2型糖尿病伴显性糖尿病性肾脏疾病患者钙磷水平变化及其相关性分析

Changes of calcium and phosphorus levels and the correlation analysis in patients with type 2 diabetes mellitus and diabetic nephropathy

目的 分析临床2型糖尿病伴显性糖尿病性肾脏疾病血清钙、磷水平特征及相关影响因素.方法 参照2007年K/DOQI建议,以90例2型糖尿病患者为研究对象,依据患者2次平均尿白蛋白与肌酐比值（ACR）分为3组,分别为正常蛋白蛋白尿组[白蛋白与肌酐比值（ACR） ＜30 mg/gCr]、微量白蛋白尿组（ACR 30～300 mg/gCr）、大量白蛋白尿组（ACR＞300 mg/gCr）,每组30例.选取同期健康体检者30例为对照组.分别检测血清钙、磷、hs-CRP、IL-6和HbA1c.并计算肾小球滤过率（eGFR）.结果 正常蛋白蛋白尿组eGFR较各组增高（P＜0.05）,微量白蛋白尿组eGFR较各组明显降低（P＜0.05）.2型糖尿病各亚组间随着白蛋白尿的有无及严重程度的不同,各组间的病程也不同,尿中白蛋白越多,其病程越长.不同程度白蛋白尿组的HbA1c含量随着尿白蛋白的加重而增高[HbA1c分别为（8.87±2.44）％、（9.27±2.74）％、（11.04±2.86）％,P均＜0.05],但在微量白蛋白尿组[（9.27±2.74）％]与正常白蛋白尿组[（8.87±2.44）％]之间差异无统计学意义.与对照组相比,2型糖尿病各亚组的血钙降低[分别为（2.22±0.19） mmol/L、（2.16±0.14） mmol/L、（2.13±0.18） mmol/L,对照组为（2.32±0.11）mmol/L,P均＜0.05],血磷[分别为（1.16±0.31） mmol/L、（1.42±0.52） mmol/L、（1.98±0.58） mmol/L,对照组为（1.08±0.28） mmol/L]、hs-CRP[分别为（4.82±0.89） mmol/L、（8.46±2.85） mmol/L、（13.09±3.49） mmol/L,对照组为（2.46±0.48） mmol/L]、IL-6[分别为（10.32±4.19） pg/L、（14.78±4.34） pg/L、（16.67±6.62） pg/L,对照组为（7.03±2.15） pg/L]均增高（P均＜0.05）.2型糖尿病各组中,随着白蛋白尿的增多,hs-CRP明显增加[分别为（4.82±0.89） mmol/L、（8.46±2.85） mmol/L、（13.09±3.49）mmol/L,P＜0.05]大量白蛋白尿阶段的血磷[（1.98±0.58） mmol/L]与对照组[（1.08±0.28） mmol/L]、正常白蛋白尿组[（1.16±0.31）mmol/L]以及微量白蛋白尿组[（1.42±0.52） mmol/L]之间的差异有统计学意义.微量白蛋白尿组血磷与hs-CRP、IL-6、HbA1c呈正相关（r值分别为0.431、0.384、0.517,P均＜0.05）.大量白蛋白尿组血磷与hs-CRP、IL-6、HbA1c呈正相关（r值分别为0.825、0.622、0.683,P均＜0.01）,与eGFR呈负相关（r值为0.600,P＜0.01）.结论 糖尿病性肾脏疾病患者存在血磷代谢异常.hs-CRP、IL-6、和HbA1c是糖尿病性肾脏疾病患者血磷增高进展的相关影响因素.

Objective To analyze serum calcium and phosphorus levels and its related factors of clinical type 2 diabetes mellitus （T2DM） with overt diabetic kidney disease （T2-dDKD）.Methods Ninety cases of T2DM patients according to K/DOQI Recommendations in 2007 were selected as the study subjects.Based on the patients＆#39; 2 times mean urinary albumin/creatinine ratio （ACR）,these people were divided into three groups,namely Normal albuminuria group （30 patients,ACR〈30 mg/gCr）,Microalbuminuria group （30 patients,ACr =30-300 mg/gCr）,Macroalbuminuria group （30 patients,ACR〉300 mg/gCr）.Thirty cases of healthy at the same period were selected as the Control group.Serum calcium,phosphorus,hs-CRP,IL-6,HbA1c were detected.And glomerular filtration rate （eGFR） was calculated.Results The eGFR in Normal albuminuria group was more higher than other groups （P〈0.05）,the eGFR of Microalbuminuria group was significantly lower than other groups （P〈0.05）.Subgroups of T2DM with different albuminuria presence and severity,duration was also different between the groups,the more albumin in urine,the longer its duration.The contents of HbA1c in the groups of varying degrees of albuminuria increased as urinary albumin aggravation （HbA1c was （8.87±2.44） %,（9.27±2.74）%,（11.04±2.86）% respectively,P〈0.05）,but there was not statistically significant between Microalbuminuria group （（9.27±2.74）%） and Normal albuminuria group （（8.87±2.44） %）.Compared with Control group,in subgroups of T2DM,serum calcium was decreased（（2.22±0.19） mmol/L,（2.16±0.14） mmol/L,（2.13±0.18） mmol/L,and the Contorl group was （2.32±0.11）mmol/L,P〈0.05）,and serum phosphorus （（1.16±0.31） mmol/L,（1.42±0.52） mmol/L,（1.98±0.58）mmol/L,and the Control group was （1.08±0.28） mmol/L）,hs-CRP （（4.82±0.89） mmol/L,（8.46± 2.85）mmol/L,（13.09±3.49） mmol/L,and the Control group was （2.46±0.48） mmol/L）,IL-6（（10.32±4.19）pg/L,（14.78±4.34） pg/L,（16.67±6.62） pg/L,and the Control group was （7.03±2.15） pg/L） were increased（P〈0.05）.In subgroups of T2DM,hs-CRP was significantly increased with the increase of the serum albumin（（4.82±0.89） mmol/L,（8.46±2.85） mmol/L,（13.09±3.49） mmol/L,P〈0.05）,there were no statistical significance about blood phosphorus among Macroalbuminuria group （1.98±0.58） mmol/L）,control group（（1.08±0.28） mmol/L）,normal albuminuria group（（1.16±0.31） mmol/L） and albumin urinary group （1.42±0.52） mmol/L）.Serum phosphorus in Microalbuminuria group were positively correlated with hs-CRP,IL-6,HbA1c （r =0.431,0.384,0.517 respectively,P〈0.05）.Serum phosphorus in Macroalbuminuria group were positively correlated with hs-CRP,IL-6,HbA1c （r=0.825,0.622,0.683 respectively,P〈0.01）,but negatively with eGFR（r=0.600,P〈0.01）.Conclusion Serum phosphorus metabolism is abnormal in patients with diabetic nephropathy,hs-CRP,IL-6,and HbA1c are the related factors influencing the progression of serum phosphorus in patients with diabetic nephropathy.