老年2型糖尿病肾病患者不同时期骨转换指标与骨量分析的临床观察

Clinical observation of bone turnover maker and bone mass analysis in elderly patients with type 2 diabetic nephropathy at different stages

目的探讨老年2型糖尿病肾病患者不同时期骨转换指标与骨量相关性。方法根据糖尿病肾病(DN)分期标准和24 h尿白蛋白定量水平,将2017年1月—2018年5月在本院内分泌一科住院治疗的老年2型糖尿病患者分为三组:即DM组25例、ALB升高组22例、肾功能不全组20例。比较三组患者一般资料和生化指标的差异,如年龄、性别、体重指数(简称BMI)、血清钙磷、糖化血红蛋白(以下简称Hb A1c)、骨转换指标I型原胶原氨基端延长肽(PINP)、甲状腺功能、骨钙素(BGP)、维生素D、骨密度(BMD)等。结果随着肾功能进一步发展BGP、PINP、25-OH-D3呈下降趋势,PTH呈上升趋势,组间比较有统计学意义(P<0.05)。各组间骨密度呈下降趋势,差异有统计学意义(P<0.05)。Pearson分析:肾功能不全组的骨密度与PTH负相关,与25-OH-D3、BGP、PINP呈正相关。结论糖尿病肾病的加重可以增加老年2型糖尿病患者骨质疏松的风险,骨转换指标、血生化指标可以直接的反映骨质量的变化及骨丢失的情况,可以预测骨质疏松的风险,并可指导临床工作。

Objective To investigate the correlation between bone turnover maker and bone mass in elderly patients with type2 diabetic nephropathy.Methods According to the standard of DN staging and the quantitative level of 24 hours urinary albumin,the elderly patients with type 2 diabetes mellitus in department of endocrinology of third affiliated hospital of Qiqihar medical college were divided into three groups:DM group(n=25),Al B elevation group(n=22),renal function insufficiency group(n=20).Compare the differences of general data and biochemical indexes among the three groups such as age,sex,BMI,serum phosphorus,Hb A1 c,propeptide of type I procollagen(PINP),thyroid function,bone gla protein(BGP),bone density(BMD)et al.Results With the further development of renal function,BGP,PINP,25-OH-D3 and BMD showed a downward trend,PTH showed an increasing trend,there was statistical significance among the three groups(P<0.05).The bone mineral density(BMD)of renal function insufficiency group was negatively correlated with PTH and positively correlated with BGP,PINP,25-OH-D3(P<0.05).Conclusions The aggravation of diabetic nephropathy could increase the risk of osteoporosis,bone turnover index.Blood biochemical index could directly reflect the changes of bone mineral density and bone loss,could predict the risk of osteoporosis,and could guide the clinical work.