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  

Changes of serum vitamin D and bone turnover markers levels in elderly type 2 diabetes patients with diabetic nephropathy

作　　者：赵真[1] 王欢[1] 卢玉[1] 王翠英[1] 黄蔚[1] 苗也[1] 刘彦[1] 郭红[1] 马清[1] 

机构地区：[1]首都医科大学附属北京友谊医院医疗保健中心,北京100050

出　　处：《临床和实验医学杂志》2015年第23期1954-1958,共5页Journal of Clinical and Experimental Medicine

基　　金：首都医科大学基础-临床科研合作基金项目(15JL-L01);北京市保健委员会的保健科研课题(京13-05号);北京市友谊医院院启动课题(Y1402)

摘　　要：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。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. Methods 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 〈 O. 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 〈 O. 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 ）. Conclusion 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 relationshi

关 键 词：老年人 糖尿病肾病 维生素D 骨转换标志物 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]