| Objective:To investigate the changes in Bone Mineral Density(BMD),Bone Mineral Content(BMC)and related influencing factors of patients with type 2 diabetes and patients with type 2 diabetic nephropathy hospitalized in the Affiliated Hospital of North Sichuan Medical College,with a view to early detection of changes in BMD in patients with diabetic nephropathy,and actively take intervention measures to reduce the risk of fractures and improve quality of life.Methods:1.371 patients with type 2 diabetespatients hospitalized in the Affiliated Hospital of North Sichuan Medical College from January 2017 to May 2019 were involved in this retrospective research.Based on the urinary albumin/creatinine ratio of timely urine samplesand estimated glomerular filtration rate,patients were divided into four groups:normal albuminuria group(group A),microalbuminuria group(group B),clinical albuminuria group(group C),and end-stage renal disease group(group D).2.Collect demographic data such as age,smoking history,height,weight and other biochemical indicators containing of urinary albumin/creatinine ratio,serum calcium,serum phosphorus,uric acid,etc.,and use DXA to measure the BMC and BMD of the lumbar spine,femoral neck,Ward’s triangle and other parts.3.Statistical analysis was performed using SPSS22.0.Non-normal distribution data were analyzed by non-parametric test,quantitative data conforming tothe normal distributionadopt analysis of varianceand qualitative data were analyzed by chi-square test.Multivariate linear regression was used to analyze the influencing factors of BMC,BMD in each part.Results:1.Comparison of general indicators:there was no significant difference in age,gender composition,body mass index,and smoking rates among patients in each group(P>0.05).The course of diabetes in end-stage renal patients was longer than that in the normal albuminuria group and microalbuminuria group(P<0.05).2.Comparison of biochemical indicators:there was a downward trend in serum calcium levels between the 4 groups,but there was no significant difference(P>0.05).The levels of serum phosphorus,magnesium and uric acid in patients with end-stage renal disease were significantly higher than those in the other three groups,the difference was statistically significant(P<0.05).The fasting plasma glucoselevel of the normal albuminuria group was lower than that of the other three groups,and the difference was statistically significant(P<0.05).Patients with end-stage renal disease have lower total cholesterol and low density lipoprotein cholesterol than the other three groups and high density lipoprotein cholesterol in patients withend-stage renal disease is lower than that innormal albuminuria group andclinical albuminuria group,the difference was statistically significant(P<0.05).There was no significant difference in triglyceride levels between the 4 groups(P>0.05).3.Compared with the normal albuminuria group,the BMD and BMC of the femoral neck of the microalbuminuria group showed a downward trend,but there was no statistical difference(P>0.05);With the progress of the disease,the BMD of the femoral neck further decreased.Compared with the normal albuminuria group,the BMDof the femoral neck of the clinical albuminuria group decreased significantly(P<0.05),and the BMC decreased also,but the difference was not statistically significant.(p>0.05).The BMC of lumbar vertebrae in the four groups increased gradually,but there was no significant difference(P>0.05).The comparison between the 4 groups,the BMD of lumbar vertebrae decreased first and then increased.The BMD of lumbar vertebrae in microalbuminuria group was lower than that in normal albuminuria group,but there was no significant difference(P>0.05).The BMD of L3,L1-4 and L2-4 in patients with end-stage renal disease was significantly higher than that in the normal albuminuria group and the microalbuminuria group,the difference was statistically significant(P<0.05).Comparison of normal albuminuria group,microalbuminuria group and clinical albuminuria group,there was no significant difference in the area of proximal femur between the 3 groups.The lumbar vertebral body area in patients with end stage renal disease was lower than that in the microalbuminuria group and clinical albuminuria group,but the difference was not statistically significant(P>0.05).4.BMD in patients with diabetic nephropathy was positively correlated with BMI,but BMD was negatively correlated with age;and the BMC in the proximal femur was negatively correlated with age and positively correlated with BMI.The BMC of lumbar vertebrae was negatively correlated with blood phosphorus and positively correlated with blood magnesium.Conclusion:1.With the development of diabetic nephropathy,the bone mineral content and bone mineral density of the proximal femur of the patients decreased gradually,leading to the risk of osteoporosis and fracture.For diabetic nephropathy patients,the measurement of bone mineral density of the femoral neck can better reflect the loss of bone mass than that of the lumbar spine.2.BMD can better reflect the bone loss of patients with diabetic nephropathy than BMC,but it should still be combined with BMC to comprehensively evaluate the bone loss of patients.3.Age and BMI are the influencing factors of BMD.Age and BMI are also the influencing factors of BMC in proximal femur. |
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