老年2型糖尿病肾病患者不同阶段对骨代谢影响

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.

Bone metabolism in different phase of elder type 2 diabetic nephropathy patients

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.