2型糖尿病患者24 h尿钠排泄和25-羟维生素D与白蛋白尿的相关性研究

Association of 24-hour urinary sodium excretion and 25-hydroxy vitamin D level with albuminuria in patients with type 2 diabetes

目的以24 h尿钠排泄作为钠摄入量评估指标,评估24 h尿钠排泄和25-羟维生素D(25-hydroxy vitamin D,25-OHD)水平对2型糖尿病患者白蛋白尿发生风险的关联影响。方法回顾性纳入2018年1月至2021年10月期间郑州大学第一附属医院内分泌与代谢病科住院成年2型糖尿病患者670例。根据24 h尿白蛋白排泄水平分为白蛋白尿阳性组与阴性组;根据24 h尿钠排泄水平分为高钠组和低钠组;根据25-OHD水平分为低VD组和高VD组。关联24 h尿钠排泄和25-OHD两分类变量进一步将患者分为4组,即高VD低钠组(85例)、高VD高钠组(122例)、低VD低钠组(248例)和低VD高钠组(215例);采用二分类回归法分析24 h尿钠排泄和25-OHD关联对白蛋白尿的影响。结果4组患者组间24 h尿白蛋白排泄水平差异有统计学意义(P<0.01);低VD高钠组的24 h尿白蛋白排泄水平显著高于低VD低钠组、高VD低钠组和高VD高钠组[39.00(13.00,319.00)mg/24 h对22.00(10.00,99.00)mg/24 h,22.00(9.00,72.50)mg/24 h,22.45(9.69,72.75)mg/24 h;P=0.047,P=0.019,P=0.030]。相关分析显示,低VD组24 h尿钠排泄与24 h尿白蛋白排泄呈正相关(P=0.017),高VD组二者间无相关性(P=0.411)。二分类回归分析显示,24 h尿钠排泄水平(P=0.017)和25-OHD(P=0.023)是2型糖尿病患者白蛋白尿阳性的独立危险因素。低VD高钠组白蛋白尿阳性风险是高VD低钠组的1.789倍(P=0.037)。结论24 h尿钠排泄和25-OHD二者关联影响2型糖尿病患者24 h尿白蛋白排泄,低25-OHD水平增加高钠摄入2型糖尿病患者白蛋白尿的发生风险。

Objective Using 24-hour urinary sodium excretion(24h-UNa)as the surrogate measure of sodium intake,to evaluate the joint association of 24h-UNa and serum 25-hydroxy vitamin D(25-OHD)levels with the risk of albuminuria in patients with type 2 diabetes mellitus(T2DM).Methods This retrospective study included 670 hospitalized T2DM cases in the Department of Endocrinology and Metabolic Diseases,the First Affiliated Hospital of Zhengzhou University from January 2018 to October 2021.Patients were divided into the albuminuria-positive group or negative-group according to the level of 24-hour urinary albumin excretion(24h-UAE);They were also divided into the high-sodium group or low-sodium group according to the level of 24h-UNa;Patients were divided into the low-VD group or high-VD group according to the level of 25-OHD.Combining 24h-UNa and 25-OHD,the patients were further divided into four groups:high-VD low-sodium group(n=85),high-VD high-sodium group(n=122),low-VD low-sodium group(n=248),and low-VD high-sodium group(n=215).The effect of 24h-UNa and 25-OHD association on albuminuria was analyzed by binary regression.Results There were significant differences in 24h-UAE level among the four groups(P<0.01),the level of 24h-UAE in the low-VD high-sodium group was significantly higher than that in low-VD low-sodium group,high-VD low-sodium group,and high-VD high-sodium group[39.00(13.00,319.00)mg/24 h vs 22.00(10.00,99.00)mg/24 h,22.00(9.00,72.50)mg/24 h,22.45(9.69,72.75)mg/24 h;P=0.047,P=0.019,P=0.030].Correlation analysis showed a positive correlation between 24h-UNa and 24h-UAE in the low-VD group(P=0.017),but not in the high-VD group(P=0.411).Binary regression analyses showed that both 24h-UNa(P=0.017)and 25-OHD(P=0.023)were independent risk factors for positive albuminuria in patients with T2DM.The risk of positive albuminuria in the low-VD high-sodium group was 1.789 times higher than that in the high-VD low-sodium group(P=0.037).Conclusion 24h-UAE in T2DM patients was affected by the combination of 24h-UNa and 25-OHD.A low level of 25-OHD increased the risk of albuminuria in high sodium intake T2DM patients.