摘要
目的探讨利用血清25-羟维生素D[25-Hydroxyvitamin D,25(OH)D]、糖化血红蛋白(glycosylated hemoglobin,HbA1c)评估糖尿病肾脏疾病(diabetic kidney disease,DKD)的能力。方法回顾性分析2021年12月1日至2024年10月31日安徽省第二人民医院收治的262例糖尿病(diabetes mellitus,DM)患者,并按是否合并DKD分为单纯DM组(n=162)及DKD组(n=100)。研究者比较了DM和DKD组患者的一般资料以及25(OH)D、HbA1c水平,并用卡方和t-检验分析两组患者指标差异是否存在统计学意义。采用Logistic多因素回归分析DKD的独立危险因素。采用受试者工作特征(receiver operating characteristic,ROC)曲线评估25(OH)D、HbA1c在DKD中的预测价值,并应用Pearson相关性分析25(OH)D与估算肾小球滤过率(estimated glomerular filtration rate,eGFR)、尿白蛋白肌酐比(urine albumin-to-creatinine ratio,A/C)的相关性。最后,将262例DM患者按eGFR[mL·min^(-1)·(1.73 m²)-1]分为G1组[eGFR≥90 mL·min^(-1)·(1.73 m²)-1,n=142]、G2组[60 mL·min^(-1)·(1.73 m²)-1≤eGFR<90 mL·min^(-1)·(1.73 m²)-1,n=87]、G3组[eGFR<60 mL·min^(-1)·(1.73 m²)-1,n=33],比较组间25(OH)D差异;并将262例DM患者按A/C(mg/mmol)分为A1组(A/C<3 mg/mmol,n=130)、A2组(3 mg/mmol≤A/C<30 mg/mmol,n=76)、A3组(A/C≥30 mg/mmol,n=56),比较组间25(OH)D差异,评估25(OH)D与DKD进展的相关性。结果与DKD组患者比较,DM组的年龄[(59.43±11.06)岁比(63.22±11.91)岁]、病程[(8.26±6.01)年比(12.29±7.41)年]、HbA1c[(8.06±2.13)%比(9.20±2.30)%]、血肌酐[(66.99±14.77)μmol/L比(95.94±45.30)μmol/L]、中性粒细胞计数[(3.52±1.23)×10^(9)/L比(4.23±2.63)×10^(9)/L]、尿白蛋白[(13.97±13.28)mg/L比(484.40±658.95)mg/L]、A/C[(2.01±2.09)比(224.19±1321.65)]、高血压率(51.9%比75.0%)降低,25(OH)D[(23.01±6.34)μg/L比(11.31±4.04)μg/L]、eGFR[(95.77±15.01)mL·min^(-1)·(1.73 m²)-1比(73.79±28.02)mL·min^(-1)·(1.73 m²)-1]升高(P<0.05)。多因素Logistic回归分析结果显示,长病程(OR=1.147,95%CI:1.045~1.285,P<0.01)、有高血压(OR=10.25,95%CI:2.241~47.060,P<0.01)、高HbA1c(OR=1.547,95%CI:1.137~2.137,P<0.01)、低25(OH)D(OR=0.431,95%CI:0.325~0.561,P<0.001)均为DKD的独立危险因素。ROC曲线分析结果显示,25(OH)D、HbA1c以及联合检测预测DKD对应的AUC为0.968(95%CI:0.948~0.988,P<0.05)、0.660(95%CI:0.595~0.726,P<0.05)、0.971(95%CI:0.952~0.990,P<0.05),联合检测与25(OH)D单独检测对DKD的预测价值相差不大,明显优于HbA1c单独检测价值。Pearson分析显示25(OH)D与eGFR呈正相关(r=0.328,P<0.05),与血肌酐、尿白蛋白、A/C、年龄、病程、中性粒细胞数、HbA1c、体重指数呈负相关(r=-0.293、-0.409、-0.128、-0.138、-0.190、-0.144、-0.182、-0.147,P均<0.05)。重新分组后,与G1组患者相比,G2、G3组患者的25(OH)D[(18.32±7.70)μg/L和(10.69±4.69)μg/L比(20.5±7.61)μg/L]均有不同程度的降低;与G2组相比,G3组的25(OH)D[(10.69±4.69)μg/L比(18.32±7.7)μg/L]进一步降低(P<0.05)。同样,与A1组相比,A2、A3组的25(OH)D[(16.56±7.42)μg/L和(11.09±4.05)μg/L比(22.92±6.60)μg/L]均有不同程度的降低;与A2组相比,A3组的25(OH)D[(11.09±4.05)μg/L比(16.56±7.42)μg/L]进一步降低(P<0.05)。结论低25(OH)D、高HbA1c与DKD相关,可作为预测DKD新的参考指标,并且25(OH)D水平可能与DKD进展相关。
Objective To investigate the potential of serum 25-hydroxyvitamin D[25(OH)D]and glycosylated hemoglobin(HbA1c)in assessing diabetic kidney disease(DKD).Methods A total of 262 patients with diabetes mellitus(DM)admitted to Anhui No.2 Provincial People’s Hospital from De⁃cember 1,2021,to October 31,2024 were retrospectively selected.They were divided into the DM group(n=162)and DKD group(n=100)based on whether they had DKD.General clinical data,25(OH)D and HbA1c were compared between the two groups.Chi-square tests and t-tests were used to assess statistical differences.Multivariate logistic regression was performed to identify independent risk factors for DKD.Receiver operating characteristic(ROC)curve analysis was applied to evaluate the predictive value of 25(OH)D and HbA1c for DKD.Pearson correlation analysis was used to assess the correlation of 25(OH)D with estimated glomerular filtration rate(eGFR)and urine albumin-to-creatinine ratio(A/C).All 262 patients were further stratified by eGFR into G1[eGFR≥90 mL·min^(-1)·(1.73 m²)-1,n=142],G2[60 mL·min^(-1)·(1.73 m²)-1≤eGFR<90 mL·min^(-1)·(1.73 m²)-1,n=87],and G3[eGFR<60 mL·min^(-1)·(1.73 m²)-1,n=33].They were also stratified by A/C into A1(A/C<3 mg/mmol,n=130),A2(3 mg/mmol≤A/C<30 mg/mmol,n=76),and A3(A/C≥30 mg/mmol,n=56).25(OH)D levels among subgroups and its correlation with DKD progression were analyzed.Results Compared with the DKD group,patients in the DM group showed significantly younger age[(59.43±11.06)years vs(63.22±11.91)years],shorter disease duration[(8.26±6.01)years vs(12.29±7.41)years],and lower HbA1c[(8.06±2.13)%vs(9.20±2.30)%],serum creatinine[(66.99±14.77)μmol/L vs(95.94±45.30)μmol/L],neutrophil count[(3.52±1.23)×10^(9)/L vs(4.23±2.63)×10^(9)/L],uri⁃nary albumin[(13.97±13.28)mg/L vs(484.40±658.95)mg/L],A/C ratio[(2.01±2.09)vs(224.19±1321.65)],and hypertension rate(51.9%vs 75.0%),but higher 25(OH)D levels[(23.01±6.34)μg/L vs(11.31±4.04)μg/L]and eGFR[(95.77±15.01)mL·min^(-1)·(1.73 m²)-1 vs(73.79±28.02)mL·min^(-1)·(1.73 m²)-1](all P<0.05).Multivariate logistic regression analysis showed that longer disease duration(OR=1.147,95%CI:1.045-1.285,P<0.01),presence of hyper⁃tension(OR=10.25,95%CI:2.241-47.060,P<0.01),higher HbA1c(OR=1.547,95%CI:1.137-2.137,P<0.01),and lower 25(OH)D levels(OR=0.431,95%CI:0.325-0.561,P<0.001)were inde⁃pendent risk factors for DKD.ROC curve analysis revealed that the area under the curve(AUC)of 25(OH)D,HbA1c and their combination in predicting DKD was 0.968(95%CI:0.948-0.988,P<0.05),0.66(95%CI:0.595-0.726,P<0.05),and 0.971(95%CI:0.952-0.990,P<0.05),respectively.The predictive value of combined testing was comparable to that of 25(OH)D alone and significantly better than HbA1c alone.Pearson correlation showed that 25(OH)D was positively correlated with eGFR(r=0.328,P<0.05)and negatively correlated with serum creatinine,urinary albumin,A/C ratio,age,dis⁃ease duration,neutrophil count,HbA1c,and body mass index(r=–0.293,–0.409,–0.128,–0.138,–0.190,–0.144,–0.182,–0.147;all P<0.05).After stratification,25(OH)D levels were signifi⁃cantly lower in the G2 and G3 groups than the G1 group[(18.32±7.70)μg/L vs(10.69±4.69)μg/L vs(20.50±7.61)μg/L],which were significantly lower in the G3 group than the G2 group(P<0.05).Similarly,25(OH)D levels were lower in the A2 and A3 groups than the A1 group[(16.56±7.42)μg/L vs(11.09±4.05)μg/L vs(22.92±6.60)μg/L)],which were significantly lower in the A3 group than the A2 group(P<0.05).Conclusion Low serum 25(OH)D and high HbA1c levels are as⁃sociated with DKD and may serve as novel reference indicators for its prediction.Furthermore,25(OH)D levels may be associated with the progression of DKD.
作者
吴珊珊
张丹凤
戚仁娟
张永明
刘茜
袁鹏
顾俊菲
Wu Shan-shan;Zhang Dan-feng;Qi Ren-juan;Zhang Yong-ming;Liu Qian;Yuan Peng;GuJun-fei(Department of Endocrinology,Anhui No.2 Provincial People’s Hospital,Hefei 230000,China;Department of Nephrology,the Second Hospital of Anhui Medical University,Hefei 230601,China;Department of Endocrinology,the First Affiliated Hospital of University of Science and Technology of China,Hefei 230022,China;Department of General Surgery,the First Affiliated Hospital of University of Science and Technology of China,Hefei 230022,China;Department of Endocrinology,the Second Affiliated Hospital of Wannan Medical College,Wuhu 241100,China)
出处
《临床肾脏病杂志》
2025年第9期727-734,共8页
Journal of Clinical Nephrology
基金
国家自然科学基金项目(82400815)
安徽省自然科学基金(2308085QH260)
安徽省教育厅基金(2024AH050555)。
