探讨血清25羟基维生素D水平在糖尿病肾损伤中的作用

Effect of serum 25-hydroxy vitamin D level in diabetic nephropathy

目的探讨血清25羟基维生素D[25-hydroxy vitamin D，25-（OH）D]水平与2型糖尿病肾损伤的关系。方法选择2012年12月至2013年5月我院内分泌科住院的2型糖尿病患者148例，选择同期健康体检者50例作为对照组。依据尿白蛋白／肌酐（albumin／creatinine，Alb／Cr）水平将糖尿病患者分为正常蛋白尿组（Alb／Cr〈30mg／gCr）、微量蛋白尿组（Alb／Cr30～299mg／gCr）和大量蛋白尿组（Alb／Cr≥300mg／gCr）。检测血清中25-（OH）D、空腹血糖（fasting plasma glucose，FPG）、糖化血红蛋白（hemoglobin Alc，HbAlc）、Cr、尿酸（uric acid，UA）、总胆固醇（total cholesterol，TCH）、甘油三酯（triglyceride，TG）、高密度脂蛋白（highdensity lipoprotein，HDL）、低密度脂蛋白（low density lipoprotein，LDL）。并对所得数据进行统计学分析。结果糖尿病患者的蛋白尿水平随着病程的延长而升高。三组糖尿病患者的病程差异有统计学意义（P〈0．01）。三组患者的收缩压、Alb／Cr、FPG、HbAlc、TCH、TG、LDL、UA和血Cr水平均高于对照组，而肾小球滤过率（glomerular filtration rate，eGFR）和HDL低于对照组，差异均有统计学意义（P均〈0．05）。大量蛋白尿组和微量蛋白尿组血清25-（OH）D水平较正常蛋白尿组和对照组明显降低，差异均有统计学意义（P均〈0．01），而正常蛋白尿组与对照组比较差异无统计学意义。病程〉10年的患者25-（OH）D水平显著低于病程5—10年及〈5年的患者，差异均具有统计学意义（P均〈0．05）。Pearson相关分析结果表明，血清25-（0H）D与尿Alb／Cr、血Cr和UA均呈负相关，而与eGFR呈正相关（P均〈0．05）。多元logistic回归分析结果表明，25-（0H）D与DN呈独立相关（β=-0．39，P〈0．01），且OR为2．98。结论血清25-（0H）D是糖尿病肾脏损伤的独立危险因素，其水平降低可能导致糖尿病肾病的发生。

Objective To explore the relationship between serum 25-hydroxy vitamin D [ 25- （OH） D ] level and kidney injury of type 2 diabetes. Methods 148 cases type 2 diabetes patients and 50 cases healthy people （control group） were collected in our hospital from December 2012 to May 2013. All patients were di- vided into normal proteinuria group [ （albumin/creatinine, Alb/Cr）〈 30 mg/gCr], microproteinuria group （Alb/Cr 30-299 mg/gCr ） and massive proteinuria group （Alb/Cr ≥ 300 mg/gCr）. 25- （OH） D, fasting plasma glucose （FPG）, hemoglobin Alc （HbAlc）, uric acid （UA）, total cholesterol （TCH）, triglyceride （TG）, high density lipoprotein（HDL） and low density lipoprotein（LDL） were detected. All data were analyzed statistically. Results Level of proteinuria in type 2 diabetes patients was increased along with the extension of course. There was statistical significance in the difference of pathogenesis among three disease groups （P〈 0.01 ）. Levels of contractive pressure, Alb/Cr, FPG, HbAlc, TCH, TG, LDL, UA and serum Cr in type 2 diabetes patients were all higher than that of control group, and levels of glomerular filtration rate （eGFR） and HDL were all lower than that of control group, the differences all had statistical significance （Pall〈 0.05）. The levels of 25 - （OH） D in massive proteinuria group and microproteinuria group were all lower than that of normal proteinuria group and control group, and the differences all had statistical significance （Pall〈 0.01 ）. Level of 25- （OH）D in 〉 10 years course patients was lower than that of 5-10 years course and 〈 5 years course, and the differences all had statistical significance （Pall〈 0.05）. Pearson relationship analysis showed that level of serum 25-（OH）D had negative correlation with levels of Alb/Cr, serum Cr and UA, but had positive correlation with eGFR（Pall〈 0.05 ）. Multiple regression analysis showed that level of serum 25-（OH）D was independently correlated with kidney injury of type 2 diabetes （β= -0.39,P〈 0.01 ）, the OR was 2.98. Conclusion Serum 25- （OH）D is an independent risk factor to kidney injury of diabetes, which level reducing may lead to diabetic nephropathy.