T2DM视网膜病变患者血清维生素D检测及与氧化应激的相关性

Detection of serum vitamin D in T2DM patients with retinopathy and the relevance to oxidative stress

目的检测2型糖尿病T2DM视网膜病变患者血清维生素D水平，分析其与氧化应激的相关性。方法将293例T2DM患者根据眼底检查是否出现糖尿病视网膜病变（diabetic retinopathy，DR）分为DR组和非糖尿病视网膜病变（NDR）组，另选择46例健康志愿者作为对照（NC）组。收集3组临床资料，检测血糖指标：空腹血糖（FBG）、糖化血红蛋白（HbA1c）；血脂指标：总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C），血清25-羟维生素D3（25（OH）D3）；氧化应激指标：丙二醛（MDA）、超氧化物歧化酶（SOD）、还原型谷胱甘肽（GSH）。分析DR组患者25（OH）D3与临床资料、血糖、血脂和氧化应激指标的相关性。结果3组25（OH）D3比较差异有统计学意义（P均〈0.05），其中DR组和NDR组25（OH）D3显著低于NC组，而DR组25（OH）D3显著低于NDR组，差异均有统计学意义（P均〈0.05）。3组MDA、SOD、GSH比较差异有统计学意义（P均〈0.05）；DR组和NDR组MDA显著高于NC组，SOD、GSH显著低于NC组，而DR组MDA显著高于NDR组，SOD、GSH显著低于NDR组，差异均有统计学意义（P均〈0.05）。相关分析显示DR组患者25（OH）D3与HDL-C、SOD、GSH呈显著正相关，与病程、FBG、MDA呈显著负相关（P〈0.05）。多元逐步回归分析显示共HDL-C（X1）、SOD（X2）、MDA（X3）纳入模型，回归方程为Y=15.434＋0.261X1＋0.078X2-0.121X3。结论T2DM视网膜病变患者存在氧化应激损伤，且25（OH）D3下降，2者可能互为因果共同参与了DR的发病。

Objective To detect the serum vitamin D levels in T2DM patients with retinopathy and to analyze the relevance to oxidative stress. MethodsTotally 293 cases of T2DM were selected and they were divided into diabetic retinopathy （DR） group and non-diabetic retinopathy （NDR） group according to the results of fundus examination whether with or without DR. 46 healthy volunteers were selected as control group （NC） . The clinical information was collected, blood sugar such as fasting blood glucose （FBG） , glycosylated hemoglobin （HbA1c） , blood lipid index such as high-density lipoprotein cholesterol （HDL-C） , total cholesterol （TC） , triglyceride （TG） , low density lipoprotein cholesterol （LDL-C） , serum 25-hydroxyl vitamin D3 （25 （OH） D3） , oxidative stress indicators such as malondialdehyde （MDA） , superoxide dismutase （SOD） and reduced glutathione （GSH） were detected. The correlation between 25 （OH） D3 and clinical data, blood glucose, blood lipids, oxidative stress indicators was analyzed. Results 25 （OH） D3 of the 3 groups had significantly difference based on statistical analysis （P〈0.05） . In details, the 25 （OH） D3 in DR and NDR group were significantly lower than that in NC group, and 25 （OH） D3 in DR group was significantly lower than that in NDR group, and the differences had statistical significance （P〈0.05） . MDA, SOD, and GSH had significantly difference between the 3 groups （P〈0.05） . In details, MDA in DR group and NDR group were significantly higher than that in NC group. SOD and GSH were significantly lower than those in NC group, while MDA in DR group was significantly higher than that in NDR group. SOD and GSH were significantly lower than those in NDR group. The differences were statistically significant （P〈0.05） . Relevant analysis showed that 25 （OH） D3 was significantly positively related to HDL-C, SOD and GSH in DR patients, and was significantly negatively related to disease course, FBG, and MDA. Multiple stepwise regression analysis showed that totally HDL-C （X1） , SOD （X2） , and MDA （X3） were included into the model. The regression equation was Y=15.434＋0.261X1＋0.078X2-0.121X3.ConclusionT2DM patients with retinopathy have the oxidative stress injury and their 25 （OH） D3 declines, which may be involved in pathogenesis of DR by reciprocal causation.