中国骨质疏松杂志

糖尿病肾病患者骨密度及骨代谢标志物的临床研究

Clinical study of bone mineral density and bone metabolism markers in patients with diabetic nephropathy

DOI：10.3969/j.issn.1006-7108.2014.02.012

英文关键词:Type 2 diabetes mellitus Diabetic nephropathy BMD Bone metabolism markers

基金项目:中国医科大学附属第一医院科学研究基金（FSFH1201）；辽宁省科技计划项目（2012225079,20102250002）；国家自然科学基金（81100216）

作者	单位
高明王涤非* 林奕辰杨慧晶吕欣浓费宁李晓琳	中国医科大学附属第一医院内分泌科，沈阳 110001（高明现工作单位为锦州市中心医院）

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中文摘要:

目的探讨2型糖尿病（T2DM）不同阶段糖尿病肾病（DN）患者的骨密度（BMD）及骨代谢标志物的变化。方法检测T2DM正常白蛋白尿患者（51例）与DN患者（微量白蛋白尿组40例，临床白蛋白尿组28例，肾功不全组20例）的BMD及骨代谢指标。结果 25羟维生素D3（25-OH-D3）在正常白蛋白尿组最高，在DN各组间随着肾功能的恶化逐渐降低（P<0.05）。DN各组血清骨钙素（BGP）及血清总I型胶原氨基端延长肽（T-PINP)均低于正常白蛋白尿组（P<0.05）。DN各组I型胶原羧基端肽β特殊序列（βCTX）均高于正常白蛋白尿组（P<0.05）。肾功不全组血清甲状旁腺激素（PTH）明显高于其它三组（P<0.05），其它各组间差异无显著性（P＞0.05）。大量白蛋白尿组及肾功不全组各部位BMD值均低于正常白蛋白尿组（P<0.05）。多元相关分析表明腰椎BMD及股骨颈BMD与年龄、血Cr、BUN、尿MA/Cr、βCTX、PTH成负相关，与血Ca、25-OH-D3、BGP、T-PINP成正相关，女性患者腰椎BMD及股骨颈BMD与绝经年限成负相关。结论随着T2DM患者肾功能逐渐下降，其骨量减少的程度逐渐加重，T-PINP、BGP、βCTX、25-OH-D3等骨代谢指标较BMD更敏感的反映DN早期骨代谢的变化。DN患者的BMD与年龄、绝经年限、尿MA/Cr、25-OH-D3等因素相关。

英文摘要:

Objective To investigate the changes of bone mineral density (BMD) and the bone metabolism markers at different stages of diabetic nephropathy (DN) in patients with type 2 diabetes mellitus (T2DM). Methods Fifty-one T2DM patients with normal albuminuria, 40 DN patients with microalbuminuria, 28 DN patients with clinical albuminuria, and 20 DN patients with renal insufficiency were selected. BMD and the bone metabolism markers in all these patients were detected. Results The concentration of 25-hydroxy vitamin D3 (25-OH-D3) was the highest in normal albuminuria group, and it decreased gradually with the deterioration of renal function in DN groups (P<0.05). The serum concentrations of bone γ-caboxyglutamic acid-containing protein (BGP) and total N-terminal propeptide of type I collagen (T-PINP) in DN groups were lower than those in normal albuminuria group (P<0.05). The concentration of β-C-terminal telopeptides of type I collagen (βCTX) in DN group was higher than that in normal albuminuria group (P<0.05). Serum level of parathyroid hormone (PTH) in renal insufficiency was significantly higher than that in the other 3 groups (P<0.05), and no significant difference among the other 3 groups were observed (P>0.05). BMD of each part in the macroalbuminuria group and renal insufficiency was lower than that in normal albuminuria group (P<0.05). Multiple correlation analysis showed that BMD of the lumbar vertebrae and the femoral neck was negatively correlated with age, serum Cr, BUN, urinary MA/Cr, βCTX, and PTH. It was positively correlated with serum Ca, 25-OH-D3, BGP, and T-PINP. BMD of the lumbar vertebrae and the femoral neck in female patients was negatively correlated with the duration of menopause. Conclusion Along with the gradual decline of renal function in T2DM patients, the extent of bone loss gradually aggravates. The bone metabolic markers, such as T-PINP, BGP, βCTX, and 25-OH-D3, are more sensitive than BMD to reflect the changes of bone metabolism at the early stage of DN. BMD of DN patients is associated with various factors including age, duration of menopause, urinary MA/Cr, and 25-OH-D3.

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