早期糖尿病肾脏病患者葡萄糖目标范围内时间与骨转换标志物的关系OA

Objective To investigate the relationship between time in range(TIR)and bone turnover markers in early diabetic kidney disease(DKD)patients.Methods We enrolled 190 patients with type 2 diabetes mellitus(T2DM)with estimated glomerular filtration rate(eGFR)in stage G1.According to urinary albumin-to-creatinine ratio(ACR),patients were divided into three groups:T2DM without albuminuria(n=59),eGFR G1/ACR A2(G1A2,n=70),and eGFR G1/ACR A3(G1A3,n=61).General data including age,sex,body mass index(BMI),and diabetes du-ration were collected.Laboratory indicators included serum creatinine(SCr),eGFR,ACR,fasting plasma glucose(FPG),postprandial glucose(PPG),glycated hemoglobin(HbA1c),25-hydroxyvitamin D3[25(OH)VitD3],procolla-gen type I N-terminal propeptide(P1NP),and β-isomerized C-terminal telopeptide of type I collagen(β-CTX).TIR was calculated from continuous glucose monitoring(CGM)data.Analysis of covariance(ANCOVA)was used to compare the differences in bone turnover markers among patients stratified by different ACR levels.Pearson correlation analysis and partial correlation analysis were adopted to evaluate the correlations between TIR and bone turnover markers.Restricted cubic spline(RCS)and quantile regression were applied to explore the relationship between TIR and β-CTX.Results Sex distribution,diabetes duration,FPG,PPG,HbA1c,TIR,ACR,SCr,25(OH)VitD₃,and P1NP differed significant-ly among the three groups(all P<0.05),while age,BMI,eGFR,and β-CTX showed no significant differences(all P>0.05).After adjusting for age,sex,and BMI,25(OH)VitD3 showed a decreasing trend with increasing ACR(P for trend<0.001),and P1NP showed an increasing trend(P for trend=0.004).β-CTX showed no significant overall differ-ence among groups,but an upward trend(P for trend=0.066).Pearson correlation analysis showed that TIR was positive-ly correlated with 25(OH)VitD₃(r=0.206,P=0.004),and was negatively correlated with β-CTX(r=-0.162,P=0.026)and P1NP(r=-0.199,P=0.006).Partial correlation analysis,controlling for HbA1c,age,sex,and BMI,showed that TIR remained positively correlated with 25(OH)VitD₃(r=0.198,P=0.007),and negatively correlated with P1NP(r=-0.257,P<0.001)and β-CTX(r=-0.218,P=0.003).RCS analysis revealed a non-linear associa-tion between TIR and β-CTX(P=0.043).Quantile regression analysis showed that TIR was negatively associated with β-CTX at the 90th percentile(β=-0.021,P=0.025).Conclusions Early-stage DKD patients showed a trend of abnormal bone turnover.TIR is independently associated with bone turnover markers,and this association is more pro-nounced in the high bone resorption population.