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Thesis
男性糖尿病患者における足部Peripheral Quantitative Computed Tomography（pQCT）の低下と糖尿病性腎症との関連

竹尾　浩紀
埼玉医科大学内科学消化器・肝臓内科部門
（指導　藤原　研司　教授）

医学博士　乙第972号　平成17年3月25日 （埼玉医科大学）

The Relation Peripheral Quantitative Computed Tomogrophy (pQCT) and Diabetic Nephropathy in Male Diabetic Patients
Hiroki Takeo (Gastroenterology and Hepatology, Department of Internal Medicine, Saitama Medical School, Moroyama, Iruma-gun, Saitama 350-0495, Japan)

Objective: Osteopenia can develop in diabetic patients. Its extent is generally evaluated in vertebral bones, but the relation to exercise is still unclear. We assessed the utility of peripheral quantitative computed tomography (pQCT) as a tool for detecting osteopenia of navicular bones in diabetic patients, including analysis of its relation to the clinical features. Patients and Methods: 158 diabetic male patients were divided into 3 groups based on 75 g oral glucose tolerance test (75gOGTT), and pQCT was evaluated in each group in relation to exercise practices by questionnaire survey, IMT thickness and plaque formation by cervical ultrasonography and urine albumin concentrations less than 30 mg/day (nl group), 30 to 300 mg/day (mi group) and more than 300 mg/day (MA group). Results: There were 10 normal, 31 impaired and 117 diabetic 75gOGTT patients (N, I and D groups, respectively). pQCT was not different between N and I groups (p=0.981), but significantly differ between N and D groups (p=0.014), and also between I and D groups (p=0.005). The abnormality by cervical ultrasonography was detected only in 1 patient by a specialist in the D group. In this group, there was no difference in pQCT between 53 patients who practiced exercise 3 times or more a week and the rest 64 patients (p=0.789). The significant difference was not found even in grouping these 117 patients by exercise practice or not (n=65 and 52, respectively, p=0.0622) and by existence of abnormal cervical findings or not (n=29 and 78, respectively, p=0.650). In patients with diabetic nephropathy, however, there was significant difference between nl and mi groups (n=86 and 24, respectively, p=0.002), and between nl and MA (n=7) groups (p=0.038), even though not significant between nl and mi groups or mi and MA groups (p=0.830). Conclusions: The present results suggest that osteopenia of navicular bones may be present in diabetic male patients with albuminuria more than 30 mg/day.
Keywords: diabetic nephropathy, albuminuria, osteopenia, IMT, exercise, pQCT