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目的评估血清甲状旁腺激素(PTH)、25-羟维生素D_3[25(OH)D_3]水平与2型糖尿病(T2DM)肾病的相关性,了解PTH、25(OH)D_3在糖尿病肾病进展中的作用。方法选取2013年2-6月在湖北省新华医院住院的198例T2DM患者为研究对象,进行基础资料的收集和生化指标的测定。依据PTH水平分为PTH升高组(>68.3 pg/ml)22例和PTH正常组(≤68.3 pg/ml)176例。依据血清25(OH)D_3水平,分为维生素D不足组(<50 nmol/L)125例和维生素D正常组(≥50 nmol/L)73例。依据24 h尿微量白蛋白(UMA)水平,分为UMA≥300 mg组(29例)和UMA<300 mg组(169例)。用SPSS 17.0软件进行t检验和多元线性逐步回归分析。结果 T2DM患者25(OH)D_3缺乏患病率为63.13%(125/198)。PTH升高组血清25(OH)D_3水平[(41.45±3.77)nmol/L]低于PTH正常组[(57.55±5.19)nmol/L],差异有统计学意义(P<0.05)。维生素D不足组UMA和2 h PG水平高于维生素D正常组,差异均有统计学意义(P<0.05)。UMA≥300 mg组25(OH)D_3水平低于UMA<300 mg组,FPG水平高于UMA<300 mg组,差异均有统计学意义(P<0.05)。多元线性回归分析结果显示,年龄、25(OH)D_3、HbA_(1C)与24 h UMA呈独立相关,标准系数分别是2.13、2.95和1.05,均有统计学意义(P<0.05)。结论糖尿病肾病患者25(OH)D_3明显缺乏,且25(OH)D_3是糖尿病肾病的独立相关因子,而PTH可能通过调节25(OH)D_3影响尿蛋白含量。
Objective To evaluate the relationship between serum parathyroid hormone (PTH), 25-hydroxyvitamin D_3 [25 (OH) D_3] and type 2 diabetes mellitus (T2DM) nephropathy and to investigate the relationship between PTH and 25 (OH) D_3 in the progression of diabetic nephropathy effect. Methods A total of 198 T2DM patients hospitalized in Xinhua Hospital of Hubei Province from February to June in 2013 were selected as the research object to collect the basic data and determine the biochemical indexes. PTH levels were divided into PTH increased group (> 68.3 pg / ml) in 22 cases and PTH normal group (68.3 pg / ml) in 176 cases. According to the serum 25 (OH) D_3 level, 125 cases were divided into vitamin D deficiency group (<50 nmol / L) and 73 cases of vitamin D normal group (≥50 nmol / L). According to 24-hour urinary albumin (UMA) levels, they were divided into UMA group (29 cases) and UMA group (300 mg) (169 cases). T test and multivariate linear stepwise regression analysis were performed with SPSS 17.0 software. Results The prevalence of 25 (OH) D_3 deficiency in T2DM patients was 63.13% (125/198). The serum 25 (OH) D_3 level in PTH increased group (41.45 ± 3.77) nmol / L was lower than that in PTH normal group (57.55 ± 5.19) nmol / L, the difference was statistically significant (P <0.05). The levels of UMA and 2 h PG in vitamin D deficient group were significantly higher than those in normal vitamin D group (P <0.05). The level of 25 (OH) D_3 in UMA≥300 mg group was lower than that in UMA <300 mg group, and FPG level was higher than that in UMA <300 mg group (P <0.05). Multivariate linear regression analysis showed that age, 25 (OH) D_3, HbA_ (1C) and 24 h UMA were independently correlated with standard coefficients of 2.13, 2.95 and 1.05, respectively, with statistical significance (P <0.05). Conclusion 25 (OH) D_3 is obviously deficient in patients with diabetic nephropathy, and 25 (OH) D_3 is an independent factor related to diabetic nephropathy. However, PTH may affect urinary protein content by regulating 25 (OH) D_3.