【摘要】 目的：虽然糖尿病的骨量减少的病因学和病理生理学还不清楚，糖尿病并发骨质量丢失已经引起注意。通过检测糖尿病患者反映骨形成的生化标志血清骨钙素以研究糖尿病肾病的骨代谢改变。方法：用放射免疫法测定３１７例糖尿病患者和６０例正常人的血清骨钙素水平，糖尿病患者按Ｍｏｇｅｎｓｅｎ方法将肾脏病变不同阶段分为５组。结果：糖尿病患者血清骨钙素水平显著低于正常对照组（４．０４±１．７４ｖｓ５．４８±１．５１ｎｇ／ｍｌ，ｐ＜０．００１）。按糖尿病肾病程度分组后Ⅰ～Ⅴ组分别为４．１９，４．３５，３．４７，３．３０，３．７４ｎｇ／ｍｌ，随ＤＮ病程的进展逐步降低，但Ⅴ组（氮质血症期）的骨钙素并不低于Ⅲ组（早期糖尿病肾病期）和Ⅳ组（糖尿病肾病期）。结论：糖尿病患者血清骨钙素水平降低提示成骨细胞活性减低，骨形成减少。在糖尿病合并微血管病变，尿白蛋白排出量增加时血清骨钙素水平下降更显著。继发性甲状旁腺机能亢进和骨转换率的增加，可能是造成氮质血症组的骨钙素不低于Ⅲ组和Ⅳ组的原因更多还原

【Abstract】 The complication of bone mass loss has been observed in diabetes,however,the etiology and pathophysiology of diabetic osteopenia are still unclear.Serum levels of ostoclacin,which is a biochemical maker of bone formation and bone remodeling,were measured in subjects with diabetes mellitus to investigate the alteration of calcium/bone metabolism in diabetic nephropathy(DN).Methods:Serum levels of osteocalcin were measured by radioimmunoassay in 317 patients with diabetes and 60 control subjects.The patients with diabetes were divided into 5 groups according to the different stages in diabetic nephtopathy described by Mogensen.Results:Serum levels of osteocalcin were significantly lower in groups of diabetic patients than in the control group (4.04 vs 5.48ng/ml, p <0 001).Serum levels of osteocalcin were gradually decreased with advancing stages of diabetic nephropathy(4 19,4 35,3 47,3.30,3.74ng/ml),but the osteocalcin in group 5 (renal failure)were not lower than in group 3 (incipient DN) and group 4 (overt DN).Conclusion:The decrease of serum osteocalin levels suggest that osteoblast function is significantly decreased in diabetic patients.In diabetic patients with microvascular complications,serum osteocalcin levels decrease significantly with increasing albuminuria excretion.The fact that serum osteocalcin levels are not lower in diabetic patients with renal function failure is attributed to the secondary hyperparathyroidism and increased rate of bone turnover.更多还原