| Objective : By measuringthe content of bone mineral density and bone metabolic markers [(25-hydroxyl vitamin D2 and D3(25 to OHD2,25-OHD3),parathyroid hormone(PTH),the general type I collagen amino terminal extension of the peptide(PINP),β-collagen degradation products(β-CTX)] of type 2 diabetesnormal albuminuria group and type 2 diabetes mellitus clinical stage nephropathy group,this research exploresthe correlation with clinical stage of kidney disease in type 2 diabetes,which would help to guide early clinical screening for type 2 diabetes clinical stage nephropathy with osteoporosis disease,and would provide a scientific basisfor timely clinical prevention and treatment of diabetes nephropathy with osteoporosis.Methods : Random data collection from 60 patients with type 2diabetesmellitus inendocrinology inpatient wardof Guangxi Liuzhou People’s Hospital from January 2018 to December 2018.There are 30 cases of type 2diabetic normoalbuminuria group(DM group,group A,the control group),30 cases of clinical stage nephropathy group(DN group,group B,the observation group).There are 7 femalepatients,23 malepatients in the control group;8 female patients,22 male patients in the observation group.Inclusion methods: 1.Diabetes was diagnosed according to the 1999 ADA diagnostic criteria and classification criteria:(1)Typical diabetes symptoms(polydipsia,polydipsia,polydipsia,polyphagia,unexplained weight loss)plus random plasma glucose≥11.1mmol/L(200mg/dl)(2)Fasting blood glucose≥7.0mmol/L.(3)Blood glucose(two hours after glucose load)≥11.1mmol/L(for those without typical diabetes symptoms,reexamination shall be conducted on another day for confirmation).(Note: Fasting status means that the patient has no calories intakeat least for 8hs.Blood glucose at any time of day should not be used to diagnose fasting glucose abnormalities or abnormal glucose tolerance.)If any of the above three items are tested positive for 2 consecutive times,diabetes can be diagnosed.2.Type ii diabetic nephropathy in clinical stage,according to the type IV diabetic nephropathy in Mogensen,is,MA(urinary microalbumin)>300mg/24h,positive urinary protein,normal serum creatinine Scr and glomerular filtration rate>20ml/min.The research collected the clinical data of the subjects,the test items and information related to bone mineral density and bone metabolism markers.Needed venous blood was drawn from all people on an empty stomach.the tested items are 25 hydroxy vitamin D2 and D3(25 to OHD2,25-OHD3),parathyroid hormone(PTH),the general type I collagen amino terminal extension of the peptide(PINP),β-determination of collagen degradation products(β-CTX),glycosylated hemoglobin(Hb A1C),fasting c-peptide(C-P),fasting plasma glucose(FPG),serum Ca2 + and serum phosphorus,as well as the course of the disease,age,height,weight,blood pressure,etc.BMD(g/cm~2),t-score and z-score of l1-4 femoral neck,total hip and lumbar spine were measured by dual-energy X-ray BMD.Results : SPSS 17.0 statistical software was used for all data analysis.Independent sample t test was used for measurement data which was expressed as mean square deviation(X±s).Chi-square test was used for comparison of enumeration data.Those not applicable to chi-square test were tested via Fisher exact method.Pearson correlation analysis was used to analyze the correlation between the indicators.Binary Logistic regression analysis was used to analyze the relationship between the included observation indicators and the subjects.p<0.05 means the difference has statistical significance,and p>0.05 means no statistical significance.The results are as follows:(1)By comparing type 2 diabetes mellitus clinical stage nephropathy group,namely observation group,and normal albuminuria group,the blood PTH was increased(p<0.05).For 25-hydroxyvitamin D2,D3(25-oh-d2,D3),the normal albuminuria group was higher than the clinical nephropathy group of type 2diabetes mellitus(p<0.05).The serum total type I collagen amino terminal prolongation peptide(PINP)in the type 2 diabetic nephropathy group was higher than that in the normal albuminuria group(p<0.05).The determination of β-collagen degradation product(β-CTX)in type 2 diabetic nephropathy group was higher than that in normal albuminuria group(p<0.05).There is no significant statistical difference in serum calcium and serum phosphorus between the type 2 diabetic normoalbuminuria group and the type 2 diabetic nephropathy group at the clinical stage(p>0.05).(2)Fisher’s exact probability method was used to detect that the clinical stage2 diabetic nephropathy group had higher bone loss and osteoporosis than the type 2 diabetic normoalbuminuria group(p<0.05).There is no significant difference in gender,age,body mass index(BMI),blood pressure,blood glucose and disease course between the two groups(p>0.05).BMD of the two groups showed no significant difference(p<0.05).(3)Pearson correlation analysis was performed for the clinical nephropathy group of type 2 diabetes mellitus.There was a positive correlation between2-hydroxyvitamin D2 and BMD values of all lumbar vertebrae,femoral neck and overall hip joint of l1-4.2-hydroxy vitamin D3 with waist 2-4 and all the lumbar spine and femoral neck and total hip BMD values were positively correlated.There was a negative correlation between D2,D3 and PTH.2-hydroxy showed positive correlation between serum calcium and vitamin D2 and D3.PTH was negatively correlated with the BMD values of l1 and l2.The BMD values of lumbar spine,femoral neck and total hip joint were negatively correlated withβ-CTX.The correlation coefficients of vitamin D2 and D3 were 0.2-0.4 on average,and those of PTH and β-CTX were 0.1-0.2on average.(4)Logistics regression analysis of risk factors for clinical nephropathy in type 2 diabetes mellitus found that 25-hydroxyvitamin D2 is negatively correlated with the prevalence of clinical nephropathy in type 2 diabetes mellitus,and PINP was positively correlated with the prevalence of clinical nephropathy in type 2 diabetes mellitus.According to binary Logistic regression analysis,when 25-hydroxyvitamin D2 decreased by 1nmol/L,the risk of clinical nephropathy of type 2 diabetes increased by 0.78 times;for every 1ng/mL increase in PINP,the risk of clinical stage 2 diabetic nephropathy was 0.879 times higher.25-hydroxyvitamin D is a protective factor in type 2 diabetic nephropathy.Conclusions:(1)In the wake of a positive urine protein,patients with type 2diabetes are easy to be with osteopenia and osteoporosis lesions.There are corresponding changes of bone metabolic markers of blood 25 to OHD2,25-OHD3 PTH PINP and β-CTX.The changes would be earlier than changes in bone mineral density values.(2)Among the bone metabolism markers in this study,It was found that the correlation coefficient between 25-hydroxyvitamin D and bone density was highest,and it is a more sensitive indicator of the risk of clinical nephropathy in type 2 diabetes,which can be used as a predictor of osteoporosis in patients with clinical nephropathy.Clinically,25-hydroxyvitamin Dshould be monitored emphatically. |
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