血清OPN、BMP2、RBP4与糖尿病肾病患者肾功能及骨密度的相关性

Correlation between serum OPN,BMP2,RBP4 and renal function and bone mineral density in diabetes nephropathy patients

目的探讨血清骨桥蛋白(OPN)、骨形态发生蛋白2(BMP2)、视黄醇结合蛋白4(RBP4)与糖尿病肾病(DN)患者肾功能及骨密度的关系。方法选取2020年1月至2021年12月在济宁医学院附属医院确诊的120例DN患者作为DN组,60例单纯糖尿病患者作为T2DM组,糖耐量试验正常的研究对象60例作为对照组,对比三组的血糖、血清OPN、BMP2、RBP4、腰椎骨密度(LBMD)、股骨颈骨密度(FNBMD)及肾功能指标,并按照DN患者的尿白蛋白排泄率(UAER)将患者分为微量白蛋白尿DN组(71例)和大量白蛋白尿DN组(49例),进行分层对比,采用简单线性相关分析法分析DN患者OPN、BMP2、RBP4与肾功能及骨密度指标的相关性。结果DN组患者的空腹血糖(FPG)、糖化血红蛋白(HbA 1c)、血肌酐(Scr)、尿白蛋白排泄率(UAER)、胱抑素(CysC)水平显著高于T2DM组和对照组,差异均有统计学意义(均P<0.05);T2DM组FPG、HbA 1c高于对照组,差异均有统计学意义(均P<0.05);DN组患者的OPN、BMP2高于T2DM组和对照组,DN组的RBP4、LBMD、FNBMD低于T2DM组和对照组,差异均有统计学意义(均P<0.05);T2DM组的OPN、BMP2高于对照组,RBP4低于对照组,差异均有统计学意义(均P<0.05);大量白蛋白尿DN组患者的FPG、HbA 1c、Scr、UAER、CysC水平显著高于微量白蛋白尿DN组患者,差异均有统计学意义(均P<0.05);大量白蛋白尿DN组患者的OPN、BMP2高于微量白蛋白尿DN组患者,大量白蛋白尿DN组患者的RBP4、LBMD、FNBMD低于微量白蛋白尿DN组患者,差异均有统计学意义(均P<0.05)。DN组患者的OPN与Scr、UAER、CysC均呈正相关(均P<0.05),BMP2与UAER、CysC均呈正相关(均P<0.05);DN组患者的OPN、BMP2与LBMD、FNBMD均呈负相关(均P<0.05),RBP4与LBMD、FNBMD均呈正相关(均P<0.05)。结论OPN、BMP2、RBP4与DN患者肾功能受损程度及骨量丢失密切相关,可在一定程度上反映T2DM患者骨代谢及骨质疏松病情程度。

Objective To investigate the relationship between serum osteopontin(OPN),bone morphogenetic protein 2(BMP2),retinol binding protein 4(RBP4)and renal function and bone mineral density in patients with diabetes nephropathy(DN).Methods A total of 120 patients with DN diagnosed in the Affiliated Hospital of Jining Medical University from January 2020 to December 2021 were selected as the DN group,60 patients with simple diabetes as the type 2 diabetes mellitus(T2DM)group,and 60 subjects with normal glucose tolerance test as the control group.The serum OPN,BMP2,RBP4,low bone mineral density(LBMD),femoral neck bone density(FNBMD)and renal function indicators of the three groups were compared.According to the urinary albumin excretion rate(UAER)of DN patients,the patients were divided into microalbuminuria DN group(71 cases)and massive albuminuria DN group(49 cases),and stratified comparison was made.The simple linear correlation analysis was used to analyze the OPN of DN patients.BMP2,RBP4,renal function and bone mineral density.Results The fasting blood glucose(FPG),glycated hemoglobin(HbA 1c),serum creatinine(Scr),UAER,and cystatin(CysC)levels of DN group patients were significantly higher than those of T2DM group and control group,and the differences were statistically significant(all P<0.05);The FPG and HbA 1c in the T2DM group were higher than those in the control group,and the differences were statistically significant(all P<0.05);The OPN and BMP2 of DN group patients were higher than those of T2DM group and control group,while the RBP4,LBMD,FNBMD of DN group were lower than those of T2DM group and control group,and the differences were statistically significant(all P<0.05);The OPN and BMP2 of the T2DM group were higher than those of the control group,while RBP4 was lower than that of the control group,and the differences were statistically significant(all P<0.05);The levels of FPG,HbA 1c,Scr,UAER,and CysC in patients with macroalbuminuria DN were significantly higher than those in patients with microalbuminuria DN,and the differences were statistically significant(all P<0.05);The OPN and BMP2 of patients in the large albuminuria DN group were higher than those in the microalbuminuria DN group,while the RBP4,LBMD,and FNBMD of patients in the large albuminuria DN group were lower than those in the microalbuminuria DN group,and the differences were statistically significant(all P<0.05).The OPN of DN group patients was positively correlated with Scr,UAER,and CysC(all P<0.05),while BMP2 was positively correlated with UAER and CysC(all P<0.05);The OPN and BMP2 of DN group patients were negatively correlated with LBMD and FNBMD(all P<0.05),while RBP4 was positively correlated with LBMD and FNBMD(all P<0.05).Conclusions OPN,BMP2,RBP4 are closely related to the degree of renal function impairment and bone loss in DN patients,and can to some extent reflect the degree of bone metabolism and osteoporosis in T2DM patients.