2型糖尿病肾病早期血清25羟基维生素D水平及其与晚期糖基化终末产物的关系  

An Investigation of the Level of Serum 25-Hydroxyvitamin D in Early Type 2 Diabetic Nephropathy and Its Relationship with Advanced Glycation End Products

作　　者：陈娇月[1] 山秀杰[1] 刘敏[1] 何建秋[1] 刘晓燕[1] 高宇[1] 韩桂艳[1] CHEN Jiaoyue;SHAN Xiujie;LIU Min(The Affiliated Hospital of Chengde Medical University, Hebei Chengde 067000, China)

机构地区：[1]承德医学院附属医院,河北承德067000

出　　处：《河北医学》2021年第1期92-97,共6页Hebei Medicine

基　　金：河北省承德市科技支撑计划项目,(编号:201606A063)。

摘　　要：目的:探讨2型糖尿病肾病患者25羟基维生素D水平及其与晚期糖基化终末产物(AGEs)的关系。方法:选取2016年11月至2018年11月于我院住院的131例T2DM患者,按照尿微量白蛋白/肌酐值(UACR)分为3组:正常蛋白尿组(B组)46例(UACR<30mg/g)、微量蛋白尿组(C组)43例(UACR30~299mg/g)、大量蛋白尿组(D组)42例(UACR≥300mg/g)。同期46名健康体检人群作为对照组(A组),比较各组之间收缩压(SBP)、舒张压(DBP)、腰围(WC)、体质指数(BMI)、空腹血糖(FBG)、血钙(Ca)、血磷(P)、肌酐(CRE)、尿素氮(BUN)、糖化血红蛋白(HbA1c)、甲状旁腺激素(PTH)、UACR、25羟基维生素D[25-(OH)D3]、晚期糖基化终末产物(AGEs)、可溶性糖基化终末产物受体(sRAGE)的差异。结果:4组的25-(OH)D3水平分别为35.78±4.99ng/mL、26.81±1.99ng/mL、24.10±4.41ng/mL、20.63±4.60ng/mL(F=108.228,P<0.01),AGEs水平分别为27.85±9.57ng/L、37.68±9.80ng/L、55.75±7.69ng/L、92.60±5.88ng/L(F=294.843,P<0.01),sRAGE水平分别为46.11±7.64ng/mL、36.79±8.88ng/mL、29.02±4.41ng/mL、20.75±4.51ng/mL(F=114.109,P<0.01),各指标组间两两比较差异均有统计学意义(P<0.01)。相关性分析显示,25-(OH)D3与BMI、WC、FBG、HbA1c、UACR、AGEs均呈负相关(r=-0.168、r=-0.337、r=-0.662、r=-0.682、r=-0.535、r=-0.659,P<0.05或0.01),与sRAGE呈正相关(r=0.691,P<0.01);多元逐步回归分析显示:WC、UACR、AGEs、sRAGE是25-(OH)D3的独立影响因素。结论:25-(OH)D3在糖尿病肾病早期即出现下降,其下降水平与AGEs独立相关,可能通过AGEs-RAGE信号通路参与早期糖尿病肾病的发生与发展。Objective:To investigate the relationship between 25-hydroxyvitamin D[25(OH)D3]levels and advanced glycation end products(AGEs)in patients with type 2 diabetic nephropathy.Methods:A total of 131 T2DM patients admitted from Nov.2016 to Nov.2018 were selected and divided into normal albuminuria group(n=46),microalbuminuria group(n=43),and macroalbuminuria group(n=42)according to the urine microalbumin/creatinine value(UACR).46 healthy volunteers were selected as the control group.The general clinical data and level of fasting blood glucose(FBG),urea nitrogen(BUN),creatinine(Scr),calcium(Ca),phosphorus(P),glycosylated hemoglobin(HbA1c),UACR,25(OH)D3,AGEs,and the soluble isoform receptor of AGE(sRAGE)were measured and compared.Results:The pairwise comparison between the four groups had significant difference with the 25-(OH)D3 levels of(35.78±4.99ng/mL,26.81±1.99ng/mL,24.10±4.41ng/mL,20.63±4.60ng/mL,F=108.228,P<0.01),AGEs levels of(27.85±9.57ng/L,37.68±9.80ng/L,55.75±7.69ng/L,92.60±5.88ng/L,F=294.843,P<0.01),and sRAGE levels of(46.11±7.64ng/mL,36.79±8.88ng/mL,29.02±4.41ng/mL,20.75±4.51ng/mL,F=114.109,P<0.01).Pearson correlation analysis showed that 25-(OH)D3 was negatively correlated with BMI,WC,FBG,HbA1c,UACR and AGEs(r=-0.168,r=-0.337,r=-0.662,r=-0.682,r=-0.535,r=-0.659,P<0.05 or 0.01),and positively correlated with sRAGE(r=0.691,P<0.01).Multiple stepwise regression analysis showed that WC,UACR,AGEs and sRAGE were independent influencing factors of 25-(OH)D3.Conclusion:25-(OH)D3 decreased in the early diabetic nephropathy,and the decreased level was independently correlated with AGEs,which may be involved in the occurrence and development of early diabetic nephropathy through the AGEs-RAGE signaling pathway.

关 键 词：糖尿病2型 肾病 维生素D 晚期糖基化终末产物 

分 类 号：R58[医药卫生—内分泌]