气阴两虚夹瘀型早期糖尿病肾病破骨细胞活性与骨代谢水平相关性研究

Study on Correlation Between Osteoclast Activity and Bone Metabolism Levels in Patients with Early Diabetic Kidney Disease of Deficiency of Both Qi and Yin Complicated with Blood Stasis Type

目的:分析气阴两虚夹瘀型早期糖尿病肾病破骨细胞活性与骨代谢水平的相关性。方法:回顾性选取90例气阴两虚夹瘀型早期糖尿病肾病患者作为研究对象,根据骨密度T值不同分为骨量正常组(25例)、骨量减少组(55例)、骨质疏松组(10例)。比较各组一般资料、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、甲状旁腺素(PTH)、Ⅰ型前胶原氨基端前肽(PINP)、骨钙素(OC)、25-羟维生素D_(3)(25-OH-D_(3))、β胶原特殊序列(β-Crosslaps)及破骨细胞相关细胞因子[巨噬细胞集落刺激因子(M-CSF)、核因子κB受体活化因子(RANKL)]水平。采用多因素Logistic回归分析气阴两虚夹瘀型早期糖尿病肾病影响骨质疏松发生因素,采用Pearson检验分析骨代谢水平与破骨细胞相关细胞因子水平的相关性。结果:3组FBG、HbA1c、PTH水平比较,差异无统计学意义(P>0.05)。骨量减少组、骨质疏松组PINP、25-OH-D_(3)、OC水平均低于骨量正常组(P<0.05),骨质疏松组PINP、25-OH-D_(3)、OC水平低于骨量减少组(P<0.05)。骨质疏松组β-Crosslaps水平高于骨量减少组、骨量正常组(P<0.05)。骨量正常组M-CSF、RANKL水平低于骨量减少组、骨质疏松组(P<0.05),骨量减少量M-CSF、RANKL水平低于骨质疏松组(P<0.05)。PINP、25-OH-D_(3)、OC水平减少及β-Crosslaps增加是糖尿病肾病患者骨质疏松发生的危险因素(P<0.05)。气阴两虚夹瘀型早期糖尿病肾病患者M-CSF、RANKL水平与骨量减少程度呈正相关(P<0.05)。结论:气阴两虚夹瘀型早期糖尿病肾病患者破骨细胞活性与骨量减少有关,检测PINP、25-OH-D_(3)、OC及β-Crosslaps水平能够预测患者发生骨质疏松风险。

Objective:To analyze the correlation between osteoclast activity and bone metabolism levels in patients with early diabetic kidney disease of deficiency of both qi and yin complicated with blood stasis type.Methods:A total of 90 cases of patients with early diabetic kidney disease of deficiency of both qi and yin complicated with blood stasis type were retrospectively selected as the study objects,and were divided into the normal bone mass group(25 cases),the bone mass reduction group(55 cases)and the osteoporosis group(10 cases)according to different T values of bone mineral density.The general data,the levels of fasting blood glucose(FBG),glycosylated hemoglobin(HbA1c),parathyroid hormone(PTH),Nterminal propeptide of typeⅠprecollagen(PINP),osteocalcin(OC),25-hydroxyvitamin D_(3)(25-OH-D_(3)),β-Crosslaps and osteoclast-related cytokines[Macrophage colony-stimulating factor(M-CSF),Receptor Activator of Nuclear Factor-κB Ligand(RANKL)]were compared among all groups.Multivariate Logistic regression was used to analyze the factors affecting the occurrence of osteoporosis in patients with early diabetic kidney disease of deficiency of both qi and yin complicated with blood stasis type,and Pearson test was used to analyze the correlation between bone metabolism and osteoclast-related cytokines.Results:There was no significant difference being found in the comparison of the levels of FBG,HbA1c and PTH among the three groups(P>0.05).The levels of PINP,25-OH-D_(3),and OC in the bone mass reduction group and osteoporosis group were lower than those in the normal bone mass group(P<0.05),while the levels of PINP,25-OH-D_(3),and OC in the osteoporosis group were lower than those in the bone mass reduction group(P<0.05).The level ofβ-Crosslaps in the osteoposis group were higher than those of the bone loss group and normal bone mass group(P<0.05).The levels of M-CSF and RANKL in the normal bone mass group were lower than those in the bone mass reduction group and osteoporosis group(P<0.05),and the levels of M-CSF and RANKL in the bone mass reduction group was lower than that in the osteoporosis group(P<0.05).Decreased levels of PINP,25-OH-D_(3),OC and increased levels ofβ-Crosslaps were risk factors for the occurrence of osteoporosis in patients with diabetic kidney disease(P<0.05).The levels of M-CSF and RANKL were positively correlated with the degree of bone mass loss in patients with early diabetic kidney disease of deficiency of both qi and yin complicated with blood stasis type(P<0.05).Conclusion:The activity of osteoclasts is related to bone mass loss in patients with early diabetic kidney disease of deficiency of both qi and yin complicated with blood stasis type.Detection of the levels of PINP,25-OH-D_(3),OC andβ-Crosslaps can help predict the risk of osteoporosis in patients.