老年男性2型糖尿病25羟维生素D状况及其与糖代谢和骨密度的相关分析

25 hydroxyvitamln D status and its correlation with glucose metabolism and bone mineral density in elderly men with type 2 diabetes mellitus

目的探讨25羟维生素D在老年男性2型糖尿病（T2DM）患者中的状况，分析其与糖代谢和骨密度的关系。方法收集老年男性T2DM患者53例（T2DM组），老年男性非糖尿病（NDM）患者51例（NDM组），测定两组患者血生化指标及25羟维生素D水平，双光能x线检测T2DM患者腰椎（L2-4）和左侧股骨近端骨密度。结果T2DN组血清25羟维生素D水平为（12．38±5．12）μg/L，显著低于NDb1组的（17．35±5．52）μ/L差异有统计学意义（P〈0．05）；老年男性T2DM患者血清25羟维生素D水平与空腹血糖、糖化血红蛋白呈负相关（r=-0．225、-0．499，P〈0．05），而与空腹胰岛素、稳态模型胰岛索抵抗指数无明显相关性（r=-0．050、-0．082，P〉0．05）；T2DM组骨质疏松患病率（30．19％，16／53）明显高于NDM组（11．76％，6／51），差异有统计学意义（P〈0．05）；25羟维生素D与股骨颈、股骨大转子、Ward三角区骨密度呈明显正相关（r=0．773、0．762、0．812，P〈0．05），与腰椎（L2-4）骨密度不相关（r=0．116，P〉0．05）。结论老年男性T2DM患者普遍存在维生素D缺乏。维生素D缺乏或不足不仅影响血糖控制，还增加骨质疏松发生风险。因此，对T2Db1患者，尤其是老年患者，应进行常规维生素D检测，对维生素D不足及缺乏的患者及时给予维生素D补充可能对改善糖代谢和防治骨质疏松有益。

Objective To explore the change of 25 hydroxyvitamin D level and its correlation with glucose metabolism and bone mineral density in elderly men with type 2 diabetes mellitus（T2DM）. Methods Hospitalized 53 elderly male patients with T2DM （T2DM group） and 51 patients without T2DM （NDM group） were chosen. Blood biochemical indexes and 25 hydroxyvitamin D level were measured. Bone mineral density of lumbar （L2-4）, left proximal femur was measured by dual energy X-ray. Results The serum 25 hydroxyvitamin D level in T2DM group was lower than that in NDM group [（12.38 ±5.12）μg/L vs. （ 17.35 ±5.52） μ g/L], and there was significant difference（P〈 0.05 ）. The serum 25 hydroxyvitamin D level was negatively associated with fasting blood glucose level and glycosylated hemoglobin （r = -0.225,-0.499, P 〈 0.05）. The serum 25 hydroxyvitamin D level was not associated with fasting insulin and homeostasis model insulin resistance index （r =-0.050, -0.082, P 〉 0.05）. The incidence of osteoporesis in T2DM group was higher than that in NDM group [30.19%（16/53） vs. ll.76%（6/51）],and there was significant difference （P 〈 0.05）. The serum 25 hydroxyvitamin D level was positively associated with bone mineral density of femur neck, greater trochanter of femur and Ward triangle（r = 0.773,0.762,0.812,P〈 0.05）. The serum 25 hydroxyvitamin D level was not associated with bone mineral density of lumbar （L2-4）（r = 0.116,P 〉 0.05）. Conclusions The prevalence of vitamin D deficiency is found in elderly men with T2DM. Vitamin D level can affect blood glucose control and increase the risk of the occurrence of osteoporosis. Therefore,T2DM patients, especially elderly patients, should be routine vitamin D testing. Vitamin D supplementation to the patients of vitamin D instreieney in time may be beneficial to glucose metabolism and the prevention and treatment of osteoporosis.