CAJ | 학술논문

目的:探讨糖尿病肾病与骨质疏松的关系.设计:病例观察实验.单位:四川大学华西医院内分泌科.对象:依据1997年美国糖尿病协会诊断标准(空腹血糖≥7 mmol/L,餐后血糖≥11.1 mmol/L),选择入院96例糖尿病患者,男性56例,年龄＜60岁,女性40例,均未绝经,排除年龄的影响和因绝经导致的骨质疏松症,患者平均年龄为(48.7±10.5)岁,病程为1个月～21年不等,平均(7.85±2.56)年,所有患者一般情况差异无显著性.方法:将纳入患者依据微量白蛋白排泄率及肾功能分成正常白蛋白尿组48例,微量白蛋白尿组28例,大量白蛋白尿组15例及肾功能衰竭组5例.采用双能X线仪测定96例患者的腰椎2～4节、股骨颈、沃德(氏)三角、转子的骨质密度,将有骨质疏松和无骨质疏松的患者分成2组对空腹血糖、餐后2 h血糖、糖基血红蛋白、碱性磷酸酶、钙、磷、血尿素氮、肌酐、体质量指数尿微量白蛋白排泄率等指标进行比较.主要观察指标:所有糖尿病患者空腹血糖、餐后2 h血糖、糖基血红蛋白、碱性磷酸酶、钙、磷、血尿素氮、肌酐、体质量指数尿微量白蛋白排泄率;所有患者的骨密度.结果:大量白蛋白尿组患者腰椎骨(L2～3)的骨密度与微量白蛋白尿组患者相比差异有显著性(P＜0.05),肾功能衰竭组患者髋关节及腰椎骨的骨密度与其他各组相比下降幅度较大,差异有显著性(P＜0.01).合并骨质疏松与未合并骨质疏松组间的病程、糖基血红蛋白、碱性磷酸酶、体质量指数差异有显著性(P＜0.05).结论:随着肾脏损害加重骨质疏松发生率增高,糖尿病肾脏损害早期可能与骨密度下降和骨质疏松的发生密切相关.
목적:탐토당뇨병신병여골질소송적관계.설계:병례관찰실험.단위:사천대학화서의원내분비과.대상:의거1997년미국당뇨병협회진단표준(공복혈당≥7 mmol/L,찬후혈당≥11.1 mmol/L),선택입원96례당뇨병환자,남성56례,년령＜60세,녀성40례,균미절경,배제년령적영향화인절경도치적골질소송증,환자평균년령위(48.7±10.5)세,병정위1개월～21년불등,평균(7.85±2.56)년,소유환자일반정황차이무현저성.방법:장납입환자의거미량백단백배설솔급신공능분성정상백단백뇨조48례,미량백단백뇨조28례,대량백단백뇨조15례급신공능쇠갈조5례.채용쌍능X선의측정96례환자적요추2～4절、고골경、옥덕(씨)삼각、전자적골질밀도,장유골질소송화무골질소송적환자분성2조대공복혈당、찬후2 h혈당、당기혈홍단백、감성린산매、개、린、혈뇨소담、기항、체질량지수뇨미량백단백배설솔등지표진행비교.주요관찰지표:소유당뇨병환자공복혈당、찬후2 h혈당、당기혈홍단백、감성린산매、개、린、혈뇨소담、기항、체질량지수뇨미량백단백배설솔;소유환자적골밀도.결과:대량백단백뇨조환자요추골(L2～3)적골밀도여미량백단백뇨조환자상비차이유현저성(P＜0.05),신공능쇠갈조환자관관절급요추골적골밀도여기타각조상비하강폭도교대,차이유현저성(P＜0.01).합병골질소송여미합병골질소송조간적병정、당기혈홍단백、감성린산매、체질량지수차이유현저성(P＜0.05).결론:수착신장손해가중골질소송발생솔증고,당뇨병신장손해조기가능여골밀도하강화골질소송적발생밀절상관.
BACKGROUND: Most of the literatures only reported that there is a great difference between diabetics who have a high 24-hour urinary albumin excretion rate and those without renal damage, but there is no obvious difference between cases of microalbuminuria and those without renal damage.OBJECTIVE: To probe into the relationship between diabetic nephropathy and osteoporosis.DESIGN: A case-control study.SETTING: Department of Endocrinology, West China Hospital of Sichuan University.PARTICIPANTS: According to the diagnostic standard set by the American Diabetes Association in 1997 (fasting blood glucose ≥ 7 mmol/L,postprandial blood glucose ≥ 11.1 mmol/L), 96 diabetic patients were selected, including 56 males ＜ 60 years old and 40 females who had not entered the menopausal period, excluding the influence of age and osteoporosis caused by menopause. The average age of the subjects was (48.7±10.5)years, their duration were from one month to twenty-one years with the aver age of (7.85±2.56) years, and their general information had no significant differences.METHODS: According to the urine albumine excretion rate and renal function, the patients were divided into four groups: normal albuminuria group (n=48), microalbuminuria group (n=28), macroalbuminuria group (n=15), renal failure group (n=5). The bone mineral densities of lumbar spines (L2-4), femoral neck, Ward's triangle and trochanter were detected with Dual energy X-ray absorptiometry, and then the fasting blood glucose,2-hour postprandial blood glucose, glycosylated hemoglobin A, alkaline phosphatase, calcium, phosphorus, blood urea nitrogen, creatinine and urine albumine excretion rate were compared between the patients with and without osteoporosis.MAIN OUTCOME MEASURES: The fasting blood glucose, 2-hour postprandial blood glucose, glycosylated hemoglobin A, alkaline phosphatase, calcium, phosphorus, blood urea nitrogen, creatinine and urine albumine excretion rate, as well as the bone mineral density, were observed in all the patients.RESULTS: The L2-3 bone mineral density in the macroalbuminuria group was significantly different from that in the microalbuminuria group (P ＜ 0.05). The proximal femur bone mineral density in the microalbuminuria group was significantly different from that in the normal albuminuria group (P ＜ 0.05). The bone mineral densities of proximal femur and lumbar spine in the renal failure group were significantly decreased as compared with those in the other groups (P ＜ 0.01). The disease course,glycosylated hemoglobin A, alkaline phosphatase and body mass index were significantly different between the patients with and without osteoporosis (P ＜ 0.05).CONCLUSION: The incidence rate of osteoporosis is increased with the aggravation of nephropathy, and diabetic nephropathy may be closely correlated with the decrease of bone mineral density and the occurrence of osteoporosis.