糖尿病肾病患者血清25-羟维生素D3与尿维生素D结合蛋白的相关性研究

Clinical investigation of relationship between serum 25-hydroxyvitamin D3 and urine vitamin D binding protein levels in patients with diabetic nephropathy

目的观察糖尿病肾病患者血清25-羟维生素D3（25（OH）D3）及尿维生素D结合蛋白（uVDBP）的变化，并进行相关影响因素的分析，为糖尿病肾病早期诊断和治疗提供新的方法。方法选择2015年1～12月威海市立医院内分泌科住院治疗的糖尿病肾病患者85例为研究对象，依据尿微量白蛋白/尿肌酐比值（UACR）将其分为三组，2型糖尿病正常白蛋白尿组28例、微量白蛋白尿组31例、临床蛋白尿组26例，并选取同期健康体检者25例为对照组。抽取空腹静脉血，检测空腹血糖（FPG）、糖化血红蛋白（HbA1c）、胆固醇（TC）、甘油三酯（TG）及肌酐（CRE）等代谢指标，运用化学发光法检测血清25（OH）D3，运用ELISA法检测uVDBP，观察不同分期糖尿病肾病患者25（OH）D3及uVDBP的变化。结果2型糖尿病正常白蛋白尿组、微量白蛋白尿组、临床蛋白尿组及对照组血清25（OH）D3组间差异均有统计学意义[（20.04±7.52）ng/mL、（16.54±6.51）ng/mL、（10.77±4.63）ng/mL、（29.65±5.47）ng/mL，F＝86.294，P〈0.001]，三组病例组25（OH）D3均显著低于对照组（均P〈0.05）；四组间uVDBP水平差异有统计学意义[（8.44±3.20）mg/L、（14.22±3.26）mg/L、（21.77±5.87）mg/L、（4.95±1.34）mg/L，F＝125.583，P〈0.001]。三组病例组uVDBP水平均高于对照组（均P〈0.05）。相关分析显示糖尿病肾病患者血清25（OH）D3随糖尿病肾病加重而逐渐降低，与UACR呈负相关（r＝－0.575，P〈0.01）；而uVDBP水平则与UACR呈正相关（r＝0.436，P＝0.015）。结论随着糖尿病肾病的进展，血清25（OH）D3水平逐渐降低，表明25（OH）D3在糖尿病肾病发病过程中可能起一定的作用；而可能作为糖尿病肾病早期参考指标的uVDBP水平则随糖尿病肾病进展而排出量逐渐增加，检测uVDBP或许能为T2DM肾病的早期诊断提供一些新线索。

Objective To investigate the serum levels of 25-hydroxyvitamin D3（25（OH）D3） and urine vitamin D binding protein（uVDBP） in patients with diabetic nephropathy（DN）, and to determine the relationship between 25（OH）D3, uVDBP and DN, in order to provide a new method for early diagnosis and treatment of DN.Methods From January 2015 to December 2015, 85 DN patients admitted into Weihai Municipal Hospital were selected.According to the ratio of UALB to UCR（UACR）, the patients were divided into three groups.Type 2 diabetes had 28 cases of normal albuminuria group, 31 cases of microalbuminuria group, and 26 cases of clinical albuminuria group.We also enrolled 25 healthy people who received outpatient service as control group.Serum 25（OH）D3 levels were measured by chemiluminescence method.Urine VDBP levels were assayed by ELISA.FPG, HbA1c, UREA, SCr, TC, TG were measured by electrochemiluminescence.Results The Results showed that serum 25（OH）D3 was significantly lower in the normal albuminuria group, microalbuminuria group and clinical proteinuria group than that in the control group（P〈0.05）, and there was statistically significant difference among the four groups[（20.04±7.52）ng/mL, （16.54±6.51）ng/mL, （10.77±4.63）ng/mL, （29.65±5.47）ng/mL, F=86.294, P〈0.001]. The Results showed that uVDBP was significantly higher in the DN group than that in the control group（all P〈0.05）, and there was statistically significant difference among the four groups[（8.44±3.20）mg/L, （14.22±3.26）mg/L, （21.77±5.87）mg/L, （4.95±1.34）mg/L, F=125.583, P〈0.001]. Correlation analysis showed that serum 25（OH）D3 decreased gradually with the increase of DN and negatively correlated with UACR（r=-0.575, P〈0.01）, while uVDBP level was positively correlated with UACR（r=0.436, P=0.015）.Conclusion With the progress of DN, serum 25（OH）D3 levels gradually decreased, indicating that 25（OH）D3 may play an important role in the pathogenesis of DN; uVDBP may be an early diagnostic method for DN.