| 摘要: | 背景與目的：當糖尿病患者出現慢性腎臟病時，易產生不正常鈣磷代謝，而造成患者不正常骨質，因此，本研究藉由探討受試者罹患糖尿病或合併慢性腎臟疾病時，其骨質流失狀況。方法：本研究採用橫斷式調查，以高雄市旗山醫院門診患者為研究對象，共收案183人。研究工具包含人口學基本資料、生活型態、家族及個人病史、病歷查閱(血液生化指標、尿液常規指標)、血壓及骨密度測量。結果：受試者腎絲球過濾率降低，其舒張壓、麩胺酸丙酮酸轉胺酶活性及高密度脂蛋白膽固醇含量也較低；但收縮壓、肌酸酐排泄量及血清三酸甘油脂含量顯著較高。腎絲球過濾率及性別分別對受試者骨密度有顯著差異，受試者腎絲球過濾率愈低，其骨密度流失狀況愈嚴重，女性受試者的骨密度流失狀況亦顯著高於男性受試者。受試者體重、身體質量指數、腎絲球過濾率、麩胺酸丙酮酸轉胺酶及舒張壓與骨密度顯著正相關；受試者年齡、罹病時間及肌酸酐與骨密度有顯著負相關。結論: 當受試者腎絲球過濾率<75ml/min/1.73m2時或空腹血糖控制不良(127mg/dl)，受試者骨密度會進入骨質流失狀態。
Background and purpose: When chronic kidney disease occurs in DM patients, the abnormal bone mass may occur in patients due to abnormal calcium and phosphorus metabolism, the present study aimed to examine whether DM by itself or in association with CKD might be a more important contributing factor to the development of bone loss. A cross-sectional study was used in bone mineral density (BMD) survey in patients with diabetic nephropathy in Cishan hospital, a total of 183 subjects were recruited. Methods: An interview to assess questionnaire was used to collect information on demographic characteristics, lifestyle, disease and medication history, medical records (biochemical parameters, urine routine), blood pressure and BMD was estimated by quantitative ultrasound (QUS). Results: The patients with a decreased estimated glomerular filtration rate (eGFR) had significantly lower diastolic pressure, glutamate pyruvate transaminase (GPT), high-density lipoprotein-cholesterol (HDL-C), and higher systolic pressure, creatinine clearance and serum triglyceride (TG). Low eGFR and female sex were associated with higher risk of BMD loss (p<0.01). Weight, BMI, eGFR, GPT and diastolic pressure had significant positive correlations with BMD, On the other hand, age, duration and creatinine clearance had significant negative correlations with BMD. Conclusion: Increased BMD loss occurred in eGFR< 75 ml/min/1.73 m2 or fasting glucose 127mg/dl in patients with diabetic nephropathy. |
