维生素 D 缺乏与 HIV 感染和未感染的注射吸毒者持续性蛋白尿。
Vitamin D deficiency and persistent proteinuria among HIV-infected and uninfected injection drug users.
机构信息
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.
出版信息
AIDS. 2012 Jan 28;26(3):295-302. doi: 10.1097/QAD.0b013e32834f33a2.
OBJECTIVE
Proteinuria occurs commonly among HIV-infected and uninfected injection drug users (IDUs) and is associated with increased mortality risk. Vitamin D deficiency, highly prevalent among IDUs and potentially modifiable, may contribute to proteinuria. To determine whether vitamin D is associated with proteinuria in this population, we conducted a cross-sectional study in the AIDS Linked to the IntraVenous Experience (ALIVE) Study.
METHODS
25(OH)-vitamin D levels were measured in 268 HIV-infected and 614 HIV-uninfected participants. The association between vitamin D deficiency (<10 ng/ml) and urinary protein excretion was evaluated by linear regression. The odds of persistent proteinuria (urine protein-to-creatinine ratio >200 mg/g on two occasions) associated with vitamin D deficiency was examined using logistic regression.
RESULTS
One-third of participants were vitamin D-deficient. Vitamin D deficiency was independently associated with higher urinary protein excretion (P < 0.05) among HIV-infected and diabetic IDUs (P-interaction < 0.05 for all). Persistent proteinuria occurred in 18% of participants. Vitamin D deficiency was associated with greater than six-fold odds of persistent proteinuria among diabetic IDUs [odds ratio (OR) 6.29, 95% confidence interval (CI) 1.54, 25.69] independent of sociodemographic characteristics, comorbid conditions, body mass index, and impaired kidney function [estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m(2)]; no association, however, was observed among nondiabetic IDUs (OR 1.06, 95% CI 0.64, 1.76) (P-interaction <0.05).
CONCLUSIONS
Vitamin D deficiency was associated with higher urinary protein excretion among those with HIV infection and diabetes. Vitamin D deficiency was independently associated with persistent proteinuria among diabetic IDUs, although not in nondiabetic persons. Whether vitamin D repletion ameliorates proteinuria in these patients requires further study.
目的
在感染 HIV 和未感染 HIV 的注射吸毒者（IDU）中，蛋白尿很常见，并且与死亡率风险增加有关。维生素 D 缺乏症在 IDU 中非常普遍，而且可能是可以改变的，可能导致蛋白尿。为了确定维生素 D 是否与该人群的蛋白尿有关，我们在 AIDS Linked to the IntraVenous Experience（ALIVE）研究中进行了一项横断面研究。
方法
在 268 名 HIV 感染和 614 名 HIV 未感染的参与者中测量了 25（OH）-维生素 D 水平。通过线性回归评估维生素 D 缺乏症（<10 ng/ml）与尿蛋白排泄之间的关系。使用逻辑回归检查与维生素 D 缺乏相关的持续性蛋白尿（两次尿液蛋白与肌酐比值>200 mg/g）的几率。
结果
三分之一的参与者维生素 D 缺乏。维生素 D 缺乏与 HIV 感染和糖尿病 IDU 的尿蛋白排泄增加独立相关（所有 P 交互<0.05）。18%的参与者发生持续性蛋白尿。在糖尿病 IDU 中，维生素 D 缺乏与持续性蛋白尿的几率增加了六倍以上相关[比值比（OR）6.29，95%置信区间（CI）1.54，25.69]，独立于社会人口统计学特征、合并症、体重指数和受损的肾功能[估计肾小球滤过率（eGFR）<60 ml/min per 1.73 m2]；然而，在非糖尿病 IDU 中未观察到相关性（OR 1.06，95%CI 0.64，1.76）（P 交互<0.05）。
结论
在 HIV 感染和糖尿病患者中，维生素 D 缺乏与尿蛋白排泄增加有关。维生素 D 缺乏与糖尿病 IDU 的持续性蛋白尿独立相关，但在非糖尿病患者中则不相关。在这些患者中，维生素 D 补充是否能改善蛋白尿需要进一步研究。
Zotero 插件