2型糖尿病患者血清25-羟维生素D水平与周围神经病变的相关性研究

Study on correlation between serum 25-hydroxyvitamin D level and peripheral neuropathy in T2DM

目的探讨2型糖尿病患者血清25-羟维生素D水平与周围神经病变的相关性。方法选取2015年3月至2016年3月该院收治的2型糖尿病患者330例,根据临床症状和四肢神经肌电图分为单纯糖尿病组(NDPN组)和糖尿病合并周围神经病变组(DPN组),其中NDPN组173例,DPN组157例,分别比较2组性别比例、年龄、糖尿病病程、体质量指数(BMI)、血肌酐、尿酸、血脂[三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]、糖化血红蛋白(HbA1c)、甲状旁腺激素(PTH)、纤维蛋白原(FIB)、空腹C肽(FC)、血钙/磷等指标,并测量比较2组血清25-羟维生素D水平,依照结果判断2组患者维生素D营养状态,分析25-羟维生素D与各指标的相关性。结果 DPN组年龄、病程及HbA1c均显著高于NDPN组,差异有统计学意义(t≥3.073,P<0.05);DPN组FC、25-羟维生素D均显著低于NDPN组,差异有统计学意义(t≥3.567,P<0.05)。DPN组正中神经运动传导速度(MCV)、正中神经感觉传导速度(SCV)、腓总神经MCV、腓浅神经SCV均显著低于NDPN组,差异有统计学意义(t≥13.524,P<0.05)。Pearson相关分析结果显示,25-羟维生素D水平与DPN的发病病程呈负相关(r=-0.465,P<0.05);与HbA1c呈负相关(r=-0.678,P<0.05);与正中神经MCV及SCV、腓总神经MCV、腓浅神经SCV呈正相关(r分别为0.310、0.362、0.596、0.523,P<0.05);与年龄、血脂及其他指标无相关性。Logistic回归模型结果显示,病程、HbA1c、25-羟维生素D是合并DPN的独立危险因素,差异有统计学意义(P<0.05);其中25-羟维生素DPN的保护因素之一。结论 25-羟维生素D、DPN患者的病程和HbA1c相关,25-羟维生素D缺乏是DPN的独立危险因素,补充维生素D可能对DPN起预防和治疗的作用。

Objective To discuss the correlation between serum 25-hydroxyvitamin D level and peripheral neuropathy in type 2diabetes mellitus（T2DM）.Methods A total of 330 cases of T2 DM in our hospital from March 2015 to March 2016 were selected and divided into the simple diabetic group（NDPN group,173cases）and the diabetic complicating peripheral neuropathy group（DPN group,157cases）based on clinical symptoms and limbs EMG;the gender,age,duration of diabetes,BMI,serum creatinine,uric acid,blood lipids[triglycerides（TG）,total cholesterol（TC）,high density lipoprotein（HDL-C）,low-density lipoprotein（LDL-C）],glycated hemoglobin（HbA1c）,parathyroid hormone（PTH）,fibrinogen（FIB）,fasting C-peptide,calcium,phosphorus and other indicators were compared between the two groups,as well as the level of serum 25-hydroxyvitamin D was detected and compared between the two groups;the vitamin D nutritional status in two groups were judged According to the results.And the correlation between 25-hydroxyvitamin D and other indicators was analyzed.Results The age,disease duration and HbA1 cin the DPN group were significantly higher than those in the NDPN group,the difference was statistically significant（t≥3.073,P〈0.05）;the levels of FC and 25-（OH）D in the DPN group were significantly lower than those in the NDPN group,the difference was statistically significant（t≥3.567,P〈0.05）.The median nerve MCV,SCV,peroneal nerve MCV,SCV of superficial peroneal nerve in the DPN group were significantly lower than those in the NDPN group,the difference was statistically significant（t≥13.524,P〈0.05）.The Pearson correlation analysis results showed that the 25-hydroxyvitamin D level was negatively correlated with the DPN onset duration,the difference was statistically significant（r=-0.465,P〈0.05）,negatively correlated with HbA1c（r=-0.678,P〈0.05）and positively correlated with the median nerve MCV and SCV,common peroneal nerve MCV and superficial peroneal nerve SCV（r=0.310,0 362,0.596 and 0.523,all P〈0.05）,had no correlation with the age,serum lipids and other indexes.The Logistic regression model results showed that the disease duration,HbA1 cand 25-hydroxy vitamin D were all independent risk factors for complicating DPN,in which 25-hydroxyvitamin was one of the protective factors of DPN.Conclusion 25-hydroxy vitamin D and disease duration of DPN are correlated with HbA1c;25-hydroxy vitamin D deficiency is an independent risk factor for DPN,indicating that the supplement of DPN vitamin D may play a role in the prevention and treatment of diabetes complicating DPN.