【摘要】 目的:以跟骨定量超声为评估依据,探讨绝经后糖尿病肾病患者骨密度变化及其骨代谢特征,并做两者关系的直线相关分析。方法:选择2003-01/2004-06上海杨浦区中心医院内分泌科住院2型糖尿病患者84例,年龄60～80岁,均为绝经后女性。根据尿白蛋白排泄率分为2组,尿白蛋白排泄率<20μg/min为单纯糖尿病组(n=44),尿白蛋白排泄率≥20μg/min为伴有糖尿病肾病组(n=40)。观察两组患者定量跟骨超声传导速度、振幅衰减和骨硬度指数的变化,同时测定空腹血糖、糖化血红蛋白、体质量指数、尿白蛋白排泄率、甲状旁腺素、骨钙素等指标。结果:按意向处理分析,进入结果分析病例84例。①伴有糖尿病肾病组跟骨定量超声振幅衰减、超声传导速度及骨硬度指数明显低于单纯糖尿病组(61.25±10.56)dB/MHz,(1480.25±112.11)m/s,(53.12±10.25)%;(68.93±13.24)dB/MHz,(1600.23±120.41)m/s,(62.65±11.45)%,t=2.9198,4.7126,4.0036,P<0.01。②伴有糖尿病肾病组患者甲状旁腺素、骨钙素水平明显高于或低于单纯糖尿病组(18.01±5.62)ng/L,(3.05±2.63)μg/L;(12.16±4.76)ng/L,(4.96±3.08)μg/L,t=5.1626,3.0412,P<0.01,0.05。③直线相关分析表明糖尿病肾病患者骨密度与甲状旁腺素水平呈负相关(r=-0.376,-0.382,-0.354,P<0.01),与骨钙素更多还原

【Abstract】 AIM:To investigate the changes of bone mineral density and the characteristics of bone metabolism in postmenopausal patients with diabetic nephropathy taking calcaneus quantitative ultrasound as the evidence of evaluation,and analyze the linear correletion between them. METHODS:Eighty-four postmenopausal female type 2 diabetic patients at 60 to 80 years of age,who were hospitalized in the Department of Endocrinology,Yangpu District Central Hospital between January 2003 and June 2004,were divided into two groups according to the excretory rate of uric albumin:simple diabetic group(n=44,excretory rate of uric albumin was less than 20 μg per minute) and diabetic nephropathy(n=40,excretory rate of uric albumin was no less than 20 μg per minute).The ultrasound conduction velocity,broadband ultrasound attenuation(BUA) and bone stiffness index were observed in both groups,meanwhile their fasting blood glucose(FBG),glycosylated hemoglobin A(HbA1c),body mass index(BMI),excretory rate of uric albumin,parathyroid hormone(PTH) and bone Gla-containing protein(BGP) were determined. RESULTS:According to intention-to-treat(ITT) analysis,all the 84 cases were involved in the analysis of results.①Broadband ultrasound attenuation(BUA),ultrasound conduction velocity and bone stiffness index in the diabetic nephropathy group[(61.25±10.56) dB/MHz,(1 480.25±112.11) m/s,(53.12±10.25)%] were obviously lower than those in the simple diabetic group[(68.93±13.24) dB/MHz,(1 600.23±120.41) m/s,(62.65 ±11.45)%] (t=2.919 8,4.712 6,4.003 6,P< 0.01).②PTH level was obviously higher but BGP level was markedly lower in the diabetic nephropathy group[(18.01±5.62),(3.05±2.63) μg/L] than in the simple diabetic group[(12.16±4.76),(4.96±3.08) μg/L](t=5.162 6,3.041 2,P< 0.01,0.05).③Linear correlation analysis showed that BMD of patients with diabetic nephropathy was negatively correlated with PTH level(r=-0.376,-0.382,-0.354,P< 0.01),but positively correlated with BGP level(r=0.398,0.346,0.342,P< 0.01). CONCLUSION:The osteoporosis is more serious in postmenopausal type 2 diabetic patients with nephropathy than in those with diabetes only.The occurrence may be related with the increase of bone resorption caused by increased PTH,and the reduce of BGP induced by decreased bone formation.更多还原