老年2型糖尿病肾病患者维生素D及骨转换标志物水平的变化特征

摘要

Objective To investigate the levels of serum 25(OH)D levels,bone turnover markers and bone mineral density and evaluate their relationship in elderly type 2 diabetes patients with diabetic nephropathy. Methnds A total of 246 elderly patients with type 2 diabetes were involved and divided into several groups according to age,serum 25(OH)D levels and albuminuria. The serum concentrations of 25(OH)D,para-thyroid hormone(PTH),osteocalcin(OC),collagen type 1 cross - linked C - telopeptide(CTX)and bone mineral dentistry(BMD)were meas-ured. The relationship among these factors was analyzed statistically. Results The 25(OH)D,OC and CTX levels showed a tendency to decrease with age,while PTH level had a rising trend( P < 0. 05). With the increase of the level of albuminuria,serum 25(OH)D level was gradually de-creased and the difference was statistically significant( P < 0. 05). Compared with the patients in normoalbuminuria group and microalbuminuria group,patients with macroalbuminuria showed lower levels of OC and CTX( P < 0. 05). BMD of lumbar vertebra and femoral neck in the mac-roalbuminuria group was significantly lower than in normoalbuminuria group( P < 0. 05). The 25(OH)D level was negatively correlated with al-buminuria level in type 2 diabetes patients. The OC and CTX levels showed a tendency to decrease with the decrease of 25(OH)D level,and OC level in vitamin D severe deficiency group was significantly lower than in sufficiency group( P < 0. 01). BMD of lumbar vertebra and femoral neck in vitamin D severe deficiency group was significantly lower than in sufficiency group( P < 0. 05). Cniclusini Vitamin D insufficiency is highly prevalent among diabetic nephropathy in type 2 diabetes patients and the 25(OH)D level has some negative correlation with the level of albuminu-ria. Bone metabolism condition is low conversion type,and the bone turnover markers have a certain relationship with albuminuria and 25(OH) D levels. Objective To investigate the levels of serum 25(OH)D levels,bone turnover markers and bone mineral density and evaluate their relationship in elderly type 2 diabetes patients with diabetic nephropathy. Methnds A total of 246 elderly patients with type 2 diabetes were involved and divided into several groups according to age,serum 25(OH)D levels and albuminuria. The serum concentrations of 25(OH)D,para-thyroid hormone(PTH),osteocalcin(OC),collagen type 1 cross - linked C - telopeptide(CTX)and bone mineral dentistry(BMD)were meas-ured. The relationship among these factors was analyzed statistically. Results The 25(OH)D,OC and CTX levels showed a tendency to decrease with age,while PTH level had a rising trend( P < 0. 05). With the increase of the level of albuminuria,serum 25(OH)D level was gradually de-creased and the difference was statistically significant( P < 0. 05). Compared with the patients in normoalbuminuria group and microalbuminuria group,patients with macroalbuminuria showed lower levels of OC and CTX( P < 0. 05). BMD of lumbar vertebra and femoral neck in the mac-roalbuminuria group was significantly lower than in normoalbuminuria group( P < 0. 05). The 25(OH)D level was negatively correlated with al-buminuria level in type 2 diabetes patients. The OC and CTX levels showed a tendency to decrease with the decrease of 25(OH)D level,and OC level in vitamin D severe deficiency group was significantly lower than in sufficiency group( P < 0. 01). BMD of lumbar vertebra and femoral neck in vitamin D severe deficiency group was significantly lower than in sufficiency group( P < 0. 05). Cniclusini Vitamin D insufficiency is highly prevalent among diabetic nephropathy in type 2 diabetes patients and the 25(OH)D level has some negative correlation with the level of albuminu-ria. Bone metabolism condition is low conversion type,and the bone turnover markers have a certain relationship with albuminuria and 25(OH) D levels.%目的：探讨老年2型糖尿病肾病患者血清25羟维生素 D[25（OH）D]水平、骨转换标志物和骨密度的变化特征及相互关系。方法收集246例老年2型糖尿病患者的临床资料，检测其各生化指标、血清25（OH）D、甲状旁腺素（PTH）及骨转换标志物骨钙素（OC）、胶原 C 端交联物（CTX）水平，并采用双能 X 线骨密度仪测定腰椎及髋部骨密度（BMD）。将研究对象按照年龄、尿白蛋白、25（OH）D 水平分层进行统计分析。结果25（OH）D 水平随年龄增加呈降低趋势，PTH 水平随增龄有升高趋势。OC 及 CTX 水平随增龄而降低（ P <0.05）。随尿白蛋白水平升高，受试者25（OH）D 水平逐渐降低且差异有统计学意义（ P <0.05）。与正常或微量尿白蛋白组相比，大量尿白蛋白组患者 OC 及CTX 水平呈下降趋势（ P <0.05）。大量尿白蛋白组患者腰椎及股骨颈 BMD 明显低于正常尿白蛋白组（ P <0.05）。25（OH）D 水平与尿微量白蛋白呈负相关。随25（OH）D 水平降低，OC 及 CTX 亦呈下降趋势，其中维生素 D 严重缺乏组OC 水平明显低于维生素 D 充足组（ P <0.01），维生素 D 严重缺乏组股骨颈及腰椎 BMD 明显低于维生素 D 充足组（ P <0.05）。结论2型糖尿病肾病患者维生素 D 水平普遍偏低并与尿白蛋白水平具有负相关性。骨代谢状态以低转换型为主，骨转换标志物水平与尿白蛋白及25（OH）D 水平具有一定相互关系。