2型糖尿病视网膜病变与血清25羟维生素D水平的关系研究

The relationship between retinopathy and serum 25-hydroxy vitamin D level in patients with type 2 diabetes mellitus

目的：探讨2型糖尿病视网膜病变（DR）与血清25羟维生素D（25-OH-VD）水平的关系。方法：选取2型糖尿病患者162例,根据眼底照相结果分为单纯糖尿病（DM）组（66例）、非增殖期糖尿病视网膜病变（NPDR）组（52例）和增殖期糖尿病视网膜病变（PDR）组（44例）,收集并比较各组的临床资料和血清学指标,分析DR的危险因素。结果：PDR组和NPDR组患者病程和Hb A1C均长于与高于DM组（P〈0.05-P〈0.01）,而PDR组患者病程和糖化血红蛋白（Hb A1C）亦长于与高于NPDR组（P〈0.05和P〈0.01）;PDR组和NPDR组25-OH-VD水平均显著低于DM组（P〈0.01）,而PDR组患者25-OH-VD水平亦明显低于NPDR组（P〈0.01）;PDR组患者SBP高于DM组（P〈0.05）,但与NPDR组差异无统计学意义（P〉0.05）;相关分析显示,患者病程、SBP和Hb A1C与DR均呈正相关关系（P〈0.05-P〈0.01）,25-OH-VD水平与DR呈负相关关系（P〈0.01）;多因素logistic回归分析显示患者病程和Hb A1C均是DR的危险因素（P〈0.01和P〈0.05）,而25-OH-VD是DR的保护因素（P〈0.01）。结论：低血清25-OH-VD水平与DR发生及严重程度相关,是其独立危险因素。

Objective：To explore the relationship between diabetic retinopathy（DR） and serum 25-hydroxy vitamin D（25-OH-VD） level in patients with type 2 diabetes mellitus（T2DM）. Methods：The 162 T2DM patients were divided into the single diabetes mellitus group（ DM group,66 cases） ,non-proliferative diabetic retinopathy（ NPDR group,52 cases） and proliferative diabetic retinopathy（ PDR group,44 cases） according to the fundus oculi results. The clinical characteristics and biochemical parameters were investigated to analyze the risk factors of DR. Results：The duration and glycated hemoglobin（ HbA1C） levels in PDR and NPDR groups were higher than those in DM group（P〈0. 05 to P〈0. 01）,and the duration and HbA1C level in PDR group were higher than those in NPDR group（P〈0. 05 to P〈0. 01）. The 25-OH-VD levels in PDR and NPDR groups were significantly less than that in DM group（P〈0. 01）,and the 25-OH-VD level in PDR group was significantly lower than that in NPDR group（P〈0. 01）. The systolic blood pressure （SBP） in PDR group was higher than that in DM group（P〈0. 05）,but the difference of the SBP level between PDR and NPDR group was not statistically significant（P〉0. 05）. Correlation analysis showed that the duration,SBP and HbA1C level of patients were positive correlation with DR（P〈0. 05 to P〈0. 01）,and the level of serum 25-OH-VD were negative correlation with DR（P〈0. 01）. Multiple logistic regression analysis showed that the duration and HbA1C level of the patients were the risk factors of DR（P〈0. 05 to P〈0. 01）,and the 25-OH-VD level was a protective factor of DR（P〈0. 01）. Conclusions：The serum level of 25-OH-VD is associated with the occurrence and severity of DR,and it is an independent risk factor of DR.