CAJ | 학술논문

目的在2型糖尿病患者中探讨25羟维生素D缺乏和不足与糖尿病肾病的关系.方法选择2011年1月至2012年12月在南京医科大学附属南京医院内分泌科住院的2型糖尿病患者594例,测量其身高、体重,测定其空腹血25羟维生素D、血脂水平,24h尿白蛋白排泄率；观察25羟维生素D缺乏(＜20 μg/L)和不足(20～＜ 30 μg/L)与糖尿病肾病之间的关系.结果所有患者中糖尿病肾病177例,其中微量白蛋白尿141例,大量蛋白尿36例.糖尿病肾病组维生素D缺乏的患病率高于无糖尿病肾病的患者(36.2％比27.8％,P＜0.05).维生素D缺乏180例,维生素D不足157例.维生素D缺乏组患者尿白蛋白排泄率显著高于维生素D正常组[(123.0 ±299.2)mg/24h比(47.6 ±97.1)mg/24h,P＜0.01],糖尿病肾病患病率更高(35.6％比26.1％,P＜0.05),大量蛋白尿患病率更高(12.2％比3.1％,P＜0.01).回归分析发现维生素D缺乏显著增加糖尿病肾病的危险(OR 1.57,95％CI 1.04～2.37),在控制多重危险因素后仍然存在(OR l.78,95％ CI l.12～2.81).维生素D水平与尿白蛋白排泄率呈负相关(r=-1.783,P＜0.001).结论维生素D缺乏在2型糖尿病患者中发生率较高.在2型糖尿病患者中维生素D缺乏与糖尿病肾病的危险性增加有关.
목적 재2형당뇨병환자중탐토25간유생소D결핍화불족여당뇨병신병적관계.방법 선택2011년1월지2012년12월재남경의과대학부속남경의원내분비과주원적2형당뇨병환자594례,측량기신고、체중,측정기공복혈25간유생소D、혈지수평,24h뇨백단백배설솔；관찰25간유생소D결핍(＜20 μg/L)화불족(20～＜ 30 μg/L)여당뇨병신병지간적관계.결과 소유환 자중당뇨병신병177례,기중미량백단백뇨141례,대량단백뇨36례.당뇨병신병조유생소D결핍적환병솔고우무당뇨병신병적환자(36.2％비27.8％,P＜0.05).유생소D결핍180례,유생소D불족157례.유생소D결핍조환자뇨백단백배설솔현저고우유생소D정상조[(123.0 ±299.2)mg/24h비(47.6 ±97.1)mg/24h,P＜0.01],당뇨병신병환병솔경고(35.6％비26.1％,P＜0.05),대량단백뇨환병솔경고(12.2％비3.1％,P＜0.01).회귀분석발현유생소D결핍현저증가당뇨병신병적위험(OR 1.57,95％CI 1.04～2.37),재공제다중위험인소후잉연존재(OR l.78,95％ CI l.12～2.81).유생소D수평여뇨백단백배설솔정부상관(r=-1.783,P＜0.001).결론 유생소D결핍재2형당뇨병환자중발생솔교고.재2형당뇨병환자중유생소D결핍여당뇨병신병적위험성증가유관.
Objective To evaluate the association between vitamin D deficiency and diabetic nephropathy in type 2 diabetic patients.Methods A total of 594 patients with type 2 diabetes were enrolled from the inpatients of the Nanjing Medical University Affiliated Nanjing Hospital.Fasting serum lipid profile,25-hydroxycalciferol vitamin D and urinary albumin excretion rate were investigated.The relationship between nephropathy and vitamin D deficiency (＜ 20 μg/L) or insufficiency (20-＜ 30 μg/L) was analyzed.Results Nephropathy was found in 177 subjects (29.8％) with albuminuria in 141 and proteinuria in 36 subjects.Vitamin D deficiency was found in 180 subjects and insufficiency in 157 subjects.The proportion of vitamin D deficiency was higher in the individuals with nephropathy than those without nephropathy (36.2％ vs 27.8％,P ＜0.05).The urinary albumin excretion rate was significantly higher in the patients with vitamin D deficiency than those with normal vitamin D concentration [(123.0 ± 299.2)mg/24h vs (47.6 ±97.1) mg/24h,P ＜0.01].The prevalence of nephropathy was higher in the patientswith vitamin D deficiency than those with normal vitamin D concentration (35.6％ vs 26.1％,P ＜ 0.05),while the prevalence of proteinuria was higher in patients with vitamin D deficency (12.2％ vs 3.1％,P ＜0.01).Logistic regression analysis demonstrated that vitamin D deficiency was associated with nephropathy (OR 1.57,95％ CI 1.04-2.37),even after the adjustment for age,gender,hypertension,dyslipidemia,smoking status,use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (OR 1.78,95％ CI 1.12-2.81).The Vitamin D concentration was significantly negatively correlated with urinaryalbumin excretion rate (r =-1.783,P ＜ 0.001).Conclusions Type 2 diabetic patients have a high prevalence of vitamin D deficiency.Vitamin D deficiency is independently associated with diabetic nephropathy.