中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2010年
28期
1-4
,共4页
顾波%路建饶%易扬%王汉青%董蓓晔
顧波%路建饒%易颺%王漢青%董蓓曄
고파%로건요%역양%왕한청%동배엽
糖尿病肾病%营养不良%肾功能衰竭,慢性%骨钙素%胶原
糖尿病腎病%營養不良%腎功能衰竭,慢性%骨鈣素%膠原
당뇨병신병%영양불량%신공능쇠갈,만성%골개소%효원
Diabetic nephropathies%Malnutrition%Kidney failure,chronic%Osteocalcin%Collagen
目的 研究老年2型糖尿病肾病(DN)不同阶段骨代谢的特点.方法 对150例老年2型DN不同阶段患者(无微量白蛋白尿组、微量白蛋白尿组、临床蛋白尿组、DN肾功能不全组、DN尿毒症组,每组30例)、60例非DN的老年慢性肾衰竭患者(非DN肾功能不全组、非DN尿毒症组,每组30例)和30例健康老年人(对照组),进行骨钙素、β-胶原蛋白、全段甲状旁腺激素(iPTH)、碱性磷酸酶、血清钙、血清磷以及钙磷乘积的检测.结果 与对照组比较,无微量白蛋白尿组、微量白蛋白尿组、临床蛋白尿组中骨钙素、β-胶原蛋白皆较低,且以微量白蛋白尿组最低(P＜0.01);而DN肾功能不全组、DN尿毒症组皆比对照组高(P＜0.01).在慢性肾衰竭阶段,DN与非DN肾功能不全期和尿毒症期比较,骨钙素、β-胶原蛋白与iPTH差异无统计学意义,但骨钙素、β-胶原蛋白与iPTH两两之间存在线性相关性.血清磷在DN肾功能不全组、DN尿毒症组中皆明显高于对照组(P＜0.01).无论DN还是非DN,钙磷乘积变化皆受血清磷影响较大,受血清钙影响较小.结论 老年2型DN患者不同阶段,受到肾功能损害的影响不同,对骨代谢影响也不一样,其产生的机制也发生变化,早期以低转运为主,后期逐渐转化为高转运,应区别对待.
目的 研究老年2型糖尿病腎病(DN)不同階段骨代謝的特點.方法 對150例老年2型DN不同階段患者(無微量白蛋白尿組、微量白蛋白尿組、臨床蛋白尿組、DN腎功能不全組、DN尿毒癥組,每組30例)、60例非DN的老年慢性腎衰竭患者(非DN腎功能不全組、非DN尿毒癥組,每組30例)和30例健康老年人(對照組),進行骨鈣素、β-膠原蛋白、全段甲狀徬腺激素(iPTH)、堿性燐痠酶、血清鈣、血清燐以及鈣燐乘積的檢測.結果 與對照組比較,無微量白蛋白尿組、微量白蛋白尿組、臨床蛋白尿組中骨鈣素、β-膠原蛋白皆較低,且以微量白蛋白尿組最低(P＜0.01);而DN腎功能不全組、DN尿毒癥組皆比對照組高(P＜0.01).在慢性腎衰竭階段,DN與非DN腎功能不全期和尿毒癥期比較,骨鈣素、β-膠原蛋白與iPTH差異無統計學意義,但骨鈣素、β-膠原蛋白與iPTH兩兩之間存在線性相關性.血清燐在DN腎功能不全組、DN尿毒癥組中皆明顯高于對照組(P＜0.01).無論DN還是非DN,鈣燐乘積變化皆受血清燐影響較大,受血清鈣影響較小.結論 老年2型DN患者不同階段,受到腎功能損害的影響不同,對骨代謝影響也不一樣,其產生的機製也髮生變化,早期以低轉運為主,後期逐漸轉化為高轉運,應區彆對待.
목적 연구노년2형당뇨병신병(DN)불동계단골대사적특점.방법 대150례노년2형DN불동계단환자(무미량백단백뇨조、미량백단백뇨조、림상단백뇨조、DN신공능불전조、DN뇨독증조,매조30례)、60례비DN적노년만성신쇠갈환자(비DN신공능불전조、비DN뇨독증조,매조30례)화30례건강노년인(대조조),진행골개소、β-효원단백、전단갑상방선격소(iPTH)、감성린산매、혈청개、혈청린이급개린승적적검측.결과 여대조조비교,무미량백단백뇨조、미량백단백뇨조、림상단백뇨조중골개소、β-효원단백개교저,차이미량백단백뇨조최저(P＜0.01);이DN신공능불전조、DN뇨독증조개비대조조고(P＜0.01).재만성신쇠갈계단,DN여비DN신공능불전기화뇨독증기비교,골개소、β-효원단백여iPTH차이무통계학의의,단골개소、β-효원단백여iPTH량량지간존재선성상관성.혈청린재DN신공능불전조、DN뇨독증조중개명현고우대조조(P＜0.01).무론DN환시비DN,개린승적변화개수혈청린영향교대,수혈청개영향교소.결론 노년2형DN환자불동계단,수도신공능손해적영향불동,대골대사영향야불일양,기산생적궤제야발생변화,조기이저전운위주,후기축점전화위고전운,응구별대대.
Objective To study the feature of bone metabolism in different phase of elder type 2 diabetic nephropathy (DN) patients.Methods One hundred and fifty elder type 2 DN patients (non-microalbuminuria group,microalbuminuria group,clinic proteinuria group,DN renal inadequacy group and DN uremia group,each group was 30 cases),60 elder non-DN patients in chronic renal failure (CRF) (non-DN renal inadequacy group and non-DN uremia group,each group was 30 cases) ,and 30 elder healthy people (control group) were selected to observe the changes of osteocalcin (OT),β -crosslaps,parathyroid hormone ( iPTH),alkaline phosphatase (AKP),serum calcium (Ca),serum phosphorus (P) and Ca × P.Results In non-microalbuminuria group,microalbuminuria group and clinic proteinuria group,OT and β -crosslaps levels were lower than those in control group,and the lowest in microalbuminunia group (P＜0.01).In DN renal inadequacy group and DN uremia group,OT and β -crosslaps levels were higher than those in control group(P＜0.01).In the phase of CRF,OT,β -crosslaps and iPTH had no statistic difference between DN patients and non-DN patients,but had linear correlation.Serum P level was higher in DN renal inadequacy group and DN uremia group than that in control group(P＜0.01).Either DN or non-DN,serum P had more influence to Ca × P than serum Ca.Conclusions In the different phase of elder type 2 DNpatients,the effect of bone metabolism is different because of the different injury of renal function.Bone metabolism in the different phase has respective feature and mechanism,with low turnover in the first and high turnover in the end.
