·糖尿病性肾脏疾病·

　　【摘要】 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>45～59 ml/(min·1.73 m2)组60例、eGFR 30～44 ml/(min·1.73 m2)组60例和eGFR 15～29 ml/(min·1.73 m2) 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 KD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。

　　【关键词】 糖尿病慢性肾脏疾病;25羟维生素D3;胰岛素抵抗;骨代谢指标

　　Study on relationship of serum level of 25 hydroxyl vitamin D3 with insulin resistance and bone metabolism in diabetic patients with chronic kidney disease SHI Mei. Department of Nephrology，The Victory of the Hospital Sinopec Shengli Petroleum Administration Bureau, Dongying 257055, China

　　【Abstract】 Objective To investigate the relationship of serum level of 25 hydroxyl vitamin D3[25(OH)D3] with insulin resistance (IR) and bone metabolism in diabetic patients with chronic kidney disease (CKD). Methods From April 2012 to February 2014, 200 diabetic patients with CKD were selected, and they were divided into three groups according to eGFR: 60 subjects in eGFR>45～59ml/(min·1.73 m2) group , 60 subjects in eGFR 30～44 ml/(min·1.73 m2) group and 80 subjects in eGFR 15～29 ml/(min·1.73 m2) group. Clinical features, IR and indexes of bone metabolism among different groups were compared. Indexes of bone metabolism between two groups with different HOMA-IR level were also compared.

　　Results The difference of age, gender, BMI, blood pressure and FPG among three groups had no statistical significance (P>0.05). The difference of duration of diabetes mellitus, duration of CKD, urine protein, blood lipid, eGFR, HbA1c, FIns, HOMA-IR and indexes of bone metabolism had statistical significance (P<0.05). In 200 patients, there were 129 patients (IR) with HOMA-IR≥3.28, and 71 patients (non-insulin resistance) with HOMA-IR<3.28. The difference of bone metabolism indexes between two groups had statistical significance (P<0.05). The serum level of 25(OH)D3 was positively related to HOMA-IR, bone mineral density (BMD) at left proximal femur, BMD at lumbar, P, Ca and BSAP (P<0.05); while it was negatively related to osteoprotegerin and PTH (P<0.05). Conclusion The serum level of 25(OH)D3 has relevance to IR and bone metabolism in diabetic patients with CKD.

　　【Key words】 Chronic kidney disease (CKD) in diabetes;25 hydroxyl vitamin D3 [25(OH)D3];Insulin resistence (IR);Index of bone metabolism