初诊2型糖尿病患者血清25(OH)D水平特点及与HOMA-IR、胰岛β细胞功能的关系研究

Characteristics of serum 25(OH) D level in newly diagnosed type 2 diabetes mellitus and its relationship with the function of islet beta cells

目的:探讨初诊2型糖尿病患者血清25-羟维生素D[25(OH)D]水平表达特点,并分析其与胰岛素抵抗(HOMA-IR)、胰岛β细胞功能的相关性。方法:将本院内分泌科2017年1月~2018年12月期间收治的200例初诊2型糖尿病患者作为研究对象(研究组),选取同期来院例行体检的40名健康志愿者作为对照(对照组),开展前瞻性研究。采用电化学发光法检测并比较两组血清25(OH)D水平差异。根据血清25(OH)D水平将研究组分为维生素D缺乏组和维生素D正常组,收集两亚组血压(SBP、DBP)、血脂(TC、TG、HDL-C、LDL-C)、血糖(FPG、2hPG、HbAlc)、炎性因子(IL-6、TNF-α)等检测指标,重点比较两亚组HOMA-IR和胰岛β细胞功能指标的差异,并采用Person相关性分析法分析血清25(OH)D水平与HOMA-IR、胰岛β细胞功能的内在相关性。结果:研究组血清25(OH)D水平(19.67±3.36)ng/mL明显低于对照组(39.13±7.13)ng/mL,维生素D缺乏组和正常组SBP、DBP、TC、TG、HDL-C、LDL-C、FPG、2hPG、HbAlc、IL-6、TNF-α水平比较差异均不显著。维生素D缺乏组和正常组HOMA-IR比较明显较高,△130/△G30、AUCCP30、AUCCP180明显较低,均差异显著。Pearson相关分析显示,血清25(OH)D水平和HOMA-β相关性不显著,和HOMA-IR呈负相关(r=-0.382),和△130/△G30、AUCCP30、AUCCP180均呈显著正相关(r值依次为0.425、0.376、0.352)。结论:初诊2型糖尿病患者维生素D多处于缺乏状态,且25(OH)D水平与胰岛β细胞早期相胰岛素分泌、总体胰岛素分泌以及HOMA-IR紧密相关,但和胰岛β细胞基础胰岛素分泌无显著关联。

Objective To investigate the expression of serum 25-hydroxyvitamin D[25(OH)D]in newly diagnosed type 2 diabetes mellitus,and to analyze its correlation with insulin resistance(HOMA-IR)and islet beta cell function.Methods 200 newly diagnosed patients with type 2 diabetes mellitus admitted to our hospital from January 2017 to December 2018 were selected as the study group,and 40 healthy volunteers who came to our hospital for routine physical examination during the same period were selected as the control group to conduct a prospective study.The difference of serum 25(OH)D level between the two groups was detected and compared by electrochemiluminescence.According to the level of serum 25(OH)D,the study group was divided into vitamin D deficiency group and vitamin D normal group.Fasting glucagon,AUC glucagon,homeostasis model insulin beta cell function index(HOMA-beta),early insulin secretion index(130/G30)and AUCCP30,AUCCP180 were compared between the two subgroups.Serum 25(OH)D level and AUCCP180 were analyzed by Person correlation analysis.The intrinsic correlation between the aforementioned alpha and beta cell function indexes and homeostasis model insulin resistance index(HOMA-IR).Results The serum 25(OH)D level(19.67±3.36)ng/mL in the study group was significantly lower than that in the control group(39.13±7.13)ng/mL.There were no significant differences in SBP,DBP,TC,TG,HDL-C,LDL-C,FPG,2hPG,HbAlc,IL-6 and TNF-a levels between the vitamin D deficiency group and the normal group.HOMA-IR was significantly higher in vitamin D deficiency group and normal group,and Delta 130/Delta G30,AUCCP30 and AUCCP180 were significantly lower.Pearson correlation analysis showed that serum 25(OH)D level was not significantly correlated with HOMA-beta,but negatively correlated with HOMA-IR(r=-0.382),and positively correlated with Delta 130/Delta G30,AUCCP30,AUCCP180(r values were 0.425,0.376,0.352,respectively).Conclusion Most newly diagnosed type 2 diabetes mellitus patients are deficient in vitamin D,and 25(OH)D level is closely related to early phase insulin secretion,total insulin secretion and HOMA-IR of pancreatic beta cells,but not to basic insulin secretion of pancreatic beta cells.