increase of FEUA,BMD of L1to L4,femoral neck, Wards triangle and greater trochanter BMD in elderly male patients with type 2 diabetes decreased(P<0.05).The levels of FEUA in the elderly patients with type 2 diabetes mellitus from low to high were normal osteoporosis, osteopenia and osteoporosis(P<0.05).FEUA levels were negatively correlated with L1to L4,femoral neck, Wards triangle and greater trochanteric BMD(r=-0.721,-0.762,-0.795,-0.776;P=0.019,0.001,P<0.001,P<0.001).HbA1 c, UA, Cr, TG, 25-(OH) VitD and FEUA were the influencing factors of bone mineral density(t=2.957,3.072,1.337,3.001,1.702,2.435,all P<0.05).ROC curve analysis showed that FEUA had a certain predictive value for OP(the area under the curve was 0.71,P=0.01),and the largest FEUA corresponding to Youden index was 12.65%.Conclusion:FEUA level was negatively correlated with OP in elderly male patients of Yin deficiency of liver and kidney syndrome with type 2 diabetes mellitus, and FEUA>12.65% had a certain predictive value for OP.Its mechanism may be the reaction of FEUA on oxidative stress state of the body, which needs further study.