标题：尿微量白蛋白/尿肌酐比值及25-(OH)D3水平与糖尿病肾病患者肾功能损伤程度的关系

      作者：郗隽 1，张瑞 1，郑恬 2    1.西电集团医院检验科，陕西 西安 701177；2.空军军医大学第一附属医院检验科，陕西 西安 710032

      卷次： 2023年34卷9期

      【摘要】 目的 分析尿微量白蛋白/尿肌酐比值(UACR)及25-羟基维生素D3 [25-(OH)D3]水平与糖尿病肾病(DN)患者肾功能损伤程度的关系。方法 选取2018年5月至2021年5月西电集团医院收治的144例 2型糖尿病(T2DM)患者作为研究对象，按24 h尿蛋白定量(2 4UAE)水平分为正常蛋白尿组48例(24 UAE<30 mg)、微量蛋白尿组52例(30 mg≤24 UAE<300 mg)和大量蛋白尿组44例(24 UAE≥300 mg)，比较三组患者的一般资料[年龄、性别、收缩压(SBP)、舒张压(DBP)、体质量指数(BMI)、糖尿病病程、心率(HR)]、血糖指标[空腹血糖( FPG)、餐后 2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)]、血脂指标[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白(LDL-C)]、肾功能指标[血尿素氮(BUN)、血肌酐(Scr)、肾小球滤过率(eGFR)、UACR]及25-(OH)D3水平，采用多因素Logistic回归分析影响DN肾功能损害的危险因素。结果 大量尿蛋白组患者的糖尿病病程为(10.79±2.44)年、BUN为(9.37±3.05) mmol/L、Scr为(203.65±21.79) mmol/L、UACR为(326.19±32.50) mg/g，明显高于正常蛋白尿组的(6.23±1.78)年、(5.16±1.18) mmol/L、(70.15±11.23) mmol/L、(9.16±2.40) mg/g和微量蛋白尿组的(7.05±1.82)年、(5.70±1.36) mmol/L、(78.59±14.03) mmol/L、(160.28±22.79) mg/g，eGFR(41.16±9.70) mL/(min·1.732)、25-(OH)D3(10.02±1.55) ng/mL，明显低于正常蛋白尿组的(102.36±18.77) mL/(min·1.732)、(17.26±3.35) ng/mL和微量蛋白尿组的(85.60±14.29) mL/(min·1.732)、(14.26±2.78) ng/mL，差异均有统计学意义(P<0.05)，而正常蛋白尿组和微量蛋白尿组患者的糖尿病病程、BUN、Scr、UACR、eGFR及 25-(OH)D3比较差异均无统计学意义(P>0.05)；经Pearson相关分析结果显示，UACR水平与BUN、Scr呈正相关(P<0.05)，与 eGFR呈负相关(P<0.05)，25-(OH)D3与BUN、Scr呈负相关(P<0.05)，与 eGFR呈正相关(P<0.05)；经多因素 Logistic回归分析结果显示，糖尿病病程、BUN、Scr、eGFR、UACR及25-(OH)D3均为DN肾功能损伤的独立危险因素(P<0.05)。结论 UACR水平随DN患者肾损伤程度的加重而升高，25-(OH)D3随肾损伤程度的加重而降低，UACR和25-(OH)D3水平与DN患者肾脏功能损伤程度相关。
      【关键词】 糖尿病肾病；肾功能损伤程度；尿微量白蛋白/尿肌酐比值；25-羟基维生素D3；相关性
      【中图分类号】 R587.2 【文献标识码】 A 【文章编号】 1003—6350（2023）09—1286—05

Relationship of urinary microalbumin/creatinine ratio and 25-(OH)D3 level with the degree of renal damage inpatients with diabetic nephropathy.
XI Jun 1, ZHANG Rui 1, ZHENG Tian 2. 1. Department of Clinical Laboratory, XidianGroup Hospital, Xi'an 701177, Shaanxi, CHINA; 2. Department of Clinical Laboratory, the First Affiliated Hospital of AirForce Military Medical University, Xi'an 710032, Shaanxi, CHINA
【Abstract】 Objective To analyze the relationship of urinary microalbumin/creatinine ratio (UACR) and25-hydroxyvitamin D3 [25-(OH)D3] level with the degree of renal damage in patients with diabetic nephropathy (DN).Methods A total of 144 patients with type 2 diabetes mellitus (T2DM) admitted to Xidian Group Hospital from May2018 to May 2021 were selected as the research subjects. They were divided into normal proteinuria group (48 cases,24 UAE<30 mg), microalbuminuria group (52 cases, 30 mg≤24 UAE<300 mg), and massive proteinuria group (44 cas-es, 24 UAE≥300 mg) according to 24 h urine protein quantification (24 UAE). General data [age, gender, systolic bloodpressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), diabetes course, heart rate (HR)], blood glucoseindexes [fasting blood glucose (FPG), 2 h postprandial blood glucose (2 hPG), glycated hemoglobin (HbA1c)], lipid in-dexes [total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein(LDL-C)], renal function indexes [blood urea nitrogen (BUN), serum creatinine (Scr), glomerular filtration rate (eGFR),UACR] and 25-(OH)D3 levels were compared among the three groups, and clinical indicators were recorded. Multivari-ate Logistic regression analysis was performed to screen the risk factors for renal damage in DN. Results The durationof diabetes, BUN, Scr, and UACR in the massive proteinuria group were (10.79 ± 2.44) years, (9.37 ±3.05) mmol/L,(203.65±21.79) mmol/L, and (326.19±32.50) mg/g, significantly higher than (6.23±1.78) years, (5.16±1.18) mmol/L,(70.15±11.23) mmol/L, and (9.16±2.4) mg/g in the normal proteinuria group and (7.05±1.82) years, (5.70±1.36) mmol/L,(78.59±14.03) mmol/L, and (160.28±22.79) mg/g the microalbuminuria group; eGFR and 25-(OH)D3 were (41.16±9.70) mL/(min·1.732) and (10.02±1.55) ng/mL, significantly lower than (102.36±18.77) mL/(min·1.732) and (17.26±3.35) ng/mL in the normal proteinuria group and (85.60±14.29) mL/(min·1.732) and (14.26±2.78) ng/mL in the microal-buminuria group; the differences were statistically significant (P<0.05). There was no statistically significant differencein above indicators between the normal proteinuria group and the microalbuminuria group (P>0.05). Pearson correlationanalysis results showed that UACR was positively correlated with BUN and Scr (P<0.05), and negatively correlated witheGFR (P<0.05). 25-(OH)D3 was negatively correlated with BUN and Scr, and positively correlated with eGFR (P<0.05).Multivariate logistic regression analysis results showed that the duration of diabetes, BUN, Scr, eGFR, UACR and25-(OH)D3 were independent risk factors for renal damage in DN (P<0.05). Conclusion As the aggravation of renaldamage in DN patients, UACR increases and 25-(OH)D3 decreases. UACR and 25-(OH)D3 levels are related to the de-gree of renal damage in patients with DN.
      【Key words】 Diabetic nephropathy; Degree of renal damage; Urine microalbumin/creatinine ratio; 25-hydroxyvi-tamin D3; Correlation