绝经后2型糖尿病患者维生素D水平与糖代谢、脂代谢、胰岛素抵抗及胰岛早期分泌功能的相关性研究

Correlation study between vitamin D level and glucose metabolism,lipid metabolism,insulin resistance,early ;secretory function of pancreatic islets in postmenopausal women with type 2 diabetes

目的：探讨绝经后女性2型糖尿病患者维生素 D 水平与糖代谢、脂代谢、胰岛素抵抗及胰岛早期分泌功能的相关性。方法选取绝经后女性2型糖尿病患者115例为观察组，在该院同期就诊的绝经后女性非2型糖尿病患者115例为对照组，行维生素 D、糖脂代谢、胰岛素抵抗、胰岛早期分泌功能检测，分析维生素 D 与糖脂代谢、胰岛素抵抗及胰岛早期分泌功能的相关性。结果观察组空腹血糖、餐后2 h 血糖、糖化血红蛋白、体质量指数、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、胰岛素抵抗指数高于对照组[（8．5±1．2）mmol／L 比（5．1±0．6）mmol／L，（13．4±1．5）mmol／L 比（7．8±0．7）mmol／L，（8．7±1．1）％比（5．6±0.5）％，（25．7±1．0）kg／m2比（22．3±0．4）kg／m2，（5．6±0．7）mmol／L 比（4．5±0．4）mmol／L，（2．3±0．5）mmol／L 比（1．7±0．3）mmol／L，（3．5±0．6）mmol／L 比（2．2±0．4）mmol／L，（3．6±0．5）比（2．5±0．4）（t ＝9．667、10.179、8．535、4．524、5．443、6．529、8．909、7．406，均 P ＜0．05]。观察组高密度脂蛋白胆固醇、胰岛素第一分泌时相峰值倍数、胰岛β细胞功能指数、空腹胰岛素、维生素 D 低于对照组[（1．0±0．2）mmol／L比（1．2±0．3）mmol／L，（5．2±1．3）比（8．4±1．6），（135．8±11．7）比（194．3±19．2），（4．1±0.9）IU ／mL 比（10.8±0．6）IU ／mL，（10．8±2．1）ng／L 比（27．4±3．8）ng／L（t ＝5．087、9．153、7．370、10．414、18．371，均 P ＜0．05]。维生素 D 与空腹血糖、餐后2 h 血糖、糖化血红蛋白、体质量指数、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、胰岛素抵抗指数呈明显负相关（r ＝－0．537、－0．512、－0．469、－0．387、－0．325、－0．316、－0．372、－0．457，均 P ＜0．05）。维生素 D 与高密度脂蛋白胆固醇、胰岛素第一分泌时相峰值倍数、胰岛β细胞功能指数、空腹胰岛素呈明显正相关（r ＝0．351、0．418、0．674、0．316，均 P ＜0．05）。结论绝经后女性2型糖尿病患者存在维生素 D 缺乏，可能参与了糖脂代谢与胰岛素抵抗，还可能是导致患者胰岛β细胞早期分泌功能降低的原因之一。

Objective To investigate correlation between vitamin D and glucose metabolism,lipid metabolism, insulin resistance,early secretory function of pancreatic islets in postmenopausal women with type 2 diabetes. Methods 115 postmenopausal women with type 2 diabetes were selected as observation group.115 postmenopausal women without type 2 diabetes were selected in hospital at same period as control group.All patients received detection of vitamin D,glucose metabolism,lipid metabolism,insulin resistance,early secretory function of pancreatic islets. Correlation between vitamin D and glucose metabolism,lipid metabolism,insulin resistance,early secretory function of pancreatic islets were analyzed.Results Fasting blood glucose,postprandial 2h blood glucose,glycosylated hemoglobin, body mass index,total cholesterol,triglyceride,low density lipoprotein cholesterol,insulin resistance index in the observation group were higher than the control group [（8.5 ±1.2）mmol/L vs （5.1 ±0.6）mmol/L,（13.4 ± 1.5）mmol/L vs （7.8 ±0.7）mmol/L,（8.7 ±1.1）% vs （5.6 ±0.5）%,（25.7 ±1.0）kg/m2 vs （22.3 ±0.4）kg/m2 , （5.6 ±0.7）mmol/L vs （4.5 ±0.4）mmol/L,（2.3 ±0.5）mmol/L vs （1.7 ±0.3）mmol/L,（3.5 ±0.6）mmol/L vs （2.2 ±0.4）mmol/L,（3.6 ±0.5）vs （2.5 ±0.4）,t =9.667,10.179,8.535,4.524,5.443,6.529,8.909,7.406, all P 〈0.05].High density lipoprotein cholesterol,insulin first secretion phase peak factor,pancreatic islet βcellfunction index,fasting insulin,vitamin D in the observation group were lower than the control group [（1.0 ± 0.2）mmol/L vs （1.2 ±0.3）mmol/L,（5.2 ±1.3）vs （8.4 ±1.6）,（135.8 ±11.7）vs （194.3 ±19.2）,（4.1 ± 0.9）IU /mL vs （10.8 ±0.6）IU /mL,（10.8 ±2.1）ng/L vs （27.4 ±3.8）ng/L,t =5.087,9.153,7.370,10.414, 18.371,all P 〈0.05].Vitamin D was significantly negatively correlated with fasting blood glucose,postprandial 2h blood glucose,glycosylated hemoglobin,body mass index,total cholesterol,triglyceride,low density lipoprotein choles-terol,insulin resistance index（r =-0.537,-0.512,-0.469,-0.387,-0.325,-0.316,-0.372,-0.457,all P 〈0.05）.Vitamin D were significantly positively correlated with high density lipoprotein cholesterol,insulin first secretion phase peak factor,pancreatic islet βcell function index,fasting insulin（r =0.351,0.418,0.674,0.316,all P 〈0.05）.Conclusion Vitamin D deficiency in postmenopausal women with type 2 diabetes may be involved in glucose -lipid metabolism and insulin resistance,but also may be one of the reasons leading to decreasing of early secretory function of pancreatic βcells.