Correlation Between 25-hydroxyvitamin D₃,CRP And The Severity Of Diabetic Kidney Disease

BackgroundWith the rapid development of society and economy and changes in lifestyles,type 2 diabetes has become one of the chronic non-communicable diseases that are globally prevalent and seriously threaten human health.Type 2 diabetes mellitus(T2DM)is a systemic metabolic disease characterized by insulin resistance mainly with progressive insufficient insulin secretion to progressive insulin deficiency and mainly with insulin resistance.The main symptoms are thirst,drink more,eat more,urinate,and lose weight.According to statistical reports,about 451 million people worldwide had diabetes in 2017,and by 2045 this number will increase to 693 million,bringing a serious socio-economic burden to the world and also seriously affecting the quality of life of patients.Diabetic kidney disease(DKD)is the most common microvascular complication of diabetes and the main cause of chronic kidney disease(CKD)and end-stage renal disease(ESRD).The pathogenesis of diabetic kidney disease is complicated,and there are many possible mechanisms involved.Vitamin D(vitamin D)is a fat-soluble vitamin,the most classic function of which is to regulate the metabolism of calcium and phosphorus.With the development of science and technology and the deepening of research,many studies have found that vitamin D can promote insulin secretion and improve insulin resistance(IR).Vitamin D deficiency results in islet β-cell dysfunction and aggravates insulin resistance.Many studies have confirmed that vitamin D deficiency is one of the important mechanisms leading to the development of diabetes into diabetic kidney disease.At the same time,vitamin D is an anti-inflammatory factor that participates in various inflammatory response pathways of the body and has a protective effect on the kidneys.C-reactive protein(CRP)is a marker of inflammation.When the body is under normal conditions,CRP levels are low.Once the body is infected by bacteria,CRP will rise rapidly.Many studies in recent years have found that CRP is a risk factor for diabetic kidney disease,and other studies have confirmed that vitamin D is involved in the inflammatory response process and can inhibit the inflammatory state.25-hydroxyvitaminD3(25(OH)D3)is an active form of vitamin D in the body,which can be used to evaluate the body’s vitamin D status.ObjectiveThis article intends to understand the relationship between 25(OH)D3 and CRP in patients with diabetic kidney disease by analyzing the correlation between the anti-inflammatory factor 25(OH)D3 and the inflammatory factor CRP and its severity with diabetic kidney disease.To prevent and delay the development of diabetic kidney disease and provide ideas for the treatment of diabetic kidney disease.MethodAccording to the established inclusion and exclusion criteria,275 patients with type 2 diabetes(aged 53.2 ± 11.5 years)hospitalized in the Department of Endocrinology and the Department of Endocrinology of the First Affiliated Hospital of Zhengzhou University from October 2018 to January 2020 were selected as the research objects,In this study,56 healthy people(aged 52.8 ± 9.1 years old)who were examined in our hospital during the same period were selected as the control group.Collect the name,gender,age,course of diabetes,systolic blood pressure(SBP),diastolic blood pressure(DBP),weight,height,and calculated body mass index(BMI)of the included subjects.Basic information such as history of coronary heart disease,history of hypertension,history of retinopathy,family history of diabetes,history of smoking,history of alcohol consumption and oral medication,etc.At the same time,all subjects are required to fast for 8 hours Then,in the early morning of the second day,fasting venous blood was drawn for fasting blood glucose(FBG),glycosylated hemoglobin Alc(HbA1c),25-hydroxyvitamin D3,C-reactive protein,urinary albumin concentration,urinary creatinine and calculated albumin creatinine to ratio(UACR),total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C)and low density lipoprotein cholesterol(LDL-C),blood urea nitrogen(BUN),serum creatinine(SCr),uric acid(UA),estimated glomerular filtration rate(eGFR),calcium,(Ca),phosphorus(P),parathyroid hormone(PTH).T2DM patients were divided into normal albuminuria group(UACR<30mg/g)according to the value of UACR,including 67 males and 37 females.Microalbuminuria group(30mg/g<UACR<300mg/g),including 72 males and 30 females.A large amount of albuminuria group(UACR>300mg/g),including 40 males and 29 females.Fifty-six healthy people who were examined in our hospital during the same period were selected as the control group,including 33 males and 23 females.Data entry and statistical analysis were performed using SPSS22.0 sofiware.The comparison of the four sets of measurement data is based on the results of the normality test and the homogeneity test of variance.The measurement data that conforms to the normal distribution is expressed as mean±standard deviation((?)),and the measurement data that is not normally distributed is expressed as the median(interquartile range)[M(Q)].Comparisons between groups were performed using the Kruskal-Wallis H test,and comparisons between the two groups were performed using the Tamhane’s T2 test.The relationship between the indicators was analyzed by non-parametric Spearman correlation analysis,the count data was tested by χ2 test,and P<0.05 was considered statistically significant.Results1.Analysis results of general data of four groups of study objectsCompared with the control group,the systolic blood pressure of the large albuminuria group and the microalbuminuria group was significantly higher(P<0.05).The PTH of the normal albuminuria group was significantly lower than that of the control group,and the difference was statistically significant(P<0.05).Compared with the control group,HbA1c,FBG,BUN,SCr and TG in normal albuminuria group,microalbuminuria group and a large amount of albuminuria group were significantly higher than those in control group(P<0.05).HDL-C in the microalbuminuria group was significantly lower than that in the control group and normal albuminuria group,and the difference was statistically significant(P<0.05).A large number of albuminuria and normal albuminuria group had significantly higher TC and LDL-C than the control group,and the difference was statistically significant(P<0.05).The eGFR of the large albuminuria group was significantly lower than that of the control group,normal albuminuria group,and microalbuminuria group(P<0.05).2.Analysis of the results of 25(OH)D3 and CRP for four groups of subjectsCompared with the control group,normal albuminuria group,and microalbuminuria group,25(OH)D3 in the large albuminuria group was significantly lower than that in the control group,normal albuminuria group,and microalbuminuria group(P<0.05).The 25(OH)D3 in the large albuminuria group and the microalbuminuria group was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).Compared with the normal albuminuria group,the 25(OH)D3 in the large albuminuria group was significantly lower,and the difference was statistically significant(P<0.05).There was no significant difference in 25(OH)D3 between control group and normal albuminuria group(P>0.05).The CRP in the microalbuminuria group and the large albuminuria group was significantly higher than that in the control group and normal albuminuria group(P<0.05).There was no significant difference in CRP between normal albuminuria group and control group(P>0.05).Compared with the normal albuminuria group,the CRP of the microalbuminuria group and the large albuminuria group increased significantly,and the difference was statistically significant(P<0.05).There was no significant difference between the CRP of the microalbuminuria group and the CRP of the large albuminuria group(P>0.05).3.Correlation between 25(OH)D3 levels of four groups of study objects and various indicators25(OH)D3 is negatively correlated with BMI,SBP,UACR,PTH,HbAlc,P,FBG,BUN,SCr,UA,TC,TG,LDL-C,CRP,r=-0.141,-0.202,-0.366,-0.177,-0.133,-0.205,-0.147,-0.110,-0.165,-0.118,-0.121,-0.150,-0.115,-0.148(P<0.05).25(OH)D3 was positively correlated with Ca,HDL-C and eGFR,r=0.147,0.120,0.122(P>0.05).4.Analysis of measurement data of T2DM patientsThere was no significant difference in gender distribution between the three groups of T2DM patients(P>0.05),and the data of the three groups were comparable.The difference between the presence or absence of retinopathy and history of hypertension was statistically significant(P<0.05).There were no significant differences in the presence or absence of coronary heart disease,the history of smoking,the history of drinking,and the family history of diabetes(P>0.05).5.Relationship between serum 25(OH)D3,CRP levels and diabetes course after T2DM patients were grouped according to diabetes courseSerum 25(OH)D3 showed a tendency to decrease with the increase of the disease course,but the difference was not statistically significant(P>0.05);the level of CRP increased with the increase of the disease course,and the difference Was statistically significant(P>0.05).Conclusion1.The serum 25(OH)D3 level in patients with type 2 diabetes decreases with the increase of urine albumin,which is closely related to the severity of diabetic kidney disease.2.The serum CRP level of patients with type 2 diabetes increases with the increase of the increase of urine albumin,which is closely related to the severity of diabetic kidney disease.3.Serum 25(OH)D3 levels in patients with type 2 diabetic kidney disease are negatively correlated with serum CRP levels,suggesting that increasing vitamin D levels is expected to reduce the inflammation of diabetic nephropathy.