老年男性2型糖尿病患者糖尿病肾病进展对骨密度的影响及相关因素分析

摘要

目的 观察老年男性2型糖尿病肾病进程与骨密度的关系以及其他影响骨代谢的相关因素.方法 225例老年男性2型糖尿病患者,其中正常清蛋白尿组59例,微量清蛋白尿组55例,大量蛋白尿组54例,大量蛋白尿伴血肌酐升高组57例,采用双能X线骨密度仪测定及挠骨、股骨近端和腰椎的骨密度,并进行临床和生化指标的分析.结果 与正常清蛋白尿组相比,微量清蛋白尿组的骨密度有下降趋势,但差异无统计学意义(P50.05);大量蛋白尿组和大量蛋白尿伴血肌酐升高组的骨密度则显著降低(P<0.05).老年男性2型糖尿病肾病患者骨密度与年龄、糖尿病病程、糖化血红蛋白(HbAlc)、血肌酐、血尿素氮及尿清蛋白肌酐比值、尿视黄醇蛋白、尿转铁蛋白呈负相关(P<0.05或＜0.01),与体质量指数、尿酸、尿TH(Tamm-Horsfall)糖蛋白呈正相关(P<0.05).结论 老年男性2型糖尿病患者的骨密度与多种因素有关,糖尿病肾病的进展是其重要的影响因素.%Objective To investigate the impact of diabetic nephropathy process and other related factors on bone mineral density (BMD) in elder male patients with type 2 diabetes. Methods BMD of radius, the upper part of femur and spine (L2-L4) were measured with dual-energy X-ray absorptiometry in 225 patients with type 2 diabetes including 4 groups: 59 cases of normal albuminuria, 55 cases of microalbuminuria, 54 cases of clinical albuminuria and 57 cases of clinical albuminuria with increased serum creatinine. Clinical and biochemical parameters of these patients were collected. Results Compared to normal albuminuria group, BMD of microalbuminuria group had a no significant descending (P>0.05), while BMD of clinical albuminuria group and clinical albuminuria with increased serum creatinine group declined significantly. BMD of radius, femur and spine were negatively correlated with age, disease duration, glycolated hemoglobin(HbAlc),serum creatinine and urea nitrogen, urinary albumin creatinine ratio, urinary retinol binding protein and transferrin, but positively correlated with body mass index, urine acid and urinary Tamm-Horsfall protein. Conclusion BMD of elder male type 2 diabetic patients were affected by varied factors, especially by gradually deteriorating diabetic nephropathy.