25-羟维生素D水平在2型糖尿病肾病患者中的检测价值研究

Study on the detection value of 25-hydroxy vitamin D in patients with type 2 diabetic nephropathy

目的探讨25-羟维生素D水平在2型糖尿病肾病患者中的检测价值。方法选取2013年1月至2015年8月收治的2型糖尿病患者600例,测量所有入选患者的身高、体重以及空腹静脉血的血脂和25-羟维生素D水平,并且计算患者1 d内的尿白蛋白排泄率。将入选患者按尿白蛋白排泄率分为大量蛋白尿组、微量蛋白尿组和正常组;根据血清25-羟维生素D水平分为维生素D正常组、维生素D不足组和维生素D缺乏组。分析患者糖尿病肾病与25-羟维生素D水平之间的关系。结果各组患者之间性别比、年龄、LDL-C、TC、Hb A1c和HDL-C水平以及体重指数(BMI)、吸烟史情况等比较差异无统计学意义(P>0.05);并且糖尿病肾病患者的TG水平、高血压患病率、肥胖率、血清肌酐水平、使用降糖药物比率等更高,糖尿病病程更长(P<0.05);而大量蛋白尿组的高血脂比率也比其他组高(P<0.05)。有糖尿病肾病患者的维生素缺乏比例显著高于无糖尿病肾病患者(P<0.05)。维生素D缺乏组患者的尿白蛋白排出率显著较另外2组患者高(P<0.05),并且女性比男性更容易缺乏维生素D;此外HDL-C水平下降与维生素D的缺乏有关,吸烟状况以及高脂血症异常比例、Hb A1c、糖尿病病程、高血压等均与维生素D缺乏无关。u AER和维生素D水平呈明显的负相关关系(r=-1.792,P<0.01),但是血肌酐浓度则与维生素D水平无明显相关关系,且缺乏维生素D能够显著增加糖尿病肾病的发病率(P<0.05)。结论 2型糖尿病患者中普遍存在25-羟维生素D水平偏低的现象,并且随着25-羟维生素D水平的降低,2型糖尿病患者出现糖尿病肾病的风险也随之增大。

Objective To investigate the detection value of 25-hydroxy vitamin D levels in patients with type 2 diabetic nephropathy.Methods A total of 600 patients with type 2 diabetes mellitus who were treated in our hospital from January 2013 to August 2015 were enrolled in the study.The body height and weight,fasting venous blood lipids and 25 hydroxyvitamin D levels were detected,and 1-day urinary albumin excretion rate(UAER)was culculated.According to the results of UAFR detection,these patients were divided into macroalbuminuria group,microalbuminuria group and normal control group.Moreover according to 25 hydroxy vitamin D levels,these patients were divided into normal vitamin D group,vitamin D insufficiency group and vitamin D deficiency group.The correlation between diabetic nephropathy and 25 hydroxyvitamin D levels was analyzed.Results There were no significant differenrences in gender,age,LDL-C,TC,HbA1c and HDL-C levels,body mass index(BMI),smoking history among groups(P>0.05).The TG levels,the incidence rate of hypertension,obesity,serum creatinine levels and hypoglycemic drugs use rate in patients with diabetic nephropathy(DN)were significantly higher,and duration of diabetes was longer(P<0.05).Moreover the proportion of high blood lipid in macroalbuminuria group was higher than that in the other groups.The proportion of vitamin deficiency in patients with DN was significantly higher than that of patients without vitamin deficiency(P<0.05).The UAER rate in vitamin D deficiency group was significantly higher than that in the other two groups(P<0.05),moreover,the female patients with vitamin deficiency were more than male patients.In addition the decrease of HDL-C levels was correlated to vitamin deficiency,however,smoking hidtory,hyperlipidemia abnormal proportion,HbA1c,duration of diabetes,hypertension were not related with vitamin deficiency.Besides UAER rate was negatively correlated with vitamin D levels(r=-1.792,P<0.01),but serum creatinine concentration was not related with vitamin D levels,moreover,which could significantly increase the incidence rate of diabetic nephropathy(P<0.05).Conclusion There exists a phenomenon of lower levels of 25-hydroxy vitamin D in patients with type 2 diabetes mellitus,moreover,with the decrease of 25-vitamin D levels,the risk of diabetic nephropathy is increased.