CAJ | 학술논문

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）明显高于其他3组（P＜0.05），其他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更敏感地反映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。
목적：탐토2형당뇨병（T2DM）불동계단당뇨병신병（DN）환자적골밀도（BMD）급골대사표지물적변화。방법검측T2DM정상백단백뇨환자（51례）여DN환자（미량백단백뇨조40례，림상백단백뇨조28례，신공불전조20례）적BMD급골대사지표。결과25간유생소D3（25-OH-D3）재정상백단백뇨조최고，재DN각조간수착신공능적악화축점강저（P＜0.05）。DN각조혈청골개소（BGP）급혈청총I형효원안기단연장태（T-PINP）균저우정상백단백뇨조（P＜0.05）。 DN각조I형효원최기단태β특수서렬（βCTX）균고우정상백단백뇨조（P＜0.05）。신공불전조혈청갑상방선격소（PTH）명현고우기타3조（P＜0.05），기타각조간차이무현저성（P＞0.05）。대량백단백뇨조급신공불전조각부위BMD치균저우정상백단백뇨조（P＜0.05）。다원상관분석표명요추BMD급고골경BMD여년령、혈Cr、BUN、뇨MA/Cr、βCTX、PTH성부상관，여혈Ca、25-OH-D3、BGP、T-PINP성정상관，녀성환자요추BMD급고골경BMD여절경년한성부상관。결론수착T2DM환자신공능축점하강，기골량감소적정도축점가중，T-PINP、BGP、βCTX、25-OH-D3등골대사지표교BMD경민감지반영DN조기골대사적변화。DN환자적BMD여년령、절경년한、뇨MA/Cr、25-OH-D3등인소상관。
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 ofβ-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.