中国全科医学
中國全科醫學
중국전과의학
Chinese General Practice
2015年
31期
3812-3817
,共6页
糖尿病肾病%维生素D结合蛋白质%影响因素分析
糖尿病腎病%維生素D結閤蛋白質%影響因素分析
당뇨병신병%유생소D결합단백질%영향인소분석
Diabetic nephropathies%Vitamin D-binding protein%Root cause analysis
目的：探讨糖尿病肾病( DN)患者维生素D结合蛋白( VDBP)水平及其影响因素,以明确VDBP与DN的关系,为DN的诊断及治疗提供新的依据。方法选取2013年8月—2014年2月在大连医科大学附属二院住院的2型糖尿病(T2DM)患者66例。根据尿微量清蛋白与尿肌酐比值(UACR)将患者分为3个亚组：正常清蛋白尿组( UACR<30 mg/g)、微量清蛋白尿组( UACR 30~300 mg/g)和临床清蛋白尿组( UACR>300 mg/g),各22例。同时选取该院门诊的健康体检者20例为健康对照组。采用酶联免疫吸附试验( ELISA )法检测4组受试者血、尿VDBP水平,同时检测其相关生化指标：空腹血糖( FPG)、糖化血红蛋白( HbA1c )、血尿素( UREA)、血肌酐( SCr)、总胆固醇( TC)、三酰甘油( TG)、高密度脂蛋白胆固醇( HDL-C)、低密度脂蛋白胆固醇( LDL-C)、血清蛋白( ALB)及尿微量清蛋白、尿肌酐。结果健康对照组及正常、微量、临床清蛋白尿组血 VDBP 水平分别为：(44．83±15．65)、(312．25±29．57)、(330．92±49．28)、(338．30±50．05) mg/L,4组间差异有统计学意义(F=409．42, P<0．01)；其中正常、微量、临床清蛋白尿组均高于健康对照组,差异有统计学意义(P<0．05)；而正常、微量及临床清蛋白尿3组比较,差异无统计学意义( P>0．05)。健康对照组及正常、微量、临床清蛋白尿组尿VDBP水平分别为：(5．26±1．34)、(8．93±3．17)、(15．19±3．38)、(21．48±7．00) mg/L,4组间差异有统计学意义(F =58．66, P<0．01)；其中两两组间比较,差异均有统计学意义(P<0．05)。因尿VDBP检测采用晨尿点标本,无24 h尿标本检测准确,故依据UACR法,用尿肌酐对尿VDBP值进行校正(尿VDBP/Cr)。健康对照组与正常、微量、临床清蛋白尿组尿VDBP/Cr水平分别为：(4．25±1．89)、(10．76±7．02)、(23．01±11．39)、(41．58±17．10) mg/g,4组间差异有统计学意义(F=47．38, P<0．01)；其中两两组间比较,差异均有统计学意义(P<0．05)。 T2DM患者尿VDBP水平与估算肾小球滤过率(eGFR)呈负相关(r=-0．413, P=0．015)。另外, T2DM患者尿VDBP水平与UREA、 SCr呈正相关(r值分别为0．505、0．454, P<0．05)；而与ALB呈负相关(r=-0．454, P<0．05)。结论T2DM患者血、尿VDBP水平均有明显升高,且伴随 DN 的进展,尿 VDBP水平逐渐升高,尿 VDBP水平与 eGFR 、UREA、 SCr、 ALB有关,故尿VDBP水平对评估DN的病情有一定价值。
目的：探討糖尿病腎病( DN)患者維生素D結閤蛋白( VDBP)水平及其影響因素,以明確VDBP與DN的關繫,為DN的診斷及治療提供新的依據。方法選取2013年8月—2014年2月在大連醫科大學附屬二院住院的2型糖尿病(T2DM)患者66例。根據尿微量清蛋白與尿肌酐比值(UACR)將患者分為3箇亞組：正常清蛋白尿組( UACR<30 mg/g)、微量清蛋白尿組( UACR 30~300 mg/g)和臨床清蛋白尿組( UACR>300 mg/g),各22例。同時選取該院門診的健康體檢者20例為健康對照組。採用酶聯免疫吸附試驗( ELISA )法檢測4組受試者血、尿VDBP水平,同時檢測其相關生化指標：空腹血糖( FPG)、糖化血紅蛋白( HbA1c )、血尿素( UREA)、血肌酐( SCr)、總膽固醇( TC)、三酰甘油( TG)、高密度脂蛋白膽固醇( HDL-C)、低密度脂蛋白膽固醇( LDL-C)、血清蛋白( ALB)及尿微量清蛋白、尿肌酐。結果健康對照組及正常、微量、臨床清蛋白尿組血 VDBP 水平分彆為：(44．83±15．65)、(312．25±29．57)、(330．92±49．28)、(338．30±50．05) mg/L,4組間差異有統計學意義(F=409．42, P<0．01)；其中正常、微量、臨床清蛋白尿組均高于健康對照組,差異有統計學意義(P<0．05)；而正常、微量及臨床清蛋白尿3組比較,差異無統計學意義( P>0．05)。健康對照組及正常、微量、臨床清蛋白尿組尿VDBP水平分彆為：(5．26±1．34)、(8．93±3．17)、(15．19±3．38)、(21．48±7．00) mg/L,4組間差異有統計學意義(F =58．66, P<0．01)；其中兩兩組間比較,差異均有統計學意義(P<0．05)。因尿VDBP檢測採用晨尿點標本,無24 h尿標本檢測準確,故依據UACR法,用尿肌酐對尿VDBP值進行校正(尿VDBP/Cr)。健康對照組與正常、微量、臨床清蛋白尿組尿VDBP/Cr水平分彆為：(4．25±1．89)、(10．76±7．02)、(23．01±11．39)、(41．58±17．10) mg/g,4組間差異有統計學意義(F=47．38, P<0．01)；其中兩兩組間比較,差異均有統計學意義(P<0．05)。 T2DM患者尿VDBP水平與估算腎小毬濾過率(eGFR)呈負相關(r=-0．413, P=0．015)。另外, T2DM患者尿VDBP水平與UREA、 SCr呈正相關(r值分彆為0．505、0．454, P<0．05)；而與ALB呈負相關(r=-0．454, P<0．05)。結論T2DM患者血、尿VDBP水平均有明顯升高,且伴隨 DN 的進展,尿 VDBP水平逐漸升高,尿 VDBP水平與 eGFR 、UREA、 SCr、 ALB有關,故尿VDBP水平對評估DN的病情有一定價值。
목적：탐토당뇨병신병( DN)환자유생소D결합단백( VDBP)수평급기영향인소,이명학VDBP여DN적관계,위DN적진단급치료제공신적의거。방법선취2013년8월—2014년2월재대련의과대학부속이원주원적2형당뇨병(T2DM)환자66례。근거뇨미량청단백여뇨기항비치(UACR)장환자분위3개아조：정상청단백뇨조( UACR<30 mg/g)、미량청단백뇨조( UACR 30~300 mg/g)화림상청단백뇨조( UACR>300 mg/g),각22례。동시선취해원문진적건강체검자20례위건강대조조。채용매련면역흡부시험( ELISA )법검측4조수시자혈、뇨VDBP수평,동시검측기상관생화지표：공복혈당( FPG)、당화혈홍단백( HbA1c )、혈뇨소( UREA)、혈기항( SCr)、총담고순( TC)、삼선감유( TG)、고밀도지단백담고순( HDL-C)、저밀도지단백담고순( LDL-C)、혈청단백( ALB)급뇨미량청단백、뇨기항。결과건강대조조급정상、미량、림상청단백뇨조혈 VDBP 수평분별위：(44．83±15．65)、(312．25±29．57)、(330．92±49．28)、(338．30±50．05) mg/L,4조간차이유통계학의의(F=409．42, P<0．01)；기중정상、미량、림상청단백뇨조균고우건강대조조,차이유통계학의의(P<0．05)；이정상、미량급림상청단백뇨3조비교,차이무통계학의의( P>0．05)。건강대조조급정상、미량、림상청단백뇨조뇨VDBP수평분별위：(5．26±1．34)、(8．93±3．17)、(15．19±3．38)、(21．48±7．00) mg/L,4조간차이유통계학의의(F =58．66, P<0．01)；기중량량조간비교,차이균유통계학의의(P<0．05)。인뇨VDBP검측채용신뇨점표본,무24 h뇨표본검측준학,고의거UACR법,용뇨기항대뇨VDBP치진행교정(뇨VDBP/Cr)。건강대조조여정상、미량、림상청단백뇨조뇨VDBP/Cr수평분별위：(4．25±1．89)、(10．76±7．02)、(23．01±11．39)、(41．58±17．10) mg/g,4조간차이유통계학의의(F=47．38, P<0．01)；기중량량조간비교,차이균유통계학의의(P<0．05)。 T2DM환자뇨VDBP수평여고산신소구려과솔(eGFR)정부상관(r=-0．413, P=0．015)。령외, T2DM환자뇨VDBP수평여UREA、 SCr정정상관(r치분별위0．505、0．454, P<0．05)；이여ALB정부상관(r=-0．454, P<0．05)。결론T2DM환자혈、뇨VDBP수평균유명현승고,차반수 DN 적진전,뇨 VDBP수평축점승고,뇨 VDBP수평여 eGFR 、UREA、 SCr、 ALB유관,고뇨VDBP수평대평고DN적병정유일정개치。
Objective To investigate vitamin D binding protein ( VDBP) levels in patients with diabetic nephropathy ( DN) , and to determine the relation between VDBP and DN, in order to provide new references for the diagnosis and treatment of DN. Methods We enrolled 66 T2DM patients who were admitted into the Second Affiliated Hospital of Dalian Medical University from August 2013 to February 2014. According to the ratio of UALB to UCR ( UACR) , the patients were divided into three groups: normal albuminuria group ( UACR<30 mg/g ) , slight albuminuria group ( UACR 30 ~300 mg/g ) and clinical albuminuria group ( UACR >300 mg/g ) , with 22 patients in each group. We also enrolled 20 healthy people who received outpatient service as control group. ELISA method was employed to detect the serum and urine VDBP level of the subjects, and biochemical indexes were measured, including FPG, HbA1c , UREA, SCr, TC, TG, HDL-C, LDL-C, ALB, UALB, UCR. Results The serum VDBP levels of control group, normal albuminuria group, slight albuminuria group and clinical albuminuria group were (44. 83 ±15. 65), (312. 25 ±29. 57), (330. 92 ±49. 28) and (338. 30 ±50. 05) mg/L respectively, with significant differences among the four groups ( F =409. 42, P <0. 01 ); normal albuminuria group, slight albuminuria group and clinical albuminuria group were higher than control group ( P <0. 05 ) , while normal albuminuria group, slight albuminuria group and clinical albuminuria group were not significantly different (P>0. 05) . The urine VDBP levels of control group, normal albuminuria group, slight albuminuria group and clinical albuminuria group were ( 5. 26 ± 1. 34 ) , ( 8. 93 ±3. 17), (15. 19 ±3. 38) and (21. 48 ±7. 00) mg/L, with significant differences among the four groups (F=58. 66, P<0. 01); the pairwise comparison among the four groups showed significant differences (P<0. 05) . Since urine VDBP test was made on urine samples taken in the morning, which leaded to poorer accuracy compared with 24 h urine samples, so UCR was used to adjust urine VDBP level by UACR method ( urine VDBP/Cr) . The urine VDBP/Cr levels of control group, normal albuminuria group, slight albuminuria group and clinical albuminuria group were ( 4. 25 ± 1. 89 ) , ( 10. 76 ± 7. 02 ) , ( 23. 01 ± 11. 39) and (41. 58 ± 17. 10 ) mg/g, with significant differences among the four groups ( F =47. 38, P <0. 01 ); the pairwise comparison among the four groups showed significant differences (P<0. 05) . The urine VDBP level of T2DM patients had negative correlation with eGFR in T2DM patients ( r = -0. 413, P =0. 015 ) . The urine VDBP level was positively correlated with UREA and SCr in T2DM patients (r values were 0. 505 and 0. 454; P<0. 05) and were negatively correlated with ALB (r = -0. 454, P<0. 05) . Conclusion T2DM patients have higher VDBP levels of serum and urine and see urine VDBP level increase as DN progresses, and urine VDBP level is related to eGFR, UREA, SCr and ALB, thus urine VDBP level has value in the assessment of DN to some extent.
