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。

Vitamin D Deficiency and Carotid Artery Intima-media Thickness and Coronary Calcification in Patients with Diabetic Nephropathy

Objective To investigate the deficiency and insufficiency of 25-hydroxyvitamin D3(25(OH)D3),1,25-dihydroxyvitamin D3(1,25(OH)2D3) in patients with diabetic nephropathy(DN),and their association with carotid artery intima-media thickness(IMT) and coronary artery calcification.Methods The concentrations of 25-hydroxyvitamin D3,1,25-dihydroxyvitamin D3 and intact parathyroid hormone(iPTH) were determined by radioimmunoassay in 151 DN patients.Based on the level of 25-hydroxyvitamin D3,the patients were divided into Vitamin D deficiency group(Vit-D-D group,<15 ng/mL),insufficiency group(Vit-D-I group,15-30 ng/mL) and normal group(Vit-D-N group,>30 ng/mL).The association of Vitamin D with IMT and coronary artery calcification was examined through group comparisons,logistic regression analysis and multiple linear regression analysis.Results The mean level of 25-hydroxyvitamin D3 was(28±18.1) ng/mL,with an interquartile range of 16.92-35.45 ng/mL.The incidence of 25-hydroxyvitamin D3 insufficiency and deficiency was 47.01%(71/151) and 18.54%(28/151) respectively.The mean level of 1,25-dihydroxyvitamin D3 was(28.93±33.13) pg/mL,with an interquartile range of 10.36-31.08 pg/mL.The incidence of 1,25-dihydroxyvitamin D3 insufficiency was 77.5%(117/151).Compared with the normal controls,the BMI,24 h urine protein,CHO and LDL of those with Vitamin D deficiency increased significantly(P<0.05).IMT was associated with age,sex,and serum phosphorus.Coronary calcification was negative correlated with 1,25-dihydroxyvitamin D3.Conclusion The incidence of vitamin D deficiency and insufficiency in DN patients is high.The patients with vitamin D deficiency have higher urinary protein,CHO and LDL.Coronary artery calcification is reveserly correlated with 1,25(OH)2D3.