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目的探讨绝经后2型糖尿病肾病患者骨密度与骨代谢的关系,并分析其骨密度影响因素。方法选取2014年10月—2016年9月浙江省中医院收治的94例2型糖尿病患者,依据尿白蛋白排泄情况分为单纯糖尿病组和糖尿病肾病组,单纯糖尿病组53例,糖尿病肾病组41例,调查2组患者临床资料,测定其骨密度(BMD),检测患者骨代谢指标骨钙素(BGP)、甲状旁腺素(PTH),I型前胶原氨基末端前肽(PINP)、I型胶原羧基端肽β特殊序列(β-CTX),比较2组差异;并分析绝经后2型糖尿病肾病患者BMD与骨代谢的关系。结果糖尿病肾病组病程、PTH、β-CTX均明显高于单纯糖尿病组(P<0.001),糖尿病肾病组BMD、BGP、PINP均明显低于单纯糖尿病组(P<0.01);偏相关分析控制年龄、病程、绝经年限、体质量指数,结果显示,绝经后2型糖尿病肾病患者BMD与PTH、PINP、β-CTX呈负相关(P<0.05);多因素线性回归分析结果显示,体质量指数、绝经年限、PINP、β-CTX是绝经后2型糖尿病肾病患者BMD的主要影响因素(P<0.05)。结论绝经后2型糖尿病肾病患者较绝经后单纯糖尿病患者存在病程较长、BMD较低、骨代谢异常的特点,骨代谢指标PTH、PINP、β-CTX可更敏感地反映绝经后2型糖尿病肾病患BMD情况,可以通过评价患者体质量指数、绝经年限、PINP、β-CTX水平,对绝经后2型糖尿病肾病患者BMD进行评估。
Objective To investigate the relationship between bone mineral density (BMD) and bone metabolism in type 2 diabetic patients with postmenopausal nephropathy and to analyze the influencing factors on BMD. Methods 94 patients with type 2 diabetes mellitus admitted to Zhejiang Provincial Hospital of Traditional Chinese Medicine from October 2014 to September 2016 were divided into simple diabetic group and diabetic nephropathy group according to urinary albumin excretion. 53 cases of simple diabetic group and 41 cases of diabetic nephropathy group For example, the clinical data of two groups of patients were surveyed to determine their bone mineral density (BMD), bone mineral density (BGP), parathyroid hormone (PTH), type I procollagen peptide (PINP) (Β-CTX), and to compare the differences between the two groups. The relationship between BMD and bone metabolism in postmenopausal type 2 diabetic nephropathy was analyzed. Results The duration of diabetic nephropathy group, PTH and β-CTX were significantly higher than those in simple diabetic group (P <0.001). BMD, BGP and PINP in diabetic nephropathy group were significantly lower than those in simple diabetic group (P <0.01) (P <0.05). The results of multivariate linear regression analysis showed that body mass index, body mass index, body mass index, body mass index and postmenopausal patients with type 2 diabetic nephropathy had negative correlation with PTH, PINP andβ- Menopausal years, PINP, β-CTX are the main influencing factors of BMD in postmenopausal type 2 diabetic nephropathy (P <0.05). Conclusions Postmenopausal patients with type 2 diabetic nephropathy have longer duration, lower BMD, and abnormal bone metabolism than those with simple diabetes mellitus. The markers of bone metabolism PTH, PINP and β-CTX may reflect more sensitively the postmenopausal type 2 diabetic nephropathy In patients with BMD, BMD in patients with postmenopausal type 2 diabetic nephropathy may be assessed by assessing patient body mass index, menopausal years, PINP, and beta-CTX levels.