慢性肾脏病患者维生素D缺乏与胰岛素抵抗的关系

目的通过比较不同时期慢性肾脏病（chronickidneydisease，CKD）患者的血清1，25-二羟维生素D3[1，25（0H）2D3]水平，探讨血清1，25（0H）2D3水平与CKD患者胰岛素抵抗的关系。方法选择98例CKD2～3期患者，均测量身高、体质量及血压。ELISA法测定血清1，25（OH）2D3，同时常规测定空腹血糖、胰岛素、血肌酐，超敏C反应蛋白、白细胞介素6（IL-6）、24h尿蛋白定量、高密度脂蛋白胆固醇（HDL-C）、收缩压，计算稳态模型胰岛素抵抗指数（HOMA-IR），分析维生素D缺乏与上述指标的关系。结果CKD3期组的体质量指数、空腹胰岛素水平、血肌酐、24h尿蛋白定量、超敏C反应蛋白、IL-6、收缩压及胰岛素抵抗指数均明显升高（P〈0．05或P〈0．01）。而CKD3期组患者有明显降低的肾小球滤过率（GFR），1，25（OH）2D3及HDL-C均显著降低（P〈0．05或P〈0．01）。相关分析表明，血清1，25（OH）2D3与HOMA-IR、IL-6、24h尿蛋白定量、收缩压、血肌酐呈负相关水平（r=-0．357、-0．207、-0．241、-0．187、-0．141，P〈0．05或P〈0．01），与CKD患者胰岛素抵抗的多元线性逐步回归分析示有显著相关性（r=-0．458，P〈0．01）。结论CKD患者维生素D缺乏可导致胰岛素抵抗。

Insulin resistance and vitamin deficiency in patients with chronic kidney disease

Objective To investigate serum 1,25 （OH）2 D3 level and insulin resistance in pa- tients with chronic kidney disease （CKD）. Methods Ninety-eight cases of 2-3 CKD patients were col- lected prospectively, serum 1,25（OH）2D3. was detected by ELISA . fasting blood glucose,insulin, ser- um creatinine, hypersensitive c-reactive protein, interleukin 6,24 h urinary protein, high density lipo- protein cholesterol,systolic blood pressure, steady state model of insulin resistance index calculation were measured, vitamin D deficiency was analyzed with the data. Results CKD stage 3 of body mass index（BMI）, fasting insulin, serum creatinine , 24 h urinary protein, hypersensitive c-reactive protein, interleukin 6, systolic blood pressure and insulin resistance index were significantly increased, and gio- merular filtration rate, 1,25 （OH）2 D3 and high-density lipoprotein cholesterol decreased significantly, Correlation analysis revealed that the steady state model of insulin resistance index, interleukin 6,24 h urinary protein, systolic blood pressure and serum creatinine were negatively correlated with serum 1, 25（OH）2D3 ,and insulin resistance in patients with CKD multiple linear stepwise regression analysis was negatively correlated with serum 1,25 （OH）2133 （ r = - 0. 458, P 〈 0. 01 ）. Conclusions Patients with CKD of vitamin D deficiency can lead to insulin resistance.