目的:糖尿病肾病(DKD)是世界范围内慢性肾病(CKD)的主要病因。在糖尿病中广泛报道了导致不良后果的矿物质水平改变,但在DKD中有限。在印度的情况下,因此,这项研究是为了解决这个问题。
方法:对54名健康对照(C)和140名2型糖尿病受试者进行了一项基于医院的病例对照研究,其中74名糖尿病和CKD受试者组成了DKD组,66名糖尿病但无CKD的受试者组成糖尿病非慢性肾脏病(DNCKD)组。高分辨率电感耦合等离子体质谱法用于评估血液中矿物质(钙(Ca),钒(V),铬(Cr),锰(Mn),铁(Fe),钴(Co),铜(Cu),锌(Zn),和硒(Se),以及一份以生食为基础的饮食摄入频率问卷。使用慢性肾病流行病学合作(CKD-EPI)方程(mL/min/1.73m2)和蛋白尿计算估计的肾小球滤过率(eGFR)。使用Spearman的等级相关性来评估分类变量之间的关系。
结果:与DNCKD和C组相比,DKD组的血浆Ca中位数显着降低(10.5mg/dLvs.11.0mg/dL和11.7mg/dL,p<0.001)。此外,血浆钙水平随着肾功能下降而降低,eGFR和蛋白尿分离证明了这一点。饮食中矿物质的摄入量与相应的血浆水平无关。然而,在DKD组中,eGFR与血浆Ca水平呈正相关(r=0.422,p=0.001),Cr(r=0.351,p=0.008),Mn(r=0.338,p=0.011),Fe(r=0.403,p=0.002),Cu(r=0.274,p=0.041),与Se呈负相关(r=-0.486,p<0.001)。
结论:DKD组的血浆Ca水平较低,与eGFR有很强的正相关,表明其在预测肾功能下降的发生和进展中的作用。
OBJECTIVE: Diabetic kidney disease (DKD) is the primary cause of chronic kidney disease (CKD) worldwide. Altered mineral levels leading to adverse outcomes are widely reported in diabetes but limited in DKD, in the Indian scenario, hence this study was taken up to address this issue.
METHODS: A hospital-based
case-control study was taken up with 54 healthy controls (C) and 140 subjects with type 2 diabetes wherein 74 subjects with diabetes and CKD formed the DKD group, and 66 subjects with diabetes but no CKD formed the diabetic no-chronic kidney disease (DNCKD) group. High-resolution inductively coupled plasma mass spectrometry was used to evaluate the blood levels of minerals (calcium (Ca), vanadium (V), chromium (Cr), manganese (Mn), iron (Fe), cobalt (Co), copper (Cu), zinc (Zn), and selenium (Se)), and a raw food-based food frequency questionnaire for dietary intakes. Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation (mL/min/1.73 m2) and albuminuria. Spearman\'s rank correlation was used to evaluate the relationship between the categorical variables.
RESULTS: The median values of plasma Ca in the DKD group were significantly lower compared with the DNCKD and C groups (10.5 mg/dL vs. 11.0 mg/dL and 11.7 mg/dL, p<0.001). Furthermore, plasma Ca levels lowered with declining kidney function, as evidenced by the eGFR and albuminuria segregation. Dietary intake of minerals did not correlate with the corresponding plasma levels. However, in the DKD group, eGFR correlated positively with the plasma levels of Ca (r= 0.422, p=0.001), Cr (r= 0.351, p=0.008), Mn (r= 0.338, p=0.011), Fe (r= 0.403, p=0.002), Cu (r= 0.274, p=0.041) and negatively with Se (r= -0.486, p<0.001).
CONCLUSIONS: Plasma Ca levels are lower in the DKD group with a strong positive association with eGFR, indicating its role in predicting the onset and progression of kidney function decline.