| Objective:We explore the correlation of bone metabolism factors with renal lesions and coronary artery calcification in patients with type 2 diabetes mellitus to provide a theoretical basis for the prevention and treatment of clinical type 2 diabetic nephropathy and cardiovascular calcification.Methods:A total of 157 patients with type 2 diabetes mellitus who were hospitalized in the Second Hospital of Shandong University from December 2021 to February 2023 were selected.Patients were divided into 3 groups according to urinary albumin/microcreatinine ratio(UACR).Patients with 30mg/g≤UACR<300mg/g were classified as early diabetic nephropathy(eDN)group,and patients with UACR≥300mg/g were classified as clinical diabetic nephropathy(cDN)group.We gathered data of patient including the gender,age,smoking history,drinking history,duration of diabetes,and history of hypertension.Fasting blood glucose(FBG),glycosylated hemoglobin(HbA1C),blood lipids,parathyroid hormone(PTH),1,25-dihydroxyvitamin D3(1.25-(OH)2D3),osteocalcin(OC),total N-terminal propeptide of type Ⅰ collagen(tPINP),β-C-terminal peptide of type Ⅰ collagen(β-CTX),calcitonin(CT),albumin(ALB),alkaline phosphatase(ALP),estimated glomerular filtration rate(eGFR),homocysteine(HCY),blood calcium(Ca),blood phosphorus(P),blood magnesium(Mg),brain natriuretic peptide(BNP)were recorded.Enzyme-linked immunosorbent assay was used to detect the content of serum unphosphorylated uncarboxylated matrix Gla protein(dp-ucMGP)in the enrolled patients.Dual-energy X-ray absorptiometry was used to measure the BMD of L1-L4 lumbar spine and unilateral femoral neck.Coronary artery calcification was assessed by cardiac computed tomography(CT)and scored by Agatston score system.Patients were grouped according to the severity of coronary artery calcification score(CACS).Patients with CACS=0 were classified as the noncalcification group(nVC).Mild calcification group(miVC)was defined as 1≤CACS≤100.Moderate calcification group(moVC)was defined as 101≤CACS≤400,and severe calcification group(sVC)was defined as CACS>400.Statistical analysis was performed using SPSS23.0 software.Two-sided P<0.05 was considered significant.Results:Part Ⅰ:There were significant differences in the duration of diabetes,age,systolic blood pressure,ALB,BUN,β2-MG,CYS-C,SCR,eGFR,BNP,HCY,β-CTX,Ca,dp-ucMGP and CACS among the DM group(80 cases),eDN group(51 cases)and cDN group(26 cases).Compared with DM group,patients in cDN group had longer duration of diabetes,older age,lower ALB,eGFR and serum Ca,and higher systolic blood pressure(SBP),BUN,β2-MG,CYS-C,SCR,BNP,HCY,dp-uc MGP and CACS.eDN group had lower ALB,eGFR and serum Ca,and higher BUN,BNP and CACS.The difference was statistically significant(P<0.05).Compared with eDN group,cDN group had lower ALB,eGFR and β-CTX,higher β2MG,CYS-C,SCR,HCY,and the difference was statistically significant(P<0.05).Spearman correlation analysis between UACR and bone metabolism indexes showed that UACR was positively correlated with dp-ucMGP(r=0.311,P<0.001)and CACS(r=0.315,P<0.001),and negatively correlated with Ca(r=-0.240,P<0.05).There was no significant difference in the incidence of osteoporosis among the three groups of all genders.After stratification by gender,the incidence of osteoporosis in female patients with DN(eDN+cDN)was significantly higher than that in DM group(P<0.05),while in male patients,the incidence of osteoporosis was not related to the presence of DN(P>0.05).Multivariate Logistic regression analysis showed that SBP and CACS were independent risk factors for the occurrence of type 2 diabetic nephropathy(P<0.05),while ALB was a protective factor for the occurrence of type 2 diabetic nephropathy(P<0.05).Part Ⅱ:The enrolled T2DM patients were divided into four groups according to CACS.There were significant differences in UACR,age,duration of diabetes,diastolic blood pressure,BNP,HbA 1C,HGB,ALB,CYS-C,β2-MG,BUN,SCr,eGFR,HYC,total cholesterol(TCH)and β-CTX between the two groups(P<0.05).Among them,diastolic blood pressure,HGB,ALB,eGFR,β-CTX and bone mineral density in the sVC group decreased,while age,duration of diabetes,BNP,HCY,UACR dp-uc MGP increased,and the difference was statistically significant(P<0.05).The CACS in T2DM patients was significantly negatively correlated with BMD(P<0.05),and the CACS increased with the decrease of BMD.The correlation analysis showed that total hip BMD(r=-0.347,P<0.05)and femoral neck BMD(r=-0.274,P<0.05)were negatively correlated with CACS in T2DM patients.There was no significant correlation between BMD of lumbar vertebrae 1-4 and CACS(r=-0.122,P>0.05).CACS was positively correlated with dp-ucMGP(r=0.376,P<0.001)and negatively correlated with β-CTX(r=-0.307,P<0.001).Decreased bone mineral density was associated with tPINP(r=0.249,P<0.05),OC(r=0.217,P<0.05)and dp-ucMGP(r=0.376,P<0.001).Ordinal multiple Logistic regression analysis showed that decreased bone mineral density,duration of diabetes,increased BNP and HCY were independent risk factors for vascular calcification in patients with type 2 diabetic nephropathy(P<0.05).Conclusions:1.There is a positive correlation between CACS and UACR in T2DM patients.With the progress of UACR,CACS and the incidence of coronary artery calcification increase.2.Serum dp-ucMGP is positively correlated with UACR and CACS in T2DM patients.With the progression of UACR and CACS,serum dp-ucMGP increases,and dp-ucMGP is an independent risk factor for increased CACS.3.The BMD of femoral neck and total hip was negatively correlated with CACS in T2DM patients,and the CACS increased with the decrease of BMD,but there was no significant correlation between the BMD of lumbar spine 1-4 and CACS.The incidence of osteoporosis in female T2DM patients with DN is higher than that in T2DM patients without DN,but there is no significant difference in the incidence of osteoporosis in male patients. |
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