25-羟基维生素D、D-二聚体及糖化血红蛋白与2型糖尿病足的临床研究

Clinical research of 25-hydroxyvitamin D,D-dimer,glycosylated hemoglobin and diabetic foot

目的探讨血清25-羟基维生素D[25-(OH)D]、D-二聚体(DD)及糖化血红蛋白(HbA1c)含量与糖尿病足病的关联性,为糖尿病足病防控提供参考。方法 70例2型糖尿病患者作为研究对象,按照是否并发糖尿病足分为实验组(30例,并发糖尿病足)与对照组(40例,未并发糖尿病足),另选40例正常健康人作为参照组;测定并比较三组25-(OH)D、DD及HbA1c水平。结果实验组患者DD水平较对照组显著增高,差异具有统计学意义(t=31.70,P<0.05),两组25-(OH)D、HbA1c水平比较差异无统计学意义(t=1.12、1.07,P>0.05);实验组与参照组25-(OH)D、DD、HbA1c水平比较,差异具有统计学意义(t=27.80、68.60、10.71,P<0.05);对照组与参照组25-(OH)D、DD、HbA1c水平比较,差异具有统计学意义(t=30.08、61.13、12.15,P<0.05)。结论 2型糖尿病及其足病患者DD明显高于正常人,同时糖尿病患者出现25-(OH)D明显降低,可通过对患者适量补充维生素D防控疾病。仅用HbA1c不能准确评估糖尿病足的发生,应结合相关指标进行预判。血浆DD水平对糖尿病足病诊断的cut off值及其补充25-(OH)D剂量范围,依然有待同行大范围实验数据的支持。

Objective To investigate correlation between 25-hydroxyvitamin D [25-（OH）D], D-dimer（DD）, glycosylated hemoglobin（HbA1c） and diabetic foot, and to provide reference for prevention and control of diabetic foot. Methods A total of 70 patients with type 2 diabetes mellitus as study subject were divided by occurrence of complicated diabetic foot into experimental group（30 cases, complicated with diabetic foot） and control group（40 cases, without diabetic foot）. There were 40 healthy people as reference group. Detection was made on 25-（OH）D, DD and HbA1c levels in the three groups for comparison. Results The experimental group had obviously higher DD level than the control group, and the difference had statistical significance（t=31.70, P〉0.05）. There was no statistically significant difference of 25-（OH）D and HbA1c levels between the two groups（t=1.12, 1.07, P〈0.05）. The difference of 25-（OH）D and HbA1c levels had statistical significance between the experimental group and the reference group（t=27.80, 68.60, 10.71, P〈0.05）. The control group and the reference group had statistically significant difference of 25-（OH）D, DD and HbA1c levels（t=30.08, 61.13, 12.15, P〈0.05）. Conclusion Patients with type 2 diabetes mellitus and diabetic foot show obviously higher DD than healthy people. Their decreased 25-（OH）D can be prevented and controlled by appropriate vitamin supplementation. HbA1c alone cannot provide accurate evaluation of diabetic foot, therefore combination with related indexes is necessary for anticipating diagnosis. Further wide-range data support by medical occupation is necessary for cut off value and 25-（OH）D supplementation range by plasma DD level in diagnosis of diabetic foot.