2型糖尿病患者血清与尿维生素D结合蛋白水平的变化

Changes in serum and urine vitamin D binding protein concentrations in type 2 diabetes

目的检测2型糖尿病患者血清与尿维生素D结合蛋白（VDBP）浓度的变化，探讨其临床意义。方法采用ELISA法检测102名健康对照组、106例2型糖尿病组患者血清VDBP、尿VDBP与尿肌酐（cr）比值及尿微量白蛋白与尿肌酐比值（UACR）。将2型糖尿病患者分为血糖控制良好组与血糖控制不佳组，正常白蛋白尿组与微量白蛋白尿组进行分析与比较。结果血清VDBP的正常参考上限为60．6μg/ml，尿VDBP／Cr的正常参考上限7．76mg／g。2型糖尿病组血清VDBP及尿VDBP／Cr水平显著高于健康对照组[血：（44．83±6．65）μg／ml对（330．92±49．28）μg/ml，尿：（5．55±2．89）mg／g对（15．19±6．38）mg／g，均P〈0．01]，其中血糖控制不佳组血清VDBP及尿VDBP／Cr水平显著高于血糖控制良好组（P〈0．05），微量白蛋白尿组尿VDBP／Cr水平显著高于正常白蛋白尿组（P〈0．01）。尿VDBP／Cr对早期2型糖尿病肾病的诊断敏感性为96．4％，特异性为68％，准确性为83％。结论检测血清VDBP水平对于评估糖尿病病情有一定参考价值，联合检测尿VDBP／Cr与UACR对于糖尿病肾病的早期诊断有重要的临床意义。

Objective To determine the changes in serum and urine vitamin D binding protein （VDBP） concentrations in type 2 diabetes, and to explore the clinical significance. Methods The serum and urine VDBP concentrations in 102 healthy individuals and 106 type 2 diabetic patients were determined by ELISA. For analysis and comparison, 106 type 2 diabetic patients were divided into imperfect glycemic control subgroup and perfect glyeemic control subgroup, microalbuminuria subgroup and normal albuminuria subgroup. Results The cut-off point of serum VDBP concentrations was 60.6μg/ml and the cut-off point of the urine ratio of VDBP and creatinine was 7.76 mg/g, and both were determined according to the upper limit of 97. 5 % credit intervals in 110 healthy individuals. Serum VDBP concentration and the urine ratio of VDBP to creatinine in type 2 diabetic patients were significantly higher than those in the healthy individuals （ P 〈 0. 01 ）, the imperfect glycemic control subgroup had higher serum VDBP concentrations and the urine ratio of VDBP to creatinine than those in the perfect glycemic control subgroup （ P 〈 0.05 ）. The microalbuminuria subgroup had higher urine ratio of VDBP to creatinine than that in the normal albuminuria subgroup （ P〈0.01 ）. Urine ratio of VDBP to creatinine in diagnosing early diabetic nephropathy had sensitivity of 96. 4 %, specificity of 68 %, and concordance of 83 %. Conclusion Detection of serum VDBP levels has some reference value in understanding the state of diabetes. Combined determinations of urine ratio of VDBP to creatinine and ratio of albumin to creatinine have significant clinical value in the early diagnosis of diabetic nephropathy.