糖尿病肾病患者血清BMP2、BMP7水平与钙磷代谢的关系

目的探讨糖尿病肾病患者血清骨形态蛋白-2(BMP2)、骨形态蛋白-7(BMP7)水平与钙磷代谢的关系。方法选取2016年11月至2018年11月西电集团医院收治的126例糖尿病肾病患者作为研究组,采用系统性回顾性分析法分析研究组临床资料,根据不同分期阶段慢性肾脏病(CKD)将患者分为5组,分别为CKD 1组22例、CKD 2组21例、CKD 3组27例、CKD 4组31例、CKD 5组25例,另选取36例同期于西电集团医院门诊体检的健康人群作为对照组,测定患者血清BMP2、BMP7、血磷、血钙、肌酐(Scr)、甲状旁腺激素(iPTH),分析血清BMP2、BMP7与钙磷代谢的关系。结果①对照组与CKD 1~2期在血磷、血钙、Scr、iPTH、BMP2、BMP7水平之间差异无明显统计学意义(P>0.05);与对照组比较,CKD 4期以后血钙及血清BMP7水平明显降低(P<0.05);CKD 3期以后血清Scr、iPTH、BMP2水平明显开始升高、血清BMP7水平明显开始降低(P<0.05);CKD 4期以后血磷、Scr、iPTH、BMP2水平明显升高,血钙、BMP7水平明显降低;CKD 5期的变化情况同CKD 4期;②经Pearson积差相关分析,血清BMP2与血磷、Scr及iPTH呈正相关,与血钙呈负相关(P<0.05);BMP7与血钙呈正相关,与血磷、Scr及iPTH呈负相关(P<0.05);③经多因素多元逐步回归分析,血磷、血钙、Scr及iPTH均为影响糖尿病肾病患者血清BMP2、BMP7水平的相关因素(P<0.05)。结论CKD 3期以后血清BMP2开始升高、BMP7开始降低,且血清BMP2与血钙呈明显负相关,BMP7与血磷、Scr及iPTH呈明显负相关;钙磷代谢情况可能是糖尿病肾病患者血清BMP2升高、BMP7降低的重要相关因素。

Relationship between serum BMP2 and BMP7 levels and calcium and phosphorus metabolism in patients with diabetic nephropathy

Objective  To investigate the relationship between serum bone morphogenetic protein-2 (BMP2), bone morphogenetic protein 7 (BMP7) levels and calcium and phosphorus metabolism in patients with diabetic nephropathy. Methods  The clinical data of 126 patients with diabetic nephropathy admitted to Xidian group hospital from November 2016 to November 2018 were analyzed retrospectively. Patients were divided into 5 groups, namely CKD1(n=22),CKD2(n=21),CKD3(n=27),CKD4(n=31),and CKD5(n=25) according to different stages of chronic kidney disease(CKD). Meanwhile, 36 cases of healthy individuals were set as control group. Serum BMP2, BMP7,serum phosphorus,serum calcium,creatinine(Scr),and parathyroid hormone(iPTH) were measured, and the relationship between serum BMP2 and BMP7 and calcium and phosphorus metabolism was also analyzed. Results   ① Serum phosphorus, serum calcium, Scr, iPTH, BMP2 and BMP7 levels had no difference among patients in the control group and CKD1-2(P>0.05). The serum calcium and serum BMP7 levels of CKD4 were significantly lower than those of the control group(P<0.05). Patients in the CKD3 had elevated serum Scr, iPTH and BMP2 levels and decreased serum BMP7 levels(P<0.05). Patients in the CKD4 and CKD5 had elevated serum phosphorus, Scr, iPTH and BMP2 levels and decreased calcium and BMP7 levels(P<0.05). ② Pearson product correlation analysis showed that serum BMP2 was positively correlated with serum phosphorus, Scr and iPTH, and negatively correlated with serum calcium(P<0.05). ③ Multivariate stepwise regression analysis showed that serum phosphorus, serum calcium, Scr and iPTH were all related factors affecting serum BMP2 and BMP7 levels in patients with diabetic nephropathy(P<0.05). Conclusions  Patient with CKD stage above three has elevated BMP2 and decreased BMP7, which is significantly correlated to the calcium and phosphorus metabolism, because the serum BMP2 is negatively correlated with serum calcium, and BMP7 is negatively correlated with serum phosphorus, Scr and iPTH.