糖尿病肾病患者血清1,25-二羟维生素D3水平变化

摘要

目的 观察血清1,25-二羟维生素D3[1,25-(OH)2D3]水平在糖尿病肾病(DN)进展中的变化.方法 选择2013年8月至2015年5月深圳市龙岗中心医院收治的2型糖尿病患者157例,按照Mogensen分期标准将患者分为单纯糖尿病(DM)组(n=36)、早期DN (EDN)组(n=38)、临床DN(CDN)组(n=42)和DN终末期(ESDN)组(n=41),另选择同期体检健康者36例作为对照组.对5组受试者的尿白蛋白排泄率(UAER)、肾小球滤过率(GFR)及血清1,25-(OH) 2D3水平进行比较.结果 对照组与DM组患者UAER、GFR比较差异均无统计学意义(P＞0.05);EDN组、CDN组和ESDN组患者UAER显著高于对照组和DM组(P＜0.05),EDN组、CDN组和ESDN组患者GFR显著低于对照组和DM组(P＜0.05);CDN组和ESDN组患者UAER显著高于EDN组(P＜0.05),但CDN组与ESDN组患者UAER比较差异无统计学意义(P＞0.05);ESDN组患者GFR显著低于EDN组和CDN组(P＜0.05),但EDN组与CDN组患者GFR比较差异无统计学意义(P＞0.05).DM组、EDN组、CDN组和ESDN组患者血清1,25-(OH)2D3水平显著低于对照组(P＜0.05),EDN组、CDN组和ESDN组患者血清1,25-(OH)2D3水平显著低于DM组(P＜0.05),CDN组和ESDN组患者血清1,25-(OH)2D3水平显著低于EDN组(P＜0.05),ESDN组患者血清1,25-(OH)2D3水平显著低于CDN组(P＜0.05).Pearson相关分析显示,糖尿病患者血清1,25-(OH)2D3水平与GFR呈正相关(r=0.389,P ＜0.001),与UAER呈负相关(r=-0.450,P＜0.001).结论 DN患者血清1,25-(OH)2D3水平显著降低,检测血清1,25-(OH)2D3水平可能对早期发现DN及其病情判断有积极意义.%Objective To observe the changes in serum 1,25-dihydroxyvitamin D3 [1,25-(OH) 2 D3] level in the progress of diabetic nephropathy(DN).Methods A total of 157 patients with type 2 diabetes mellitus were selected from August 2013 to May 2015 in Longgang Central Hospital of Shenzhen City.The patients were divided into diabetes mellitus(DM) group (n =36),early DN (EDN) group (n =38),clinical DN (CDN) group (n =42) and end stage DN (ESDN) group (n =41) according to Mogensen staging standards.Another 36 healthy subjects were selected as control group.The urinary albumin excretion rate (UAER),glomerular filtration rate (GFR) and serum 1,25-(OH) 2 D3 level were compared in the five groups.Results There was no significant difference in UAER and GFR between the control group and DM group(P ＞ 0.05).The UAER in EDN group,CDN group and ESDN group was significantly higher than that in control group and DM group (P ＜ 0.05).The GFR in EDN group,CDN group and ESDN group was significantly lower than that in control group and DM group(P ＜ 0.05).The UAER in CDN group and ESDN group was significantly higher than that in EDN group(P ＜ 0.05),but there was no significant difference in UAER between the CDN group and ESDN group(P ＞0.05).The GFR in ESDN group was significantly lower than that in EDN group and CDN group(P ＜ 0.05),but there was no significant difference in GFR between EDN group and CDN group(P ＞0.05).The level of serum 1,25-(OH)2D3 in DM group,EDN group,CDN group and ESDN group was significantly lower than that in control group (P ＜ 0.05).The level of serum 1,25-(OH)2D3 in EDN group,CDN group and ESDN group was significantly lower than that in DM group(P ＜ 0.05).The level of serum 1,25-(OH) 2D3 in C DN group and ESDN group was significantly lower than that in EDN group (P ＜ 0.05).The level of serum 1,25-(OH)2D3 in ESDN group was significantly lower than that in CDN group (P ＜ 0.05).Pearson correlation analysis showed that the serum 1,25-(OH)2D3 level was positively correlated to GFR (r =0.389,P ＜ 0.001),and the serum 1,25-(OH)2D3 level was negatively correlated to UAER (r =-0.450,P ＜ 0.001).Conclusion The level of serum 1,25-(OH)2D3 in DN patients decreases obviously.The detection of serum 1,25-(OH)2D3 may be helpful in the early diagnosis and evaluation of DN.