2型糖尿病患者血清1,25-二羟维生素D3与糖尿病肾病的相关性

Relationship between serum 1,25-dihydroxyvitamin D3 and diabetic nephropathy in patients with type 2 diabetes mellitus

目的探讨2型糖尿病患者血清1,25-二羟维生素D 3[1,25-(OH)2D 3]水平与糖尿病肾病(DN)的关系。方法选择2018年3月至2019年9月新乡医学院第三附属医院收治的300例2型糖尿病患者为研究对象,采用免疫比浊法及苦味酸法分别测定尿白蛋白和尿肌酐,计算尿白蛋白/肌酐比值(UACR),根据UACR将患者分为正常蛋白尿组(UACR<30 mg·g-1,n=95)、微量蛋白尿组(30 mg·g-1≤UACR<300 mg·g-1,n=90)及临床蛋白尿组(UACR≥300 mg·g-1,n=115)。采用酶联免疫吸附试验(ELISA)法检测血清1,25-(OH)2D 3水平;采用全自动生物化学分析仪和ELISA法测定血清肌酐(SCr)、尿素氮(BUN)水平,并计算肾小球滤过率(GFR)。观察各组患者血清1,25-(OH)2D 3水平与UACR、GFR、SCr、BUN的关系。结果微量蛋白尿组、临床蛋白尿组患者血清1,25-(OH)2D 3水平显著低于正常蛋白尿组(P<0.05),临床蛋白尿组患者血清1,25-(OH)2D 3水平显著低于微量蛋白尿组(P<0.05)。3组患者血清BUN水平比较差异无统计学意义(P>0.05)。微量蛋白尿组、临床蛋白尿组患者血SCr水平显著高于正常蛋白尿组(P<0.05),临床蛋白尿组患者血SCr水平显著高于微量蛋白尿组(P<0.05)。微量蛋白尿组、临床蛋白尿组患者血清GFR水平显著低于正常蛋白尿组,临床蛋白尿组患者血清GFR水平显著低于微量蛋白尿组(P<0.05)。多因素logistic回归分析显示,年龄及1,25-(OH)2D 3水平是DN的独立危险因素。Pearson相关分析显示,1,25-(OH)2D 3与UACR、SCr呈负相关(r=-0.257、-0.145,P<0.05),与GFR呈正相关(r=0.389,P<0.05),与BUN无显著相关性(r=0.256,P>0.05)。结论DN的发生、发展可能与1,25-(OH)2D 3水平降低有关,在控制血压、血糖、血脂等指标的基础上早期筛查血清1,25-(OH)2D 3水平并及时补充维生素D对延缓DN的发生、发展可能有一定临床意义。

Objective To explore the relationship between serum 1,25-dihydroxyvitamin D 3[1,25-(OH)2D 3]level and diabetic nephropathy(DN)in patients with type 2 diabetes mellitus(T2DM).Methods Three hundreds patients with T2DM who were admitted to the Third Affiliated Hospital of Xinxiang Medical University from March 2018 to September 2019 were selected as the research subjects.Urine albumin and creatinine were measured by immunoturbidimetric method and picric acid method respectively,and urine albumin/creatinine ratio(UACR)was calculated.According to the UACR,the patients were divided into normal proteinuria group(UACR<30 mg·g-1,n=95),microalbuminuria group(30 mg·g-1≤UACR<300 mg·g-1,n=90)and clinical proteinuria group(UACR≥300 mg·g-1,n=115).The enzyme-linked immunosorbent assay(ELISA)method was used to detect the serum 1,25-(OH)2D 3levels;the automatic biochemical analyzer and ELISA method were used to determine the serum creatinine(SCr)and urea nitrogen(BUN)levels,and glomerular filtration rate(GFR)was calculated.The relationship between serum 1,25-(OH)2D 3 level and UACR,GFR,SCr and BUN in each group were observed.Results The level of serum 1,25-(OH)2D 3 in the microalbuminuria group and clinical proteinuria group was lower than that of the normal proteinuria group(P<0.05),and the serum 1,25-(OH)2D 3 level of patients in the clinical proteinuria group was lower than that in the microalbuminuria group(P<0.05).There was no significant difference in serum BUN level among the three groups(P>0.05).The serum SCr level of patients in the microproteinuria group and clinical proteinuria group was significantly higher than that in the normal proteinuria group,and the serum SCr level in the clinical proteinuria group was significantly higher than that in the microproteinuria group(P<0.05).Serum 1,25-(OH)2D 3 levels of patients in the microproteinuria group and clinical proteinuria group were significantly lower than that in normal proteinuria group,and the difference was statistically significant(P<0.05);the serum 1,25-(OH)2D 3 level in the clinical proteinuria group was lower than that in the microalbuminuria group(P<0.05).Serum GFR level of patients in the microalbuminuria group and clinical proteinuria group were significantly lower than that in the normal proteinuria group.Serum GFR level of patients in the clinical proteinuria group was lower than that in the microalbuminuria group(P<0.05).Multivariate logistic regression analysis showed that age and 1,25-(OH)2D 3 level were independent risk factors for DN patients.Pearson correlation analysis showed that 1,25-(OH)2D 3 was negatively correlated with UACR and SCr(r=-0.257,-0.145;P<0.05)and positively correlated with GFR(r=0.389,P<0.05).However,there was no obvious correlation with BUN(r=0.256,P>0.05).Conclusion The occurrence and development of DN may be related to the decrease of 1,25-(OH)2D 3 level.Based on the control of blood pressure,blood sugar,blood lipids and other indicators,early screening of serum 1,25-(OH)2D 3 concentration and timely Vitamin D supplementation may have some clinical significance to delay the occurrence and development of DN.