低25羟维生素D水平与糖尿病视网膜病变的相关性分析

Association of low serum 25-hydroxy vitamin D level with the retinopathy in type 2diabetic patients

目的探讨T2DM患者血清25羟维生素D(25-OH-VitD)水平与DR的相关性。方法选取T2DM患者509例,根据免散瞳眼底照相机摄片程度将患者分为糖尿病视网膜病变(DR,n=229)组及糖尿病无视网膜病变(NDR,n=280)组。DR组根据视网膜病变程度分为DR1亚组(n=172)和DR2亚组(n=57),比较各组的临床和生化特征。结果 DR组糖尿病病程、SBP、BMI、HbA1c、糖化血清蛋白(GA)及UAER均高于NDR组(P<0.05),血清25-OH-VitD及镁水平低于NDR组(P<0.05)。DR2组年龄、病程、SBP、HbA1c及UAER水平高于DR1组(P<0.05),血清25-OH-VitD水平低于DR1组(P<0.05)。Spearman相关分析表明,DR与病程、SBP、BMI、HbA1c、GA、LDL-C及UAER呈正相关(P<0.05);与血清25-OH-VitD及镁水平呈负相关(P<0.05)。多元逐步回归分析显示,UAER(β=0.375,P=0.000)、病程(β=0.049,P=0.000)、血清25-OH-VitD(β=-0.033,P=0.000)、HbA1c(β=0.071,P=0.002)及SBP(β=0.006,P=0.040)是DR的独立危险因素。结论血清25-OH-VitD水平降低与DR发生及严重程度相关。

Objective To explore the relationship between serum 25-hydroxy vitamin D （25-OH- VitD） level and diabetic retinopathy （DR） in patients with type 2 diabetes mellitus （T2DM）. Methods 509 T2DM patients were recruited and divided into two groups including DR group（n= 229） and NDR group（n： 280） according to the fluorescence fundus angiographies. The DR group was assigned to 2 subgroups based on the severity of diabetic retinopathy： DR1 group （n： 172） and DR2 group （n= 57）. Their clinical characteristics and biochemical parameters were compared and the associated factors of DR were analyzed. Results The duration, SBP, BMI, HbA1 c,GA, UAER were significantly higher in DR group than in NDR group （ P 〈0.05 ）, hut the levels of serum 25-OH-VitD and magnesium were significantly lower in DR group than in NDR group （P〈0. 05）. The age, duration, SBP, BMI, HbAx c, UAER were significantly higher in DR2 group than in DR1 group （P（0. 05）, and the serum 25-OH-VitD level was significantly lower in DR2 group than in DR1 group（P%0.05）. Spearman correlation analysis revealed that DR was positively correlated with duration, SBP, BMI, HbA1 c,GA, LDL-L, UAER （P-〈 0.05） ; DR was negatively correlated with the levels of serum 25-OH-VitD and magnesium （P〈0. 05）.Multiple stepwise regression analysis further revealed that except for 24 h urinary albumin （β= 0. 375, P=0. 000）, diabetic duration （p=0. 049, P=0. 000）, HbAlc（p=0. 071, P=0. 002） and SBP （p= 0. 006, P=0. 040）, 25-OH-VitD （β= --0. 033,P=0. 000） were also an independent risk factor of DR. Conclusion Low serum 25-OH-VitD level is associated with the occurrence and severity of diabetic retinopathy.