超重和肥胖合并2型糖尿病微量白蛋白尿患者维生素D营养状况临床分析

Analysis of vitamin D nutrition status in overweight and obese patients with T2DM and microalbuminuria

目的:探讨超重和肥胖合并2型糖尿病微量白蛋白尿(MAU)患者维生素D营养状况。方法:选取收治的189例超重和肥胖的初诊2型糖尿病患者,按照是否合并MAU分为两组,分别为非MAU组[24 h尿白蛋白排泄率(24 hUAER)<30 mg/24 h,n=129例]和MAU组(24 hUAER≥30 mg/24 h,n=60例)。比较两组的实验室检查指标,采用单因素Pearson相关性分析和多因素Logistic回归方程分析MAU和维生素D营养状况的关系。结果:与非MAU组比较,MAU组收缩压(SBP)、舒张压(DBP)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、甘油三酯(TG)、血尿酸、同型半胱氨酸(Hcy)水平、维生素D不足或缺乏比例较高,差异有统计学意义(均P<0.05),高密度脂蛋白胆固醇(HDL-C)、血清25-羟基维生素D[25(OH)D]水平较低,差异有统计学意义(均P<0.05)。与维生素D正常组比较,维生素D不足或缺乏组HbA1c、HOMA-IR、24 hUAER水平较高,差异有统计学意义(均P<0.05)。Pearson相关性分析显示24 hUAER与SBP、DBP、HbA1c、HOMA-IR、TG、血尿酸、Hcy呈正相关(均P<0.05),与HDL-C、25(OH)D呈负相关(均P<0.05)。多因素Logistic回归方程显示维生素D不足或缺乏是超重和肥胖合并2型糖尿病合并MAU的独立危险因素(P<0.05)。结论:超重和肥胖合并2型糖尿病合并MAU患者中维生素D营养状况不佳,维生素D不足或缺乏检出率偏高,可能是MAU发生的独立危险因素,值得临床关注。

Objective:To investigate the nutritional status of vitamin D in overweight and obese patients with T2DM and microalbuminuria(MAU).Methods:189 cases of overweight and obese patients with T2DM were selected.According to whether combined with MAU,they were divided into non-MAU group[24-hour urinary albumin excretion rate(24 hUAER)<30 mg/24 h,129 cases]and MAU group(24 hUAER≥30 mg/24 h,60 cases).The laboratory test indicators of the two groups were compared,and the single factor Pearson correlation analysis and the multivariate Logistic regression equation were used to analyze the relationship between MAU and vitamin D nutritional status.Result:Compared with non-MAU group,the levels of SBP,DBP,HbA1c,HOMA-IR,TG,UA,Hcy,and the proportion of vitamin D insufficient or lack in MAU group were higher,and the levels of HDL-C and 25(OH)D were lower(all P<0.05).Compared with the normal vitamin D group,the levels of HbA1c,HOMA-IR and 24 hUAER in the vitamin D deficiency or deficiency group were higher(all P<0.05).Pearson correlation analysis showed that 24 hUAER was positively correlated with SBP,DBP,HbA1c,HOMA-IR,TG,blood uric acid,and Hcy,and negatively correlated with HDL-C and 25(OH)D(all P<0.05).Multivariate Logistic regression analysis showed that insufficient or lack of vitamin D was an independent risk factor for overweight and obese patients with T2DM and MAU(P<0.05).Conclusion:The nutritional status of vitamin D in overweight and obese patients with T2DM and MAU is not good,and the detection rate of vitamin D insufficient or lack is high,which may be an independent risk factor of MAU,which deserves clinical attention.