老年营养风险指数与糖尿病肾病患者骨密度的相关性

Correlation between geriatric nutritional risk index and bone mineral density in patients with diabetic kidney disease

目的 基于老年营养风险指数(GNRI)研究糖尿病肾病(DN)患者的营养和骨质疏松状况并探讨GNRI与骨密度(BMD)的相关性。方法 选取2022年3月—2023年3月在兰州大学第二医院内分泌科或肾病科住院的2型糖尿病(T2DM)患者234例,分为DN组与单纯T2DM组,并进一步将DN组分为骨质正常组、骨质减少组、骨质疏松组,组间比较并分析GNRI与DN患者BMD的关系。结果 DN组与单纯T2DM组相比较,GNRI值差异有统计学意义(P=0.04),DN组发生营养不良的风险更高(P=0.035);DN骨质减少组和骨质疏松组GNRI值均小于骨质正常组;但骨质减少组和骨质疏松组比较,GNRI差异无统计学意义。GNRI与尺骨、桡骨、腰椎、股骨颈、全髋的BMD呈正相关关系(P值分别为0.015、0.037、0.000、0.002);多元线性回归分析显示,女性的尺骨、桡骨、腰椎、全髋BMD较男性低(β值分别为-0.686、-0.416、-0.239,P<0.05),而高GNRI值的人群腰椎、股骨颈、全髋BMD较低GNRI值人群高(β值分别为0.322、0.295、0.421,P<0.05)。结论 DN患者GNRI与尺骨、桡骨、腰椎、股骨颈、全髋的BMD呈正相关关系,高GNRI是DN患者腰椎、股骨颈、全髋骨密度降低的保护因素。

Objective To study the nutritional status and osteoporosis of diabetic patients with diabetic ne-phropathy and to further investigate the correlation between GNRI and bone mineral density(BMD),based on the geriatric nutritional risk index(GNRI).Methods A total of 234 patients with typeⅡdiabetes mellitus(T2DM)hospitalized in the Department of Endocrinology or Nephrology of the Second Hospital of Lanzhou University from March 2022 to March 2023 were selected and divided into a DN group and sole T2DM group,and the DN group was further divided into normal bone group,osteopenia group and osteoporosis group to analyze the relationship between GNRI and BMD in patients with DN.Results Compared with the sole T2DM patients,there was a statistically significant difference in GNRI value(P=0.04),and the DN group had a higher risk of malnutrition(P=0.035);the GNRI value of the DN osteopenia group and osteoporosis group was lower than that of the normal bone group.There was no significant difference in GNRI between os-teopenia and osteoporosis groups.GNRI was positively correlated with the BMD of ulna and radius,lumbar spine,femoral neck and total hip(P=0.015,0.037,0.000,0.002).The results of a multiple linear regression analysis showed that BMD of ulna,radius,lumbar spine and total hip in females was lower than that in males(β=0.686,-0.416,-0.239,P<0.05).The BMD of lumbar spine,femoral neck and total hip in the high GNRI group was higher than that in the low GNRI group(β=0.322,0.295,0.421,P<0.05).Conclusion GNRI in DN patients is positively correlated with BDM of ulna and radius,lumbar spine,neck of femur and hip.High GNRI is a protective factor for lower bone density of lumbar spine,neck of femur and hip in DN patients.