2型糖尿病患者血25羟维生素D的改变及其对糖代谢与骨密度的影响

Serum level of 25-hydroxyvitamin D and its impact on glucose metabolism and bone mineral density in type 2 diabetic patients

目的探讨2型糖尿病患者血25羟维生素D[25（OH）D]的改变及其对糖代谢与骨密度的影响。方法选择我院住院的2型糖尿病患者258例，以25（OH）D为50nmol／L为临界值进行分组，分为维生素D缺乏组[25（OH）D〈50nmol／L]192例及维生素D相对不足组[25（OH）D为50-70nmol／L]66例。双能x线骨密度仪（DXA）测量患者腰椎L2一L4及股骨颈骨密度，取腰椎Total值、股骨颈Neck和Total值为判定指标，采用稳态模型评估胰岛素抵抗（HOMA—IR）程度，收集分析患者糖代谢与骨代谢相关指标数据并进行统计分析。结果258例2型糖尿病患者中骨质疏松57例，占22．1％。其中维生素D缺乏组与维生素D相对不足组的糖尿病病程、空腹胰岛素和胰岛素抵抗指数差异均有统计学意义[（7．98±1．09）、（3．77±1．21）年，（6．42±1．30）、（5．79±1．08）mU／L、（2．35±0．54）、（1．85．4-0．41），t值分别为4．849、3．871、2．705，P均〈0．05]，而空腹血糖与糖化血红蛋白差异均无统计学意义（P均〉0．05），维生素D缺乏组与维生素D相对不足组的甲状旁腺激素、腰椎Total值、股骨颈Neck值、股骨颈Total值差异均有统计学意义[（36．51±7．59）、（32．02±6．89）ng／L，（0．87±0．14）、（0．99±0．12）g／cm。，（0．70±O．10）、（0．79±0．11）g／cm2，（0．84±0．14）、（0．97±0．15）g／cm。，t值分别为2．008、2．799、2．564、2．340，P均〈0．05]。结论2型糖尿病患者中普遍存在维生素D缺乏，维生素D的水平将影响糖尿病患者胰岛素抵抗和血糖控制及骨密度水平，导致骨质疏松发病率明显增加。因此，对糖尿病患者应进行常规维生素D检测，并对维生素D缺乏的患者及时给予维生素D补充治疗。

Objective To investigate the change of 25-hydroxyl vitamin D level and its impact on glucose metabolism and bone mineral density in type 2 diabetic patients. Methods Two hundred and fifty-eight cases of type 2 diabetic patients in our hospital were collected. In accordance with 25 （OH） D = 50 nmol/L for the critical values,they were grouped into vitamin D deficiency group （n = 192） and the relative lack of vitamin D group （ n = 66）. Dual-energy X-ray absorptiometry （DXA） measurement of the lumbar vertebrae L2 - IA and femoral neck bone mineral density were undertaking. Taking the total value of the lumbar spine, femoral neck and total value as judgment indicators, homeostasis model assessment of insulin resistance （ HOMA-IR）, we collected and statistically analyzed glucose metabolism and bone metabolism indicators in patients with diabetes. Results Among 258 cases of type 2 diabetes, there were 57 cases of osteoporosis accounting for 22. 1%. There was significant difference on the duration of diabetes [ （ 7. 98 ＋ 1.09 ） years old vs （ 3.77 ＋ 1.21 ） years old, t = 4. 849,P 〈 0. 05 ], FINS [ （6.42 ± 1.30）mU/L vs （5.79 ± 1.08）mU/L, t = 3. 871,P 〈 O. 05 ] and HOMA-IR [ （2. 35 ±0. 54） vs （ 1.85 ±0. 41 ） ,t =2. 705 ,P 〈0. 05 ] ,but no significant difference on the FPG and HbAlc （P〉 0. 05） between two groups. PTH [ （36. 51 ±7.59） ng/L vs （32. 02 ±6. 89） ng/L,t =2. 008,P 〈0. 05], bone mineral density in the lumbar total value [ （0. 87 ＋0. 14） g/cm2 vs （0. 99 ±0. 12） g/cm2 ,t =2. 799 ,P 〈 0. 05 ], femoral neck Neck [ （ 0.70 ±0. 10 ） g/cm2 vs （ 0. 79± 0. 11 ） g,/cm2, t = 2. 564, P 〈 0. 05 ] and Total [ （0. 84 ± 0. 14） g/cm2 vs （0. 97 ＋ 0. 15 ） g/cm2, t = 3. 340 P 〈 0.05 ] were statistically different, but no significant difference on the rest of the indicators. Conclusion The prevalence of vitamin D deficiency was found in patients with diabetes. Vitamin D level could affect insulin resistance and glycemic control and bone mineral density level. Therefore, routine vitamin D testing to the diabetic patients and giving vitamin D replacement therapy to vitamin D deficiency patients in a timely manner were necessary.