血清皮质醇、促肾上腺皮质激素水平预测糖尿病肾病患者钙磷代谢紊乱价值分析  

Value analysis of serum cortisol and ACTH levels in predicting calcium and phosphorus metabolism disorders in patients with diabetic nephropathy

作　　者：陈璟 李文亚[2] 邵翔 孔维信[1] Chen Jing;Li Wenya;Shao Xiang;Kong Weixin(Department of Nephrology, Suzhou Kowloon Hospital Affiliated to School of Medicine, Shanghai Jiaotong University, Jiangsu Province,Suzhou 215028, China)

机构地区：[1]上海交通大学医学院附属苏州九龙医院肾内科,215028 [2]上海交通大学医学院附属苏州九龙医院内分泌科,215028

出　　处：《疑难病杂志》2021年第8期770-774,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：2018苏州市民生科技项目(SYS2018007)。

摘　　要：目的观察糖尿病肾病(DN)患者血清皮质醇(COR)、促肾上腺皮质激素(ACTH)水平及其与血钙、血磷水平的相关性,及其预测钙磷代谢紊乱的价值。方法选择2018年1月—2020年1月上海交通大学医学院附属苏州九龙医院肾内科诊治DN患者152例为DN组,并选取同期2型糖尿病住院患者70例为糖尿病组,检测2组患者血清COR、ACTH、血钙及血磷水平,分析DN患者血清COR、ACTH水平与血钙及血磷水平的相关性,预测DN患者钙磷代谢紊乱的价值。结果DN组血清COR、ACTH、血磷水平及钙磷乘积高于糖尿病组,血钙水平低于糖尿病组(t=10.059、27.934、19.580、20.741、10.892,P均<0.001);152例DN患者钙磷代谢紊乱发生率为21.05%(32/152),钙磷代谢紊乱亚组血清COR、ACTH、血磷水平及钙磷乘积均高于钙磷代谢正常亚组,血钙水平低于钙磷代谢正常亚组(t=7.299、18.661、2.178、11.949、9.577,P<0.05);血清COR、ACTH与血钙呈负相关,与血磷呈正相关(r=-0.981、-0.897、0.949、0.952,P均<0.001);血清COR、ACTH过表达是DN患者发生钙磷代谢紊乱的危险因素[OR(95%CI)=1.065(1.040~1.092)、25.671(3.264~98.597)],二者单独及联合预测DN患者钙磷代谢紊乱风险的AUC(95%CI)分别为0.831(0.762~0.899)、0.847(0.773~0.920)、0.861(0.804~0.919)。结论DN患者有较高的钙磷代谢紊乱风险,血清COR、ACTH过表达可能是引起DN患者钙磷代谢紊乱的危险因素,可作为预测DN患者钙磷代谢紊乱风险的有效指标。Objective To observe the serum cortisol(COR)and adrenocorticotropic hormone(ACTH)levels in patients with diabetic nephropathy(DN)and their correlation with serum calcium and phosphorus levels,and their value in predicting calcium and phosphorus metabolism disorders.Methods From January 2018 to January 2020,152 patients with DN diagnosed and treated by the Department of Nephrology,Suzhou Kowloon Hospital,Shanghai Jiaotong University School of Medicine,were selected as the DN group,and 70 patients with type 2 diabetes in the same period were selected as the diabetes group,and the serum COR of the patients in the two groups was tested.ACTH,blood calcium and blood phosphorus levels,analyze the correlation between serum COR,ACTH levels and blood calcium and blood phosphorus levels in DN patients,and predict the value of calcium and phosphorus metabolism disorders in DN patients.Results Serum COR,ACTH,blood phosphorus levels and calcium-phosphorus product in the DN group were higher than those in the diabetes group,and blood calcium levels were lower than those in the diabetes group(t=10.059,27.934,19.580,20.741,10.892,all P<0.001).The incidence of calcium and phosphorus metabolism disorder in 152 patients with DN was 21.05%(32/152).The serum COR,ACTH,blood phosphorus levels and calcium-phosphorus product of the calcium and phosphorus metabolism disorder subgroup were higher than those of the normal calcium and phosphorus metabolism subgroup,and the blood calcium level was lower than that of calcium and phosphorus.The subgroup with normal metabolism(t=7.299,18.661,2.178,11.949,9.577,P<0.05).Serum COR and ACTH were negatively correlated with serum calcium,and positively correlated with serum phosphorus(r=-0.981,-0.897,0.949,0.952,all P<0.001).Serum COR and ACTH overexpression are risk factors for calcium and phosphorus metabolism disorders in DN patients[OR(95%CI)=1.065(1.040-1.092),25.671(3.264-98.597)],both alone and in combination predict calcium and phosphorus in DN patients The AUC(95%CI)of metabolic disorder risk

关 键 词：糖尿病肾病 皮质醇 促肾上腺皮质激素 血钙 血磷 代谢紊乱 相关性 

分 类 号：R587.2[医药卫生—内分泌]