血清25-羟维生素D3、脂蛋白相关磷脂酶A2与早期糖尿病肾病的相关性研究

目的 探讨早期糖尿病肾病(diabetic nephropathy, DN)患者血清25 羟维生素D3［25(OH)D3］、脂蛋白相关磷脂酶A2(LP PLA2)水平，分析其与早期DN的相关性。方法 选取入住我院内分泌科的2型糖尿病(T2DM)患者160例，根据尿蛋白排泄率(UAER)分为微量白蛋白尿组(n=80)与正常白蛋白尿组(n=80)，同时选取我院同期健康体检者80例作为对照组，采用酶联免疫吸附试验(ELISA法)检测血清LP PLA2水平，化学发光法检测血清25(OH)D3水平，全自动生化分析仪检测生化指标，对比3组血清LP PLA2、25(OH)D3水平变化，分析其与早期DN的相关性。结果 ①正常白蛋白尿组及微量白蛋白尿组血清LP PLA2水平明显高于对照组，血清25(OH)D3明显低于对照组(均P<0.05), 而正常白蛋白尿组血清LP PLA2低于微量白蛋白尿组，血清25(OH)D3高于微量白蛋白尿组(均P<0.05)。②微量白蛋白尿组UAER与低密度脂蛋白 胆固醇(LDL C)、收缩压(SBP)、舒张压(DBP)、病程、血糖(FPG)、糖化血红蛋白(HbA1c)、尿酸(UA)、同型半胱氨酸(Hcy)、胱抑素C(CysC)、LP PLA2均呈正相关(均P<0.05或P<0.01)，与25(OH)D3呈负相关(P<0.01)。③SBP、DBP、病程、FPG、HbA1c、CysC、LP PLA2为早期DN的独立危险因素，25(OH)D3为其保护因素。结论 血清LP PLA2、25(OH)D3与早期DN的发生、发展密切相关， LP PLA2是其危险因素，25(OH)D3是其保护因素。

Correlation analysis on serum level of 25 hydroxy vitamin D3 and lipoprotein associated phospholipase A2 with early diabetic nephropathy

Objective To investigate the level of 25 hydroxy vitamin D3 (25［OH］D3) and lipoprotein associated phospholipase A2 (Lp PLA2) in diabetic nephropathy(DN) patients and explore the correlation between serum level of 25(OH)D3 and Lp PLA2 and the early DN. Methods A total of 160 patients with type 2 diabetes mellitus(T2DM) were randomly divided into micro albuminuria group (n=80) and normal albuminuria group (n=80) according to the urinary albumin excretion rate (UAER). Another 80 health volunteers served as the control group. Serum Lp PLA2 level was measured by enzyme linked immunoadsorption determination (ELISA). Serum 25(OH)D3 level was measured by chemi luminescence method, and the biochemical indicators were measured by automatic biochemical analyzer. The differences of Lp PLA2 and 25(OH)D3 among three groups were compared, and the correlation between serum level of 25(OH)D3 and Lp PLA2 and the early DN was analyzed. Results ①Seurm Lp PLA2 was significantly higher in normal albuminuria and micro albuminuria group than that in control group, but serum 25(OH)D3 was significantly lower in normal albuminuria and micro albuminuria group than that in control group (P<0.05). Seurm Lp PLA2 was significantly higher in micro albuminuria group than that in normal albuminuria group, but seurm 25(OH)D3 was significantly lower in micro albuminuria group than that in normal albuminuria group (P<0.05). ②The level of UAER was positively correlated with the low density lipoprotein cholesterin(LDL C), systolic blood pressure (SBP), diastolic blood pressure (DBP), disease course, fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), uric acid(UA), homocysteine(Hcy), Cys C and Lp PLA2(P<0.05 or P<0.01), but was negatively correlated with 25(OH)D3 (P<0.01). ③SBP, DBP, course of sisease, FPG, HbA1c, CysC and LP PLA2 were independent risk factors for early DN, but 25(OH)D3 was protective factor for it. Conclusion The levels of 25( OH) D3 and LP PLA2 are closely related to the occurrence and development of early DN. 25(OH)D3 is the protective factor, while LP PLA2 is a risk factor for it．