维生素D缺乏与糖尿病患者糖尿病肾病发生率的关系研究：前瞻性3年随访研究

doi:10.16150/j.1671-2870.2018.02.011

摘要/Abstract

摘要： 目的：通过3年随访观察,研究不同25羟维生素D [25(OH)D]水平对2型糖尿病患者糖尿病肾病(daibetes nephropathy,DN)发病率的影响。方法：选择2009年6月至2012年6月期间在我院内分泌科就诊的尿微量白蛋白正常的2型糖尿病患者共530例,入组时所有患者均需测定空腹血糖、C肽、糖化血红蛋白、25(OH)D、血脂、24 h尿微量白蛋白等。根据基线25(OH)D水平将研究人群分为3组,分别为维生素D（vitamin D,VitD）缺乏组、VitD不足组和VitD正常组,对3组患者进行为期3年的随访,随访结束时再次留取24 h尿检测尿白蛋白排泄率以确诊有无DN,并分析其DN发病率。结果：3年后,VitD缺乏组患者尿白蛋白排泄率显著高于VitD正常组[25.9(3.1~379.6) mg/24 h比18.8（2.5~103.7） mg/24 h,P<0.01],VitD缺乏组较VitD正常组、VitD不足组的DN发生率更高(26.2%比5.3%,26.2%比12.7%,P<0.05)。行回归分析发现,VitD缺乏显著增加了DN发病风险(RR=1.58,95%CI为1.13~2.79),且在控制多重危险因素后这种作用仍然存在（RR=1.23,1.05~2.12）。结论：通过3年的前瞻性队列研究证实,在2型糖尿病患者中VitD缺乏使DN的发病风险显著增加,VitD缺乏可能是DN发生及进展的重要原因。

关键词: 维生素D, 2型糖尿病, 糖尿病肾病, 尿白蛋白排泄率

Abstract: Objective: To study the effect of 25-hydroxyvitamin D level on incidence of diabetic nephropathy in type 2 diabetic patients by 3-year follow-up study. Methods: From June 2009 to June 2012, a total of 530 type 2 diabetic patients with normal albuminuria were recruited. The fasting blood glucose, C peptide, glycosylated hemoglobin, 25-hydroxyvitamin D, blood lipids and 24 h urinary albumin excretion rate were measured in all the patients at baseline. The study patients were divided into 3 groups based on the baseline 25-hydroxyvitamin D level. All patients were followed up for 3 years. At the end of follow-up, 24 h urine was taken to detect the urinary albumin excretion rate to determine whether there was diabetic nephropathy. The incidence of diabetic nephropathy in the three groups was analyzed at the end of 3-year follow-up. Results: After 3 years, the urinary albumin excretion rate in vitamin D deficiency group was significantly higher than that in vitamin D normal group[25.9(3.1-379.6) mg/24 h vs 18.8（2.5-103.7） mg/24 h, P<0.01]. The incidence of diabetic nephropathy in the vitamin D deficiency group was higher than those in the vitamin D normal group and vitamin D insufficient group (26.2% vs 5.3%, 26.2% vs 12.7% P<0.05). Regression analysis showed that vitamin D deficiency significantly increased the risk of diabetic nephropathy (RR=1.58, 95%CI: 1.13-2.79), and this effect remained after controlling other multiple risk factors (RR=1.23, 1.05-2.12). Conclusions: A 3-year prospective cohort study confirmes that vitamin D deficiency significantly increases the risk of diabetic nephropathy in patients with type 2 diabetes. Vitamin D deficiency is an important factor for the development and progression of diabetic nephropathy.

Key words: Vitamin D, Type 2 diabetes mellitus, Diabetic nephropathy, Urinary albumin excretion rate

中图分类号:

R591.44

谭姣容, 田冬梅, 杨昕, 张立娟, 王芳, 苏玉霞. 维生素D缺乏与糖尿病患者糖尿病肾病发生率的关系研究：前瞻性3年随访研究[J]. 诊断学理论与实践, 2018, 17(02): 176-180.

TAN Jiaorong, TIAN Dongmei, YANG Xin, ZHANG Lijuan, WANG Fang, SU Yuxia. Study on relationship between vitamin D deficiency and incidence of diabetic nephropathy: A prospective follow-up study of three years[J]. Journal of Diagnostics Concepts & Practice, 2018, 17(02): 176-180.

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