肥胖糖尿病肾病患者血清甲状旁腺激素及骨密度的研究

目的探讨肥胖糖尿病肾病患者的血清甲状旁腺激素(PTH)及骨密度(BMD)的特点。方法回顾性分析乌鲁木齐市友谊医院2018年2月至2019年2月收治的90例2型糖尿病肾病患者,根据体质指数(BMI)将其分为A组非超重型(体重正常,BMI 18.5~22.5 kg/m^2)糖尿病肾病患者,B组肥胖型糖尿病肾病患者(BMI 22.6~25.5 kg/m^2),C组超重型糖尿病肾病患者(BMI>25.5 kg/m^2)。另选取30例非肥胖非肾病的2型糖尿病患者作为对照组。测定并比较每组患者血清PTH,血钙,血磷与Ward三角区值、股骨大转子区、股骨颈、桡骨全段、腰椎区的骨密度值,记录血清PTH所导致的不良反应,以及骨质疏松所导致的并发症的情况进行统计分析。结果A组血钙水平显著高于对照组,血钙水平与对照组比较差异统计学意义(P>0.05);B、C两组患者的血清PTH、血磷水平均显著高于对照组,血钙水平低于对照组(P<0.05),且随着BMI升高,血清PTH、血磷水平显著升高,血钙水平显著降低。A组股骨大转子区、股骨颈、腰椎区骨密度值低于对照组(P<0.05),B、C两组Ward三角区值、股骨大转子区、股骨颈、桡骨全段、腰椎区骨密度值均明显低于对照组,且随着BMI升高,各部位骨密度值明显降低。A组疲劳乏力、肾结石绞痛的发生率均高于对照组(P<0.05),B、C两组疲劳乏力、肾结石绞痛、恶心呕吐、血清PTH型高血压的发生率均明显高于对照组,且随着BMI升高,血清PTH所导致的不良反应发生率明显升高。A组颈椎腰椎病、致残数的发生率均高于对照组,B、C两组行动受阻、颈椎腰椎病、骨折史,致残数均明显高于对照组,差异均具有统计学意义(P<0.05),且随着BMI升高,骨质疏松所导致的并发症发生率明显升高。结论血清PTH与BMD的测定对于肥胖糖尿病肾病的早期诊断具有重要意义,且PTH值随着糖尿病肾病患者的肥胖程度逐步增高,BMD值随着糖尿病肾病患者的肥胖程度逐步降低,且不同区域的骨密度均有不同程度的变化。

Study on serum parathyroid hormone and bone mineral density in obese diabetic nephropathy

Objective To investigate the characteristics of serum parathyroid hormone(PTH)and bone mineral density(BMD)in obese diabetic nephropathy patients.Methods The data of 90 patients with type 2 diabetic nephropathy admitted to Urumqi Friendship Hospital from February 2018 to February 2019 were retrospectively analyzed.They were divided into group A(normal weight patients with non-super heavy diabetic nephropathy),Group B(obese diabetic nephropathy patients)and group C(patients with super severe diabetic nephropathy)according to their body mass index(BMI).Another 30 non-obese and non-renal disease type 2 diabetes patients were selected as the control group.The serum PTH,blood calcium,blood phosphorus and ward triangle value,femoral greater trochanter area,femoral neck,full radius,lumbar spine of bone mineral density were measured and compared in each group,and the adverse reactions caused by serum PTH and the complications caused by osteoporosis were recorded for statistical analysis.Results The level of blood calcium in group A was significantly higher than that of the control group,and the levels of serum PTH,blood phosphorus were significantly different from those of the control group(P>0.05).The levels of serum PTH and blood phosphorus in groups B and C were significantly higher than those in the control group.And as BMI increased,the levels of serum PTH and blood phosphorus increased significantly,and the levels of blood calcium decreased significantly.The bone mineral density values of femoral greater trochanter area,femoral neck,and lumbar vertebrae area in group A were lower than those in the control group(P<0.05).Ward triangle values,femoral trochanter area,femoral neck,full radius,and lumbar vertebrae bones in groups B and C Density values were significantly lower than those in the control group,and with the increase of BMI,the bone density values of each part decreased significantly.The incidence of fatigue and renal stone colic was higher in group A than in the control group(P<0.05).The incidence of fatigue,renal stone colic,nausea and vomiting,and serum PTH-type hypertension were significantly higher in groups B and C.In the control group,with the increase of BMI,the incidence of adverse reactions caused by serum PTH increased significantly.The incidence rate of cervical lumbar spondylosis and disability in group A was higher than that in control group,and the number of disability,cervical lumbar spondylosis,and fracture history in group B and C were significantly higher than those in control group.The differences were statistically significant(P<0.05),and with the increase of BMI,the incidence of complications caused by osteoporosis increased significantly.Conclusion The determination of serum PTH and BMD is of great significance for the early diagnosis of obese diabetic nephropathy patients.PTH value increases and BMD value decreases with the gradually increased obesity level,and the different parts of the bone mineral density all have different degrees of change.It is worthy of basic research value.