维生素D在糖尿病发病机制中的作用

维生素D不仅能调节钙磷代谢,而且作为一种免疫调节剂,可能在NOD鼠和人类1型糖尿病(T1DM)的发生中起抑制作用。维生素D的缺乏可以使T1DM的发病率上升,补充维生素D通过调节免疫,可预防T1DM的发生和延缓胰岛炎的进展。因此,在婴幼儿时期防治维生素D缺乏是减少T1DM发生的简单和安全的方法。维生素D缺乏也与2型糖尿病(T2DM)的发生有关。维生素D的活性形式——1,25(OH)2D3,在体内需要激活维生素D受体(VDR)来发挥其效应。研究显示,VDR基因多态性存在着较大的种族差异,VDR基因多态性的研究,可以为不同人群糖尿病易感性的差异,提供基因水平依据。     

Vitamin D receptor and PCNA expression in severe parathyroid hyperplasia of uremic patients

Objective　To clarify the role of vitamin D receptor (VDR) expression in parathyroid proliferation and resistance of parathyroid glands to 1,25(OH)2D3 with secondary hyperparathyroidism (SHPT). Methods　This study used archive parathyroid with 7 uremic patients. The expression of proliferation cell nuclear antigen (PCNA) and VDR was evaluated in nineteen-surgically excised parathyroid tissues, including 11 diffuse hyperplasia (DH-type) and 8 nodular hyperplasia (NH-type) of parathyroid glands, by immunohistochemistry (avidin-biotin complex method). Results　The weight of parathyroid in SHPT was remarkably increased by 16.1 times. The numbers of parathyroid cells were increased by 1.86 times. The rate of PCNA was remarkably increased in parathyroid hyperplasia with SHPT compared with that in control group ［(6.35±3.36)‰ vs (1.73±1.31)‰, P<0.001］. The number of PCNA in DH-type was lower than that in NH-type (P<0.001). The density of VDR in the parathyroid with SHPT was significantly decreased ［(40.28±13.13)% vs (83.79±3.77)%, P<0.001］, VDR immunoreactivity expression in NH-type was lower than that in DH-type ［(27.14±4.12)% vs (49.84±7.33)%, P<0.001］. A significantly negative correlation was found between VDR density and the weight of the parathyroid (r=-0.46, P<0.05), the same as VDR and PCNA (r=-0.75, P<0.001). Conclusion　VDR density was significantly decreased in parathyroid tissue of uremic patients showing nodular hyperplasia compared with that in diffuse hyperplasia and there was significantly negative correlation between VDR density and the weight of the parathyroid, and this may contribute to the progression of SHPT. Furthermore, VDR deficiency may cause the resistance of parathyroid cells to 1, 25(OH)2D3, in part.     

糖尿病肾病Vit D缺乏与颈动脉内中膜厚度及冠脉钙化相关关系研究

目的了解糖尿病肾病(DN)患者血清维生素D不足与缺乏的发生情况,探讨其与颈动脉内中膜厚度(IMT)、冠脉钙化之间的相关关系。方法采用放射免疫分析法检测151例DN患者空腹血清25-羟胆骨化醇〔25(OH)D3〕、1,25-二羟胆骨化醇〔1,25(OH)2D3〕、全段甲状旁腺激素(iPTH)浓度,根据25(OH)D3水平将DN患者分为维生素D缺乏组(Vit-D-D)、不足组(Vit-D-I)及正常组(Vit-D-N),比较各组间矿物质代谢、脂代谢、颈动脉内中膜厚度(IMT)、冠脉钙化等指标的差异。多元线性回归分析法分析IMT与25(OH)D3、1,25(OH)2D3、iPTH、脂代谢指标的相关性;logistic回归分析法分析冠脉钙化与25(OH)D3、1,25(OH)2D3、iPTH、脂代谢指标的相关性。结果 DN患者血清25(OH)D3水平为(28±18.1)ng/mL,四分位数间距16.92～35.45ng/mL,Vit-D-I组71例,占47.01%,Vit-D-D组28例,占18.54%。血清1,25(OH)2D3水平为(28.93±33.13)pg/mL,四分位数间距10.36～31.08pg/mL,Vit-D-I者117例,占77.5%。与Vit-D-N组相比,Vit-D-D组的体质量指数(BMI)、24h尿蛋白、胆固醇(CHO)和低密度脂蛋白(LDL)增高,差异有统计学意义(P<0.05)。多元线性回归分析,IMT与年龄、性别、血磷正相关,logistic回归分析,冠脉钙化与血清1,25(OH)2D3负相关。结论 DN患者中维生素D不足和缺乏发生率高,维生素D缺乏者具有较高的尿蛋白、CHO和LDL,冠脉钙化与血清1,25(OH)2D3呈负相关关系。     

维生素D受体FokⅠ多态性对牙周组织细胞CYP24A1表达的影响

目的：维生素D受体（vitamin D receptor,VDR）基因的第二外显子存在唯一一个可以影响VDR蛋白结构的多态性位点,其可以由限制性核酸内切酶FokⅠ所识别,分为FF、Ff和ff三型。CYP24A1是维生素D 24羟化酶的编码基因,是常见的维生素D效应基因。本研究将探讨人牙龈成纤维细胞（human gingival fibroblasts,hGF）和牙周膜细胞（human periodontal ligament cells,hPDLC）中VDR FokⅠ多态性对CYP24A1表达的影响。方法：原代培养12名供体的hGF和hPDLC,提取基因组DNA,PCR扩增包含多态性位点的267 bp的片段。根据FokⅠ对片段酶切的结果判断VDR-FokⅠ基因型。确定基因型后,给各基因型hGF和hPDLC以10 nmol/L 1α,25双羟维生素D3（1,25OH2D3）或1 000 nmol/L 25羟维生素D3（25OHD3）刺激48 h,提取RNA,其中10 nmol/L 1,25OH2D3刺激48 h后还提取蛋白。之后给予hGF和hPDLC VDR拮抗剂ZK159222,再以10 nmol/L 1,25OH2D3或1 000 nmol/L 25OHD3刺激48 h,提取RNA。应用Real-time PCR和Western blot的方法检测维生素D24羟化酶CYP24A1和VDR的mRNA和蛋白的表达水平。结果：12名供体中,FF、ff和Ff型分别为4例、3例和5例。1,25OH2D3刺激hGF和hPDLC后,FF型细胞CYP24A1的mRNA表达水平显著高于Ff型或ff型细胞（hGF：F=31.147,P＜0.01;hPDLC：F=23.347,P＜0.01）;FF型细胞CYP24A1的蛋白表达水平同样显著高于Ff型或ff型细胞（hGF：F=12.368,P＜0.01;hPDLC：F=15.749,P＜0.01）。25OHD3刺激hGF和hPDLC后,FF型细胞CYP24A1的mRNA表达水平也显著高于Ff型或ff型细胞（hGF：F=32.061,P＜0.01;hPDLC：F=32.569,P＜0.01）。如1,25OH2D3刺激伴有ZK159222,则三型细胞CYP24A1的mRNA表达水平差异无统计学意义（hGF：F=0.246,P=0.787;hPDLC：F=0.574,P=0.583）。如25OHD3刺激伴有ZK159222,则三型细胞CYP24A1的mRNA表达水平差异也无统计学意义（hGF：F=1.636,P=0.248;hPDLC：F=0.582,P=0.578）。不同刺激条件下,hGF和hPDLC两种细胞比较CYP24A1或VDR的表达水平,差异均无统计学意义。结论：在hGF和hPDLC中,FF型VDR可介导比其他基因型VDR更为显著的CYP24A1上调,提示FF型VDR可能具有更强的转录活性。     

维生素D及其受体在妇科肿瘤中的研究进展

维生素D受体(VDR)是介导1,25二羟维生素D3发挥生物效应的核内生物大分子,为类固醇激素/甲状腺受体超家族成员。1,25二羟维生素D3是维生素D的活性形式,它除了具有钙、磷代谢调节作用外,还能调节正常组织和肿瘤细胞的生长和分化。VDR基因上存在多个多态性位点,与部分肿瘤的发生发展密切相关。本文主要综述VDR的结构及其功能、基因多态性,维生素D的细胞作用机制及与妇科肿瘤的相关性研究。     

维生素D受体基因多态性与婴幼儿佝偻病的相关性

目的研究维,圭素D受体fVDR）基因Apal位点多态性与婴幼儿佝偻病的相关性,探讨其遗传易感性,为临床早期诊断治疗提供理论依据。方法采用病例对照研究方法,选择确诊的佝偻病患儿56例和正常婴幼儿76例作为研究对象。应用聚合酶链反应-限制性片段长度多态性分析检测VDR基因ApaI位点的多态性,比较两组之间的VDR基因型频率、等位基因频率以及VDR基因型中相关指标的相关性。结果病例组VDR基斟ApaI位点基因型分布频率AA为14．3％、Aa为46．4％、aa为39．3％,对照组AA为13．3％,Aa为50％,aa为36．8％,两组之间差异无统计学意义;病例组VDR基因ApaI位点等位基因分布频率A为37．5％,a为62．5％,对照组A为38．2％,a为61．8％,两组之间差异无统计学意义;两组之间VDR基因ApaI位点不同基因型之间血清钙水平不同（x2=6．719,P〈0．05）。结论VDR基因ApaI基凶型与血清钙水平有相关性,VDR基因ApaI酶切位点的多态性与婴幼儿佝偻病无相关性。     

1,25-二羟维生素D3及其类似物对免疫系统的调节作用

1,25-二羟维生素D3是维生素D的活性形式,是一种第二类固醇类激素,和维生素D受体（VDR）结合发挥作用。VDR是核受体超家族中的一员,这一核受体超家族还包括类固醇激素受体,甲状腺激素受体和维甲酸受体。1,25-二羟维生素D3调节钙磷代谢,控制细胞的增殖和分化,产生免疫调节作用。对1,25-二羟维生素D3及其类似物功能研究的进展和免疫调节机制的新认识,提示它们在治疗自身免疫性疾病和诱导同种异体移植耐受上可有广泛的应用。1,25-二羟维生素D3及其类似物除了直接作用于T细胞外,还通过各种机制调节抗原呈递细胞的表型和功能,尤其是树突细胞。体内和体外实验都已证明1,25-二羟维生素D3及其类似物诱导树突细胞获得致耐受性,这一特性可被用于人类自身免疫性疾病及同种异体移植排斥的治疗。作者就1,25-二羟维生素D3及其类似物功能研究的新进展和免疫调节机制的新认识作一综述。     

Suppression of secondary hyperparathyroidism in uraemia: acute and chronic studies

A study was conducted evaluating the response of serum parathyroid hormone to acute hypercalcaemia and long term administration of 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) in patients receiving maintenance haemodialysis. During infusion of elemental calcium 4 mg/kg/h over four hours in 12 patients not receiving vitamin D the concentration of serum amino terminal parathyroid hormone fell by 31-96% (mean 74.8 (SD 17.6)%) while that of carboxy terminal parathyroid hormone changed little. There was a strong inverse correlation between baseline serum calcium concentration and percentage fall in amino terminal parathyroid hormone during infusion (r = 0.88; p less than 0.001). In seven patients who received prolonged treatment with 1,25(OH)2D3 after calcium infusion there was a positive correlation between maximum percentage fall in amino terminal parathyroid hormone during infusion and the percentage fall in amino terminal parathyroid hormone after 1,25(OH)2D3 treatment (r = 0.79; p less than 0.05). The responsiveness of the parathyroid glands to changes in calcium in acute studies may be used to predict the efficacy of long term treatment with 1,25(OH)2D3. Patients in whom calcium infusion does not suppress parathyroid hormone may have true parathyroid autonomy and require early parathyroidectomy.     

Postnatal evaluation of vitamin D and bone health in women who were vitamin D-deficient in pregnancy, and in their infants

OBJECTIVE: To determine the postnatal vitamin D status and bone health of women identified as vitamin D-deficient in pregnancy, and of their infants. DESIGN AND PARTICIPANTS: Retrospective audit conducted between 27 August and 5 November 2003. The study included women delivering between August and October 2002 at the Royal Women's Hospital, Melbourne, who had had a 25-hydroxyvitamin D (25-[OH]D) level < 30 nmol/L in pregnancy, and their infants at age 4-10 months. SETTING: The outpatient clinic at the Royal Children's Hospital, Melbourne. MAIN OUTCOME MEASURES: Maternal and infant serum levels of vitamin D, total alkaline phosphatase (tALP), parathyroid hormone (PTH), calcium and phosphorus; x-ray results in children with clinical or laboratory findings suggestive of rickets. RESULTS: Of 69 mother-infant pairs invited to participate, 47 (68%) attended. All 47 women had 25-(OH)D levels < 50 nmol/L, and 39 (83%) had levels < 30 nmol/L. Vitamin D supplements had been prescribed in pregnancy for 35 women (74%), and 19/35 reported having taken them as prescribed. None had continued to take supplements postnatally, but one had recently started taking them again. Among 45 infants from whom blood samples were successfully obtained, 18 (40%) had 25-(OH)D levels < 50 nmol/L, and 14 (31%) had levels < 30 nmol/L. Twelve of 16 breastfed infants had 25-(OH)D levels < 30 nmol/L, compared with 2/29 fed formula milk (P = 0.001). CONCLUSIONS: Most mothers who had been vitamin D-deficient in pregnancy were also deficient postnatally, indicating that treatment offered, counselling and/or treatment compliance were inadequate. Their infants, especially if breastfed, were at high risk of vitamin D deficiency and increased bone formation. Breastfed infants of mothers at high risk of vitamin D deficiency should receive vitamin D supplements.     

维生素D受体多态性的研究进展

维生素D是维持人体生命所必需的营养素,只有在体内转变成1,25-(OH)2D3后,才成为有生理活性的有效物质,经过血液循环运送到各个靶器官发挥作用。维生素D受体(VDR)是介导1,25-(OH)2D3发挥生物学效应的核内生物大分子物质,VDR是由VDR基因编码,VDR基因是研究骨代谢性疾病遗传基础的候选基因之一。该文就VDR基因与钙吸收、骨量、VDR基因的协同作用以及与其基因、环境因素的交互作用对骨量影响的研究进展进行综述。     

维生素D与免疫功能的研究

维生素D是维持人体生命所必需的营养素,体内的维生素D有内源性和外源性两种,最终被转化为有较强生物活性的1,25-二羟维生素D3[1,25-(OH)2D3],经血液循环运送到各个靶器官发挥作用。最近研究表明,维生素D是一种新的神经内分泌-免疫调节激素,对细胞免疫具有重要的调节作用,包括维生素D受体(VDR)在免疫相关细胞内的表达,1,25-(OH)2D3对细胞因子生成的调控,VDR和各羟化酶缺损的转基因动物研究等。因此,除了对血钙、血磷代谢的调节预防和治疗佝偻病外,维生素D在免疫功能的调节方面也越来越受关注。     

Interrelations of calcium-regulating hormones during normal pregnancy

Profound changes in calcium metabolism occur during pregnancy. The mother has to make available extra calcium for fetal requirements while ensuring that her plasma and bone calcium concentrations are satisfactorily maintained. In a cross-sectional study plasma concentrations of the major calcium-regulating hormones--namely, calcitonin, parathyroid hormone, 25-hydroxyvitamin D (25-OHD), and 1,25-dihydroxyvitamin D (1,25-(OH)2D)--were measured to establish their interrelations during normal pregnancy. The major changes observed were increases in the circulating concentrations of 1,25-(OH)2D and calcitonin. Concentrations of parathyroid hormone and 25-OHD remained within the normal range. The increased concentrations of 1,25-(OH)2D enable the increased physiological need for calcium to be met by enhancing intestinal absorption of this element. The simultaneous rise in calcitonin opposes the bone-resorbing activities of 1,25-(OH)2D, thereby protecting the integrity of the maternal skeleton. Maternal calcium homeostasis is thus maintained yet the requirements of the fetus are fulfilled.     

维生素D_3对自身免疫病的调节作用

免疫细胞存在维生素D受体(VDR),维生素D3通过其体内代谢活性产物1,25-(OH)2D3与VDR结合发挥免疫调节作用。1,25-(OH)2D3除了直接作用于T细胞外,还通过多种机制调节抗原递呈细胞的表型和功能,尤其是树突状细胞。对12,5-(OH)2D3免疫调节机制的认识提示其在自身免疫性疾病的治疗中可广泛应用。近年来的研究表明1,2,5-(OH)2D3可通过多种机制调节1型糖尿病、多发性硬化症、系统性红斑狼疮等自身免疫病的发病。     

维生素D与胎儿生长受限关联的研究进展

胎儿生长受限(fetal growth restriction,FGR)是常见的妊娠并发症,与围产儿死亡率高和青少年健康成长问题及成年后心血管及代谢性疾病密切相关。尽管FGR的发病率高达5%~10%,但目前仍没有很好的预防和治疗方法。维生素D是人体必需的一种脂溶性激素,在人体中有多种存在形式,1,25(OH)₂D为其活性形式,能与维生素D受体(vitamin D receptor,VDR)结合并发挥广泛的生物学功能,对正常妊娠的维持以及胎儿的生长发育具有重要作用。VDR属核受体超家族成员,是维生素D代谢途径中的一个重要组成部分,参与激活调节和启动众多涉及到细胞增殖和分化的基因的表达与调控。VDR基因存在多态性并影响VDR的转录活性,改变VDR蛋白功能,并直接或间接地影响维生素D的功能,与多种疾病的遗传易感性相关。人体和动物实验研究表明:子宫内膜基质以及妊娠早期蜕膜组织细胞中均有VDR表达,VDR蛋白参与早期胚胎植入过程的免疫调节,FGR患者胎盘VDR表达下降。因此,孕期维生素D状态以及VDR基因多态性可能与胎儿生长发育迟缓以及新生儿低出生体重有关。本文就维生素D、维生素D受体基因多态性与FGR的关系作一综述。      

维生素D受体基因多态性与2型糖尿病及血清1,25-二羟基维生素D3的相关性研究

目的探讨维生素D受体(vitamin D receptor,VDR)基因ApaI酶切位点多态性与2型糖尿病及血清1,25-二羟基维生素D3[1,25(OH)2D3]的相关性。方法采用聚合酶链反应限制性片段长度多态性(PCR-RFLP)技术,检测105例2型糖尿病患者和105例正常者的VDR基因型,用酶联免疫吸附(Elisa)法测定血清1,25(OH)2D3水平,并检测相关临床及生化指标,比较VDR基因型和等位基因频率的分布差异及不同基因型血清1,25(OH)2D3等相关指标的差异。结果维生素D受体基因ApaⅠ位点基因型和等位基因频率在两组中的分布差异明显(P<0.01)。糖尿病组等位基因a和基因型aa频率明显高于对照组。基因型AA组及Aa组血清1,25(OH)2D3高于基因型aa组,而收缩压、舒张压及空腹血糖低于基因型aa组,且差别有显著性意义(P<0.05或0.01)。结论 Apa I位点的VDR基因多态性与2型糖尿病存在相关性。血清1,25(OH)2D3水平、空腹血糖及血压与VDR基因多态性密切相关。     

1,25-（OH）2D3及LPS对2型糖尿病肾病尿毒症患者单核细胞维生素D受体表达的影响

目的探讨1,25-(OH)2D3及TLR4配体(脂多糖,LPS)对2型糖尿病(T2DM)和糖尿病肾病(diabetic ne-phropathy,DN)尿毒症患者血清干预的单核细胞维生素D受体(VDR)表达的影响,进一步探索1,25-(OH)2D3在T2DM和DN炎症性免疫反应中的作用。方法分离研究对象(健康对照组、T2DM组和DN尿毒症组)外周血血清,孵育THP-1单核细胞,然后于含或不含10-7mol/L的1,25-(OH)2D3培养液中培养48 h后,再用终浓度为1μg/ml的LPS干预24 h,收集单核细胞和培养上清。采用RT-PCR检测VDR mRNA表达,Western blot、免疫荧光检测THP-1单核细胞内VDR蛋白表达。ELISA法检测细胞培养上清IL-6和IL-10浓度。结果与正常对照组比较,在LPS的刺激下T2DM组和DN尿毒症组THP-1单核细胞内VDR mRNA水平下调[对照组(0.99±0.25);T2DM组(0.65±0.24);DN尿毒症组(0.62±0.27),P<0.05];DN尿毒症组THP-1单核细胞内VDR蛋白表达比正常对照组和T2DM组显著下调[对照组(0.48±0.05);T2DM组(0.50±0.06);DN尿毒症组(0.20±0.01),P<0.01],且LPS增强以上患者血清孵育的THP-1单核细胞炎症细胞因子IL-6的分泌[对照组(15.13±1.61);T2DM组(24.06±2.92);DN尿毒症组(70.77±5.48),P<0.05];而1,25-(OH)2D3可部分阻断上述作用。结论 LPS能下调T2DM和DN尿毒症患者单核细胞VDR mRNA和蛋白的表达,引起促炎和抗炎细胞因子失调。1,25-(OH)2D3可部分逆转LPS的作用,对T2DM和DN尿毒症可能具有一定的保护作用。     

维生素D及维生素D受体的研究进展

维生素D受体（VDR）是亲核蛋白,属于类固醇激素／甲状腺激素受体超家族成员,在体内主要介导维生素D的细胞作用。维生素D的主要活性代谢产物1,25．二羟胆骨化醇在体内作用广泛,与VDR结合后,除了产生经典的调节钙、磷代谢的作用外,还具有抑制增殖、促进分化、调节免疫及抑制细胞坏死、抑制肿瘤的浸润和转移等非钙调作用。近年来,活性维生隶D及其衍生物的抗肿瘤作用备受注目,广泛应用于临床前抗肿瘤研究,有可能成为防治肿瘤的很有前景的药物。     

Annual intramuscular injection of a megadose of cholecalciferol for treatment of vitamin D deficiency: efficacy and safety data

AIM: To evaluate the efficacy and safety of an annual intramuscular injection of cholecalciferol for vitamin D deficiency. DESIGN: Prospective open-label study. PARTICIPANTS: Five men and 45 women (mean age 66.3 years) with vitamin D deficiency who were given a single therapeutic intramuscular injection of 600 000 IU (15 mg) cholecalciferol (vitamin D(3)). OUTCOME MEASURES: Serum levels of calcium, creatinine, 25-hydroxyvitamin D(3) (25OHD(3)) and parathyroid hormone, as well as early morning 2-hour urine calcium/creatinine excretion index. Specimens were collected at baseline and after 4 and 12 months of therapy. Data are reported as mean +/- 1 SD. RESULTS: Vitamin D deficiency was severe (< 12.5 nmol/L) in one participant, moderate (12.5-24 nmol/L) in 14, and mild (25-49 nmol/L) in 35. Twenty-four participants (48%) had secondary hyperparathyroidism. Following intramuscular cholecalciferol injection, serum 25OHD(3) levels normalised in all participants and remained above 50 nmol/L throughout the study. Serum 25OHD(3) levels were significantly higher at 4 months (114 +/- 35 nmol/L), and 12 months (73 +/- 13 nmol/L) compared with baseline (32 +/- 8 nmol/L) (P < 0.001), increasing by an average of 128% over the 12 months. There was a corresponding decrease in serum parathyroid hormone levels at 4 months (6 +/- 3 pmol/L) and at 12 months (5.2 +/- 3 pmol/L), with a 30% decrease at 12 months from baseline (7.4 +/- 4 pmol/L) (P < 0.01). Primary hyperparathyroidism was unmasked in one participant at 4 months and mild hypercalcaemia (serum calcium, < 2.70 mmol/L) was noted in two participants (4%) at 12 months. Serum creatinine levels remained normal in all participants throughout the study, while increases in 2-hour urine calcium/creatinine excretion index were seen in 10 participants (20%) at 12 months, three of whom had had elevated values at baseline. CONCLUSIONS: Once-yearly intramuscular cholecalciferol injection (600 000 IU) is effective therapy for vitamin D deficiency. While this therapy appears to be safe, the potential for developing hypercalciuria needs to be examined in a large randomised controlled trial.     

维生素D受体mRNA在白血病患者外周血细胞中的表达

目的 :检测白血病患者外周血维生素D受体 (VDR)mRNA表达 ,探讨 1,2 5 (OH) 2 D3 诱导分化的分子学机制。方法 :以RT_PCR技术检测白血病患者外周血细胞中VDRmRNA表达。结果 :白血病患者外周血细胞中均有VDRmRNA表达。结论 :白血病患者外周血细胞是维生素D3(VD3)作用的靶细胞 ,1,2 5 (OH) 2 D3 的作用可能是通过VD3 核受体 (VDR)而介导 ,提示VD3 能用于各种类型白血病的诱导分化治疗     

慢性肾脏病患者活性维生素D3缺乏及其原因探讨

目的：观察慢性肾脏病（chronickidneydisease,CKD）患者活性维生素风水平以及探讨25（OH）D,缺乏的原因。方法：对174例住院CKD患者的临床资料进行前瞻性研究。测定血清25（OH）D,水平、空腹血糖fFBG）、空腹胰岛素（FINS）及C肽（CP）,并常规检测Scr、BUN、碱性磷酸酶（ALP）、白蛋白（Alb）,血清钙、磷,全段甲状旁腺激素（iPTH）、C反应蛋白（CRP）、24h尿蛋白等。根据25（OH）D,水平将CKD患者分三组,A组25（OH）D,〈25nmoL／1（n=47）、B组25（0H）D325～50nmol／L（n=115）、C组25（0H）D3〉50nmol／L（n=12）,比较各组间差异。分析CKD患者25（0H）D,与各临床指标的关系。结果：非透析患者25（0H1D,水平不足占93．3％,其中25（0H1D,严重缺乏占24．2％。透析患者25（OH）D3不足的占95．8％,严重缺乏占39．1％。c组Alb和Ca^2＋明显高于A、B组,C组尿蛋白和Scr与A、B组有明显减低（P〈0．05）。单因素相关分析显示,25（OH）D,与Alb（r=0．435）、eGFR（r=0．256）正相关（P〈0．01）,和Scr（r=-0．284）、尿蛋白（r=-0．383）、CP（r=-0．208）负相关（P〈0．01）,与年龄、BMI、iPTH、ALP、CRP、FINS、胰岛素抵抗指数（IR）呈负相关,与胰岛素敏感指数（ISI）呈正相关,但差异均无统计学意义（均P〉0．05）。多元线性回归分析结果显示,25（0I-I）D,与尿蛋白、Scr和CP呈负相关,与Alb呈正相关。结论：慢性肾脏病中维生素D不足和缺乏普遍存在,大量蛋白尿和高C肽是维生素D不足和缺乏的高危因素。Alb、尿蛋白、高C肽是影响维生素D水平的重要因素之一。