血清25羟维生素D缺乏与糖尿病肾病的关系  

The association between vitamin D deficiency and diabetic nephropathy in type 2 diabetic patients

作　　者：李冬梅[1] 张颖[1] 丁波[1] 刘炳丽[1] 蒋兰兰[1] 邢昌赢[2] 马建华[1] 

机构地区：[1]南京医科大学附属南京医院内分泌科,210029 [2]南京医科大学第一附属医院肾内科

出　　处：《中华内科杂志》2013年第11期970-974,共5页Chinese Journal of Internal Medicine

摘　　要：目的在2型糖尿病患者中探讨25羟维生素D缺乏和不足与糖尿病肾病的关系。方法选择2011年1月至2012年12月在南京医科大学附属南京医院内分泌科住院的2型糖尿病患者594例，测量其身高、体重，测定其空腹血25羟维生素D、血脂水平，24h尿白蛋白排泄率；观察25羟维生素D缺乏（〈20μg,／L）和不足（20～〈30μg／L）与糖尿病肾病之间的关系。结果所有患者中糖尿病肾病177例，其中微量白蛋白尿141例，大量蛋白尿36例。糖尿病肾病组维生素D缺乏的患病率高于无糖尿病肾病的患者（36．2％比27．8％，P〈0．05）。维生素D缺乏180例，维生素D不足157例。维生素D缺乏组患者尿白蛋白排泄率显著高于维生素D正常组[（123.0±299．2）mg／24h比（47．6±97．1）mg／24h，P〈0．01]，糖尿病肾病患病率更高（35．6％比26．1％，P〈0．05），大量蛋白尿患病率更高（12．2％比3．1％，P〈0．01）。回归分析发现维生素D缺乏显著增加糖尿病肾病的危险（OR1．57，95％CI1．04～2．37），在控制多重危险因素后仍然存在（OR1．78，95％CI 1．12～2．81）。维生素D水平与尿白蛋白排泄率呈负相关（r=-1．783，P〈0．001）。结论维生素D缺乏在2型糖尿病患者中发生率较高。在2型糖尿病患者中维生素D缺乏与糖尿病肾病的危险性增加有关。Objective To evaluate the association between vitamin D deficiency and diabetic nephropathy in type 2 diabetic patients. Methods A total of 594 patients with type 2 diabetes were enrolled from the inpatients of the Nanjing Medical University Affiliated Nanjing Hospital. Fasting serum lipid profile, 25-hydroxyealciferol vitamin D and urinary albumin excretion rate were investigated. The relationship between nephropathy and vitamin D deficiency （ 〈 20 p.g/L） or insufficiency （20 - 〈 30 p,g/L） was analyzed. Results Nephropathy was found in 177 subjects （29. 8% ） with albuminuria in 141 and proteinuria in 36 subjects. Vitamin D deficiency was found in 180 subjects and insufficiency in 157 subjects. The proportion of vitamin D deficiency was higher in the individuals with nephropathy than those without nephropathy （36. 2% vs 27.8% , P 〈 0. 05 ）. The urinary albumin excretion rate was significantly higher in the patients with vitamin D deficiency than those with normal vitamin D concentration [ （ 123.0 ~： 299. 2 ） mg/24h vs （47.6 ± 97.1 ） mg/24h, P 〈 0. 01 1. The prevalence of nephropathy was higher in the patients with vitamin D deficiency than those with normal vitamin D concentration （35.6% vs 26. 1% , P 〈 0. 05 ） , while the prevalence of proteinuria was higher in patients with vitamin D deficency （ 12. 2% vs 3.1% , P 〈 0. 01 ）. Logistic regression analysis demonstrated that vitamin D deficiency was associated with nephropathy （OR 1.57, 95% CI 1.04 -2. 37）, even after the adjustment for age, gender, hypertension, dyslipidemia, smoking status, use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers （ OR 1.78, 95% CI 1.12 - 2. 81 ）. The Vitamin D concentration was significantly negatively correlated with urinary albumin excretion rate （ r = - 1. 783, P 〈 0. 001 ）. Conclusions Type 2 diabetic patients have a high prevalence of vitamin D deficiency. Vitamin D deficiency is independently associated with diabetic nephropathy.

关 键 词：维生素D 糖尿病肾病 糖尿病 2型 尿白蛋白排泄率 

分 类 号：R587.2[医药卫生—内分泌]