初诊2型糖尿病血清维生素D和AGEs变化及意义

CHANGES IN SERUM LEVELS OF 25-HYDROXYVITAMIN D AND ADVANCED GLYCATION END PRODUCTS IN PATIENTS WITH AN INITIAL DIAGNOSIS OF TYPE 2 DIABETES AND THEIR CLINICAL SIGNIFICANCE

目的观察初诊2型糖尿病病人体内血清25-羟维生素D(25-OH-D)和晚期糖基化终末产物(AGEs)含量变化,分析其变化与胰岛素抵抗和胰岛β细胞早相分泌功能的关系。方法选取初诊2型糖尿病病人60例为观察组,另选择同期参加门诊体检的40名健康人作为正常对照组。分别测定两组血清25-OH-D、AGEs、白细胞介素-1β(IL-1β)、空腹血糖、血脂和糖化血红蛋白(HbA1c)等指标,并同期进行精氨酸试验。两因素间关系采用Pearson相关分析,多个变量间的分析采用多元逐步回归分析。结果与对照组比较,观察组25-OH-D含量明显降低,而AGEs、IL-1β明显增高,差异均有统计学意义(t=-9.276~4.430,P<0.01)。相关分析显示,25-OH-D与胰岛素第一时相峰值倍数呈正相关(r=0.453,P<0.01),而与稳态模型胰岛素抵抗指数(HOMA-IR)、AGEs和IL-1β呈负相关(r=-0.425^-0.315,P<0.01)。多元逐步回归分析显示,校正性别、年龄、血脂、血压、HbA1c和IL-1β后,胰岛素第一时相峰值倍数与25-OH-D呈显著正相关(t=5.028,P<0.01),与AGEs呈显著负相关(t=-2.933,P<0.01);HOMA-IR与25-OH-D呈显著负相关(t=-2.234,P<0.05),与AGEs呈显著正相关(t=11.513,P<0.01)。结论初诊2型糖尿病病人体内维生素D水平降低,而AGEs水平升高,可能与胰岛素抵抗和胰岛β细胞早相分泌功能下降相关。

Objective To investigate the changes in the serum levels of 25-hydroxyvitamin D（25-OH-D）and advanced glycation end products（AGEs）in patients with an initial diagnosis of type 2 diabetes and their association with insulin resistance and early-phase secretion function of pancreaticβcells. Methods A total of 60 patients with an initial diagnosis of type 2 diabetes were enrolled as observation group,and 40 healthy persons who underwent physical examination were enrolled as normal control group.Related indices were measured for both groups,including serum 25-OH-D,AGEs,interleukin-1β（IL-1β）,fasting blood glucose,blood lipids,and HbA1 c,and the arginine test was also performed.A Pearson correlation analysis was performed to investigate the correlation between two factors,and a multiple stepwise regression analysis was performed for multiple variables. Results Compared with the normal control group,the observation group had a significant reduction in serum 25-OH-D level and significant increases in the serum levels of AGEs and IL-1β（t=-9.276 to 4.430,P〈0.01）.The correlation analysis showed that 25-OH-D was positively correlated with the insulin secretion peak in the first phase（r=0.453,P〈0.01）and negatively correlated with homeostasis model assessment of insulin resistance（HOMA-IR）,AGEs,and IL-1β（r=-0.425 to-0.315,P〈0.01）.The multiple stepwise regression analysis showed that after adjustment for sex,age,blood lipids,blood pressure,HbA1 c,and IL-1β,insulin secretion peak was positively correlated with 25-OH-D（t=5.028,P〈0.01）and negatively correlated with AGEs（t=-2.933,P〈0.01）;HOMA-IR was negatively correlated with 25-OH-D（t=-2.234,P〈0.05）and positively correlated with AGEs（t=11.513,P〈0.01）. Conclusion Patients with an initial diagnosis of type 2 diabetes have a reduction in serum 25-OHD and an increase in AGEs,which may be associated with insulin resistance and reduced early-phase secretion function of pancreaticβcells.