2型糖尿病肾病患者25-羟维生素D水平变化及意义

Changes and significance of 25-hydroxyvitamin D levels in patients with type 2 diabetic nephropathy

目的探讨25-羟维生素D[25(OH)D]水平在2型糖尿病肾病患者中的检测价值。方法采用便利抽样与回顾性分析方法,选择2014年8月-2018年2月期间在湖北医药学院附属东风医院肾病内科诊治的糖尿病肾病患者180例作为研究对象,调查患者的临床资料,记录患者血清25(OH)D、尿白蛋白排泄率(UAER)水平,记录患者的病情状况并进行相关性分析。其中UAER≥300 mg/24 h表示存在糖尿病肾病;UAER≥30 mg/24 h表示存在微量白蛋白尿。结果在180例患者中,微量白蛋白尿50例,大量蛋白尿20例;平均血清25(OH)D水平为(31.0±15.5)ng/mL,大量尿蛋白组的血清25(OH)D水平也显著低于其他两组(P<0.05)。维生素D正常组120例,不足组40例和缺乏组20例。维生素D缺乏组UAER显著高于其他两组(P<0.05),3组血肌酐、高密度脂蛋白胆固醇(HDLC)、三酰甘油(TG)等比较也有显著性差异(P<0.05),Pearson相关分析显示糖尿病肾病患者的血清25(OH)D水平与患者UAER、血肌酐呈显著负相关(P<0.05),与HDL-C呈现显著正相关性(P<0.05);通过开展多元线性逐步回归分析发现,血肌酐与UAER是影响血清25(OH)D水平的独立因素(P<0.05)。结论血清25(OH)D在2型糖尿病肾病患者中呈现低水平,与患者的血脂与UAER有显著相关性,可影响患者的病情进展,其在临床上有很好的检测价值。

Objective To investigate the values of 25-hydroxyvitamin D[25(OH)D] in patients with type 2 diabetic nephropathy.Methods From August 2014 to February 2018,used the convenient sampling and retrospective research methods,180 patients with diabetic nephropathy diagnosed and treated by Department of Nephrology,Dongfeng Hospital affiliated to Hubei Medical College were selected as subjects and were to investigate the clinical data of patients.The patient's serum 25(OH)D,urinary albumin excretion rate(UAER)levels were recorded,and the patient's condition were recorded and analyzed for correlation.The UAER≥300 mg/24h were indicated the presence of diabetic nephropathy;UAER≥30 mg/24h were indicated the presence of microalbuminuria.Results There were 50 patients of microalbuminuria,20 patients of massive proteinuria;average serum 25(OH)D level were(31.0±15.5)ng/mL,the serum 25(OH)D level of large urine protein group were significantly lower than the other two groups(P<0.05).There were 120 patients in the normal group of vitamin D,40 patients in the inadequate group and 20 patients in the lack group.The UAER in the vitamin D deficiency group were significantly higher than the other two groups(P<0.05).There were also significant differences in serum creatinine,high-density lipoprotein cholesterol(HDL-C)and triglyceride(TG)compared between the three groups(P<0.05).Pearson correlation analysis showed that serum 25(OH)D levels in patients with diabetic nephropathy were significantly negatively correlated with UAER and serum creatinine(P<0.05),and were significantly positively correlated with HDL-C(P<0.05).Stepwise regression analysis found that serum creatinine and UAER were independent factors taht affected serum 25(OH)D levels(P<0.05).Conclusions Serum 25(OH)D are low level in patients with type 2 diabetic nephropathy that have significant correlation with serum lipids and UAER,which may affect the patient's disease progression and have good clinical values.