阿法骨化醇对新诊断2型糖尿病患者胰岛β细胞第一时相分泌的影响

Effects of 1α- hydroxyvitamin D3 on the first- phase insulin secretion of beta cell in preliminary type 2 diabetic patients

目的通过观察阿法骨化醇[1α-hydroxyvitamin D3,1,α-(OH)2D3]对初诊2型糖尿病患者胰岛β细胞第一时相分泌及血浆中25羟维生D[25-hydroxy vitamin D,25(OH)D]水平的影响,旨在初步探讨它们之间的相互关系。方法受试者分3组:初诊2型糖尿病组(Type 2 Diabetes mellitus,T2DM组)158例、初诊2型糖尿病+阿法骨化醇治疗组[T2DM+1,α-(OH)2D3组]155例及正常对照组(NGT组)152例,以葡萄糖刺激后3到5min急性胰岛素反应(3-5minutes acute insulin response,AIR3-5)来表示第一时相胰岛素分泌功能指数,测定胰岛β细胞第一时相胰岛素分泌功能指数、血浆中25(OH)D及血脂水平并进行比较分析。结果 T2DM组TC、TG、LDL-C、BMI均高于对照组,而AIR3-5、25(OH)D、HDL-C低于对照组,差异具有统计学意义(P<0.05);T2DM+1,α-(OH)2D3组AIR 3-5、25(OH)D、TG、HDL-C与正常对照组比较,差异无统计学意义(P>0.05),而TC、TG、LDL-C、BMI均高于对照组,差异具有统计学意义(P<0.05);T2DM+1,α-(OH)2D3组AIR 3-5、25(OH)D、HDL-C明显高于T2DM组,差异具有统计学意义(P<0.05),而TG明显低于T2DM组,差异具有统计学意义(P<0.05),TC、LDL-C、BMI与T2DM组比较,差异无统计学意义(P>0.05)。AIR 3-5与25(OH)D、HDL-C呈正相关,与TC、TG、LDL-C、BMI均呈负相关。结论初诊T2DM患者25(OH)D、AIR 3-5水平降低,而使用阿法骨化醇治疗组,血浆中25(OH)D水平升高,胰岛β细胞第一时相胰岛素分泌功能得以明显改善,因此,阿法骨化醇提高了血浆中25(OH)D水平,改善了胰岛β细胞第一时相胰岛素分泌功能,同时改善了脂质代谢,可能对防治糖尿病及改善脂质代谢具有重要意义。

Objective To observe the effects of 1α - hydroxyvitamin D3 [ 1 ,α - （ OH）2D3 ] on the first - phase insulin secretion of beta cell and plasma 25 - hydroxyvitamin D in patients with in - preliminary diagnosis of type 2 diabetes mellitus and further investigate the relationship between them. Methods Clinical cases were divided in- to three groups： 158 patients with newly diagnosed type 2 diabetes mellitus （T2DM group） and 155 patients with newly diagnosed type 2 diabetes mellitus using 1α - （OH） 2D3 therapy [ T2DM ＋ 1,α - （ OH ） 2D3 group ] and 152 patients with normal glucose tolerance （NGT group） as control group. AIR3 -5 （3 -5 minutes acute insulin response） was used to evaluate the first -phase insulin secretion function and calculated as the average internal insulin concentration from the third to the fifth minute after the glucose loading. 25 （OH） D, total cholesterol （ TC）, triglyeride （ TG）, low density lipoprotein - cholesterol （ LDL - C ）, high density lipoprotein - cholesterol （ HDL - C） were detected and compared. Results The levels of TC, TG, LDL - C and BMI were significantly higher in T2DM group than those in NGT group （P 〈 0.05 ）. The AIR3 - 5, 25 （OH） D and HDL - C levels were significantly lower in T2DM group than those in NGT group （ P 〈 0.05 ）. No significant difference of AIR 3 - 5, 25 （OH） D, TG and HDL - C between T2DM ＋ 1, α - （OH） 2D3 and NGT groups was shown （P 〉 0.05 ）. The levels of TC, TG, LDL -C and BMI were significantly higher in T2DM ＋ 1 ,α- （OH）2D3 group than those in NGT group （P 〈 0.05 ）. The levels of AIR 3 - 5, 25 （OH） D, TG and HDL - C were significantly higher in T2DM ＋ 1 ,α - （ OH）2D3 group than those in T2DM group （P 〈0.05）. The TG level was significantly lower in T2DM ＋ 1 ,α - （ OH）2D3 group than those in T2DM group （ P 〈 0.05 ）. There was no significant difference of TC, TG, LDL - C and BMI levels between T2DM ＋ 1, ot - （OH） 2D3 and T2DM groups （P 〉 0.05）. AIR3 - 5 was positively correlated with 25 （OH）D and HDL - C and negatively correlated with TG, LDL - C and BMI. Conclusion The levels of 25 （OH） D and AIR3 - 5 are decreased in patients with preliminary type 2 diabetes mellitus. The 25 （OH） D level is increased and the first - phase insulin secretion function of beta cell is improved in T2DM ＋ 1 ,eL - （ OH）2D3 group. Therefore, lcx - hydroxyvitamin D3 could improve the level of 25 （OH） D , the first - phase insulin secretion function of beta cell and lipid metabolism in patients with newly diagnosed type 2 diabetes mellitus, suggesting that 1 oL -hydroxyvitamin D3 might be beneficial for preventing diabetes mellitus and improving lipid metabolism.