Abstract: Background　The associations of vitamin D with obesity，obesity-related complications，diabetes and diabetes-related complications have become a new study field and a hot topic.However，there are few reports on the association of vitamin D with early diabetic kidney disease（EDKD） in overweight or obese populations.Objective　To explore the association between serum 25-hydroxy vitamin D〔25（OH）D〕 level and microalbuminuria（MAU） in overweight or obese male patients with newly diagnosed type 2 diabetes mellitus （T2DM）.Methods　A total of 261 newly diagnosed male T2DM patients from the Affiliated Hospital of Zunyi Medical University were enrolled from January to December 2018.They were divided into DM group（82 with DM），microalbuminuria（MAU） group（47 with normal body weight complicated by MAU），OWB-DM group（65 with overweight or obesity），and OWB-MAU group（67 with overweight or obesity complicated by MAU） according to 24 hour urinary albumin excretion rate（UAER） and body mass index（BMI）.By serum 25（OH）D level，overweight or obese patients were divided into quartiles 1，2，3，4 groups〔Q1 group，serum 25（OH）D<18.13 μg/L，n=33；Q2 group，18.13 μg/L≤serum 25（OH）D<21.22 μg/L，n=33；Q3 group，21.22≤μg/Lserum 25（OH）D<24.32 μg/L，n=32；Q4 group，serum 25（OH）D≥24.32 μg/L，n=34〕.The clinical data of male T2DM patients were collected，the correlation between 24 h UAER and other indicators in overweight or obese male T2DM patients，and the relationship between serum 25（OH）D level and MAU were analyzed.Results　There were significant differences in mean levels of BMI，systolic blood pressure（SBP），diastolic blood pressure（DBP），fasting plasma glucose（FPG），2-hour postprandial blood glucose（2 hPG），glycosylated hemoglobin（HbA1c），total cholesterol （TC），triacylglycerol（TG），high-density lipoprotein cholesterol（HDL-C），low-density lipoprotein cholesterol（LDL-C），homeostasis model assessment of insulin resistance index（HOMA-IR），estimated glomerular filtration rate（eGFR）and serum 25（OH）D among DM，MAU，OWB-DM and OWB-MAU groups （P<0.05）.The mean level of serum 25（OH）D in MAU group〔（20.84±4.12）μg/L〕，OWB-DM group〔（23.46±3.35）μg/L〕 or OWB-MAU group〔（18.00±4.46）μg/L〕 was significantly decreased compared with that of DM group〔（26.14±3.40）μg/L〕（P<0.05）.The mean serum 25（OH）D level in OWB-MAU group was significantly lower than that of MAU and OWB-DM groups（P<0.05）.Q1 group〔72.80（54.70，133.20）mg/24 h〕 had much higher mean 24 hUAER level than Q2〔38.50（18.25，78.85）mg/24 h〕，Q3〔27.90（19.95，69.80）mg/24 h〕，Q4〔20.0（13.20，24.50）mg/24 h〕groups（P<0.05）.The mean 24 hUAER level in Q4 group was much lower than that of Q2 and Q3 groups（P<0.05）.Spearman correlation analysis showed that 24 hUAER was negatively correlated with serum HDL-C and 25（OH）D levels（rs=-0.199，-0.405，P<0.05），and was positively correlated with BMI，SBP，DBP，2 hPG and TG（rs=0.257，0.350，0.282，0.421，0.202，P<0.05） in overweight or obese patients.Binary Logistic regression analysis showed that 25（OH）D，SBP and 2 hPG were independent influencing factors for MAU in overweight or obese male patients（OR=0.717，1.173，1.327，P<0.05）.Conclusion　The level of serum 25（OH）D in overweight or obese T2DM male patients was lower than those with normal weight.24 hUAER was closely related to decreased serum 25（OH）D，disorders of glucose and lipid metabolism，and increased blood pressure.Decreased serum 25（OH）D and increased SBP and 2hPG may be involved in the progression of EDKD in overweight or obese male patients.

Key words: Overweight；Obesity；Diabetes mellitus, type 2；Male；25-hydroxy vitamin；Albuminuria

摘要： 背景　维生素D作为肥胖、糖尿病及相关并发症的影响因素已成为近年来研究的新领域和热点之一，但关于维生素D在超重或肥胖男性早期糖尿病肾病（EDKD）中的研究鲜有报道。目的　探讨超重或肥胖的初诊男性2型糖尿病（T2DM）患者血清25羟维生素D〔25（OH）D〕与微量白蛋白尿（MAU）的关系。方法　选取2018年1—12月就诊于遵义医科大学附属医院的初诊男性T2DM患者261例，根据24 h尿白蛋白排泄率（24 hUAER）及体质指数（BMI）分为单纯糖尿病组（DM组，n=82）、正常体质量糖尿病微量白蛋白尿组（MAU组，n=47）、超重或肥胖糖尿病组（OWB-DM组，n=65）、超重或肥胖糖尿病微量白蛋白尿组（OWB-MAU组，n=67）。根据血清25（OH）D水平的四分位数，将超重或肥胖患者分为Q1组〔血清25（OH）D<18.13 μg/L，n=33〕、Q2组〔18.13 μg/L≤血清25（OH）D<21.22 μg/L，n=33〕、Q3组〔21.22 μg/L≤血清25（OH）D<24.32 μg/L，n=32〕、Q4组〔血清25（OH）D≥24.32 μg/L，n=34〕。收集男性T2DM患者临床资料，分析超重或肥胖男性T2DM患者24 hUAER与其他指标的相关性及血清25（OH）D水平与MAU的关系。结果　DM组、MAU组、OWB-DM组、OWB-MAU组BMI、收缩压（SBP）、舒张压（DBP）、空腹血糖（FPG）、餐后2 h血糖（2 hPG）、糖化血红蛋白（HbA1c）、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、胰岛素抵抗指数（HOMA-IR）、估算肾小球滤过率（eGFR）、血清25（OH）D比较，差异有统计学意义（P<0.05）。其中，与DM组〔（26.14±3.40）μg/L〕相比，MAU组、OWB-DM组及OWB-MAU组血清25（OH）D降低〔（20.84±4.12）、（23.46±3.35）、（18.00±4.46）μg/L，P<0.05〕；与MAU组、OWB-DM组相比，OWB-MAU组血清25（OH）D降低（P<0.05）。Q1、Q2、Q3、Q4组24 hUAER比较，差异有统计学意义（P<0.001）。其中，Q2、Q3、Q4组24 hUAER〔38.50（18.25，78.85）、27.90（19.95，69.80）、20.0（13.20，24.50）mg/24 h〕均低于Q1组〔72.80（54.70，133.20）mg/24 h，P<0.05〕，Q4组24 hUAER低于Q2、Q3组（P<0.05）。Spearman秩相关分析显示超重或肥胖男性患者24 hUAER与HDL-C、血清25（OH）D呈负相关（rs=-0.199、-0.405，P<0.05），与BMI、SBP、DBP、2 hPG、TG呈正相关（rs=0.257、0.350、0.282、0.421、0.202，P<0.05）。二元Logistic回归分析显示，血清25（OH）D、SBP、2 hPG是超重或肥胖男性T2DM患者发生MAU的影响因素（OR=0.717、1.173、1.327，P<0.05）。结论　超重或肥胖男性T2DM患者血清25（OH）D水平明显降低，其24 hUAER与低水平的血清25（OH）D、糖脂代谢紊乱、高血压密切相关，血清25（OH）D的降低及SBP、2 hPG的升高可能参与了超重或肥胖男性患者EDKD的进展。

关键词: 超重；肥胖症；糖尿病, 2型；男性；25-羟维生素D；白蛋白尿