Inukai T, Fujiwara Y, Tayama K, Aso Y, Takemura Y
Department of Medicine, Dokkyo University School of Medicine, Koshigaya Hospital, Japan.
Diabetes Res Clin Pract. 1997 Oct;38(1):53-9. doi: 10.1016/s0168-8227(97)00090-9.
Serum levels of markers for bone remodeling and diabetic metabolic markers were measured in subjects with non-insulin-dependent diabetes mellitus (NIDDM) to investigate the relationship between early diabetic nephropathy and calcium/bone metabolism. 1 alpha,25(OH)2 D3 (Vit D), osteocalcin (OC), intact parathyroid hormone (PTH) and urine albumin excretion (UAE) were measured in all subjects. Serum levels of Vit D and OC were significantly decreased in diabetic subjects compared to age-matched, non-diabetic controls. In diabetic patients, a significant positive correlation was observed between intact PTH and OC. No significant correlation was found between levels of Vit D and OC. In early diabetic nephropathy without increased serum creatinine, Vit D decreased and OC increased with increasing UAE. Levels of hemoglobin Alc (HbAlc) and fructosamine (FRA) were not correlated with levels of Vit D or OC. Levels of Vit D were decreased and levels of OC were increased in diabetic subjects with proliferative retinopathy or with micro- or macro-albuminuria.
Results of the present study indicate that changes in bone remodeling markers such as Vit D and OC levels are present in the early stages of diabetic nephropathy, and that circulating intact PTH is important in restoring the reduced OC levels in diabetic patients, probably as a reflection of bone remodeling.
在非胰岛素依赖型糖尿病（NIDDM）患者中测量了骨重塑标志物和糖尿病代谢标志物的血清水平，以研究早期糖尿病肾病与钙/骨代谢之间的关系。对所有受试者测量了1α,25(OH)2 D3（维生素D）、骨钙素（OC）、完整甲状旁腺激素（PTH）和尿白蛋白排泄量（UAE）。与年龄匹配的非糖尿病对照组相比，糖尿病患者血清维生素D和OC水平显著降低。在糖尿病患者中，观察到完整PTH与OC之间存在显著正相关。维生素D和OC水平之间未发现显著相关性。在血清肌酐未升高的早期糖尿病肾病中，随着UAE增加，维生素D降低而OC升高。糖化血红蛋白（HbAlc）和果糖胺（FRA）水平与维生素D或OC水平无关。患有增殖性视网膜病变或微量或大量蛋白尿的糖尿病患者维生素D水平降低而OC水平升高。
本研究结果表明，在糖尿病肾病早期存在骨重塑标志物如维生素D和OC水平的变化，并且循环中的完整PTH对于恢复糖尿病患者降低的OC水平很重要，这可能反映了骨重塑情况。
