糖尿病肾病患者25羟维生素D水平与颈动脉内膜中层厚度的相关性
摘要
目的探讨糖尿病肾病患者血清25羟维生素D水平与颈动脉内膜中层厚度(IMT)的关系。方法回顾性分2015年10月至2017年2月就诊于丹阳市人民医院内分泌科的糖尿病肾病患者324例,测量空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)、体质量、血液生化指标及25羟维生素D水平;根据25羟维生素D水平分为维生素D缺乏组(A组,<20μg/L)、维生素D不足组(B组,20～30μg/L)和维生素D正常组(C组,>30μg/L);采用彩色多普勒超声诊断仪测定三组患者IMT,分析25羟维生素D水平与IMT的相关性。结果 A组25羟维生素D平均浓度(16.6±3.4)μg/L;B组25羟维生素D平均浓度(23.8±4.1)μg/L;C组25羟维生素D平均浓度(32.0±2.6)μg/L;校正年龄、性别后,3组维生素D水平差异有统计学意义(P<0.05)。单因素Logistic回归分析显示IMT与年龄、FPG、HbA1c、收缩压、舒张压、LDL-C、肌酐、24 h UAE呈正相关,与BMI、eGFR、25羟维生素D呈负相关。多元线性回归分析显示25羟维生素D、HDL-C是IMT的保护因素,年龄、LDL-C、HbA1c是IMT的危险因素。结论糖尿病肾病患者血清25羟维生素D水平与IMT呈负相关关系;低水平25羟维生素D可作为颈动脉血管病变的独立危险因素。
引文
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2 钱家麒,张伟明,徐莜琪.1999年全国透析移植登记报告[J].中华肾脏病杂志,2001;17(2):77-8.
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4 孟祥龙,丁涵露,张渊,等.血浆活化蛋白C在2型糖尿病肾病动脉粥样硬化形成中的作用[J].中华肾脏病杂志,2014;30(1):1-5.
5 刘溯,杨宇红,曹东华,等.不同水平25羟维生素D与老年糖尿病患者颈动脉IMT的相关性[J].实用临床医药杂志,2015;19(13):30-2.
6 中华医学会肾脏病学分会.肾脏病学临床诊疗指南(2009年版)[J].中华肾病杂志,2009;37(3):250-3.
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13 Kilkkinen A,Knekt P,Aro A,et al.Vitamin D status and the risk of cardiovascular disease death[J].Am J Epidemiol,2009;170:1032-9.
14 Hosseinpanah F,Yarjanli M,Sheikholeslami F,et al.Associations between vitamin D and cardiovascular outcomes:tehran lipid and glucose study[J].Atherosclerosis,2011;218(1):238-42.
15 Tomaschitz A,Pilz S,Ritz E,et al.Independent association between 1,25-dihydroxyvitamin D,25-hydroxyvitamin D and the reninangiotensin system:the Ludwigshafen Risk and Cardiovascular Health(LURIC) study[J].Clin Chim Acta,2010;411(17-18):1354-60.
16 Komorovsky R,Desideri A.Carotid ultraund ament of patients with coronary artery disease:a useful index for risk stratification[J].Vas Health Risk Manag,2005;1(2):13-136.
17 Chue CD,Townend JN,Steeds RP,et al.Artefim stiffness in chronic kidney disease:causes and consequences[J].Heart,2010;96(11):817-23.
2 钱家麒,张伟明,徐莜琪.1999年全国透析移植登记报告[J].中华肾脏病杂志,2001;17(2):77-8.
3 崔健,陈虹,黄秉仁.维生素D的研究进展[J].生理科学进展,2011;42(2):95.
4 孟祥龙,丁涵露,张渊,等.血浆活化蛋白C在2型糖尿病肾病动脉粥样硬化形成中的作用[J].中华肾脏病杂志,2014;30(1):1-5.
5 刘溯,杨宇红,曹东华,等.不同水平25羟维生素D与老年糖尿病患者颈动脉IMT的相关性[J].实用临床医药杂志,2015;19(13):30-2.
6 中华医学会肾脏病学分会.肾脏病学临床诊疗指南(2009年版)[J].中华肾病杂志,2009;37(3):250-3.
7 王宏斌,夏先考,吴建华.CKD-EPI方程估算肾小球滤过率的评价[J].国际检验医学杂志,2011;32(9):936-8.
8 Bonakdaran S,Kharaqani B.Association of serum uric acid and metabolic syndrome in type 2 diabetes[J].Curr Diabetes Rev,2014;10(2):113-7.
9 潘晓霞,李振作,李红专,等.2型糖尿病血尿酸水平与颈动脉内膜中层厚度的相关性分析[J].山东医药,2015;55(37):47-9.
10 Karras A,Haymann JP,Bozec E,et al.Large artery stiffening and remodeling are independently associated with all-cause mortality and cardiovascular events in chronic kidney disease[J].Hypertension,2012;60(6):1451-7.
11 Wang L,Song Y,Manson JE,et al.Circulating 25-hydroxyvitamin D and risk of cardiovascular disease:a meta-analysis of prospective studies[J].Circ Cardiovasc Qual Outcomes,2012;5(6):819-29.
12 Holick MF.Vitamin D deficiency[J].N Engl J Med,2007;357(19):266-81.
13 Kilkkinen A,Knekt P,Aro A,et al.Vitamin D status and the risk of cardiovascular disease death[J].Am J Epidemiol,2009;170:1032-9.
14 Hosseinpanah F,Yarjanli M,Sheikholeslami F,et al.Associations between vitamin D and cardiovascular outcomes:tehran lipid and glucose study[J].Atherosclerosis,2011;218(1):238-42.
15 Tomaschitz A,Pilz S,Ritz E,et al.Independent association between 1,25-dihydroxyvitamin D,25-hydroxyvitamin D and the reninangiotensin system:the Ludwigshafen Risk and Cardiovascular Health(LURIC) study[J].Clin Chim Acta,2010;411(17-18):1354-60.
16 Komorovsky R,Desideri A.Carotid ultraund ament of patients with coronary artery disease:a useful index for risk stratification[J].Vas Health Risk Manag,2005;1(2):13-136.
17 Chue CD,Townend JN,Steeds RP,et al.Artefim stiffness in chronic kidney disease:causes and consequences[J].Heart,2010;96(11):817-23.