25(OH)D水平与2型糖尿病大血管病变的关系研究

Association between serum 25-hydroxyvitamin D level and macroangiopathy in patients with type 2 diabetes

目的探讨2型糖尿病(T2DM)患者血清25-羟维生素D[25(OH)D]水平与大血管病变的关系。方法选取716例T2DM患者,检测血清25(OH)D水平、颈动脉内膜中层厚度(IMT)、糖化血红蛋白(Hb A1c)、血脂、肝肾功能、血钙及超敏C反应蛋白(hs-CRP)等指标,根据颈动脉IMT分为IMT增厚组(IMT>0.9 mm)和IMT正常组(IMT≤0.9 mm)两组,比较两组间血清25(OH)D水平及分析相关影响因素。结果 IMT增厚组血清25(OH)D水平低于IMT正常组;相关分析显示:颈动脉IMT与年龄、收缩压、糖尿病病程、hs-CRP、吸烟、低密度脂蛋白胆固醇、Hb A1c及腰臀比呈正相关(P<0.05),与25(OH)D、估算肾小球滤过率呈负相关(P<0.05);血清25(OH)D与颈动脉IMT、Hb A1c、糖尿病病程、总胆固醇、甲状旁腺素及空腹血糖呈负相关(P<0.05),与空腹C肽呈正相关(P<0.05)。结论 T2DM患者血清25(OH)D水平缺乏可能与大血管病变的发生发展相关。

Objective To explore the association between serum 25-hydroxyvitamin D [25（OH）D ] level and macroangiopathy in patients with type 2 diabetes mellitus （T2DM）. Methods A total of 716 patients with T2DM were recruited. Carotid intima-media thickness （IMT）, 25（OH）D, glycated hemoglobin （HbAlc）, blood lipid, hepatic and renal function indexes, calcium, and hypersensitive C-reactive protein （hs-CRP） were measured. According to carotid IMT, the patients were divided into IMT thickening group （IMT 〉 0.9 mm） and IMT normal group （IMT ≤ 0.9 mm）. The variance of 25（OH）D between the two groups was compared and the correlation factors were analyzed. Results The 25（OH）D level in the IMT thickening group was signifcantly lower than that in the IMT normal group （P 〈 0.05）. Correlation analysis revealed that age, systolic blood pressure, duration of diabetes, hs-CRP, smoking, LDL-C, HbA1c and waist-to-hip ratio were positively correlated with carotid IMT （P 〈 0.05）; while the level of serum 25（OH）D and estimated glomerular fltration rate were negatively correlated with carotid IMT （P 〈 0.05）. Carotid IMT, HbA1c, duration of diabetes, total cholesterol, parathyroid hormone and fasting blood glucose were negatively correlated with serum 25（OH）D （P 〈 0.05）; while fasting C peptide was positively correlated with 25（OH）D （P 〈 0.05）. Conclusions In the patients with T2DM, serum 25（OH）D defciency may be associated with the development of macroangiopathy.