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目的探讨糖尿病慢性肾脏疾病(CKD)患者血清25羟维生素D3[25(OH)D3]水平和IR及骨代谢的关系。方法选取2012年4月至2014年2月CKD患者200例作为研究对象,根据eGFR水平分为eGFR>45~59ml/(min·1.73m2)组60例、eGFR 30~44ml/(min·1.73m2)组60例和eGFR 15~29ml/(min·1.73m2)组80例。比较各组临床资料、IR和骨代谢指标,比较不同胰岛素抵抗指数(HOMA-IR)患者的骨代谢指标。结果 3组年龄、性别、BMI、血压和FPG比较,差异无统计学意义(P>0.05),糖尿病病程、CKD病程、尿蛋白、血脂、eGFR、HbA1c、FIns、HOMA-IR和骨代谢指标比较,差异有统计学意义(P<0.05)。200例患者中,HOMA-IR≥3.28(IR)者129例,HOMA-IR<3.28(非IR)者71例。两组骨代谢指标比较,差异有统计学意义(P<0.05)。25(OH)D3水平与HOMA-IR、左侧股骨近端骨密度(BMD)、腰椎BMD、血磷、血钙及骨特异性碱性磷酸酶(BSAP)呈正相关(P<0.05),与骨保护素和甲状旁腺激素(PTH)呈负相关(P<0.05)。结论 CKD患者血清25(OH)D3水平降低,与IR水平和骨代谢水平有相关性。
Objective To investigate the relationship between serum 25-hydroxyvitamin D3 [25 (OH) D3] and IR and bone metabolism in patients with chronic kidney disease (CKD). Methods 200 patients with CKD from April 2012 to February 2014 were enrolled in this study. According to eGFR level, 60 patients with eGFR> 45-59ml / (min · 1.73m2), eGFR 30-44ml / (min · 1.73m2) ) Group and 80 patients with eGFR 15 ~ 29ml / (min · 1.73m2) group. The clinical data, IR, and bone metabolic parameters of each group were compared to compare the bone metabolic parameters of patients with different insulin resistance index (HOMA-IR). Results There was no significant difference in age, sex, BMI, blood pressure and FPG between the three groups (P> 0.05), diabetic course, CKD course, urinary protein, serum lipids, eGFR, HbA1c, FIns, , The difference was statistically significant (P <0.05). Among the 200 patients, 129 were HOMA-IR≥3.28 (IR) and 71 were HOMA-IR <3.28 (non-IR). There was significant difference between the two groups in bone metabolism index (P <0.05). The level of 25 (OH) D3 was positively correlated with HOMA-IR, left proximal BMD, lumbar BMD, serum phosphorus, serum calcium and bone specific alkaline phosphatase (BSAP) There was a negative correlation between osteoprotegerin and parathyroid hormone (PTH) (P <0.05). Conclusions The serum level of 25 (OH) D3 in CKD patients is decreased, which is correlated with the level of IR and the level of bone metabolism.