新诊断2型糖尿病患者血清维生素D与胰岛素抵抗及胰岛β细胞功能的相关性研究

Relationship between serum vitamin D and insulin resistance and islet beta cell function in patients with newly diagnosed type 2 diabetes mellitus

目的分析新诊断T2DM患者维生素D(VitD)的水平,探讨VitD与新诊断T2DM患者IR及胰岛β细胞功能的关系。方法选取2015年2月至2017年3月于我院内分泌科住院的新诊断T2DM患者(T2DM组)303例,同期体检健康人群为对照组(NC)158名。按照25(OH)D水平三分位数将T2DM组分为3个亚组。检测血清25-羟基维生素D[25(OH)D]、FPG、FIns等,并于OGTT或馒头餐试验后采集0.5、2h静脉血检测血糖和胰岛素。IR评估分别采用HOMA-IR和Matsuda胰岛素敏感指数(Matsuda ISI);胰岛β细胞功能评估分别采用HOMA-β和早期胰岛素分泌指数(ΔI_(0～30)/ΔG_(0～30))。结果 NC组血清25(OH)D水平高于T2DM组[(19.07±5.71)vs(15.36±6.68)ng/ml,P=0.01]。随着25(OH)D水平增高,HOMA-IR呈下降趋势(P=0.011),而Matsuda ISI则呈上升趋势(P=0.002)。T2DM患者与25(OH)D HOMA-IR和Matsuda ISI有相关性(r=-0.288,P=0.002;r=0.259,P=0.005)。多元线性回归分析结果显示,25(OH)D是影响T2DM患者HOMA-IR和Matsuda ISI的独立因素(P<0.05)。结论 T2DM组VitD水平低于NC组,可能与导致T2DM发病的IR以及IS下降有关。

Objective To explore relationship between serum vitamin D（VitD）and insulin resistance（IR）and isletβcell function in patients with newly diagnosed type 2 diabetes mellitus（T2DM）. Methods A total of303 subjects with newly diagnosed T2 DM and 158 subjects with NC were enrolled in this study.Patients with newly diagnosed T2DM were divided into three subgroups according to tertiles of serum 25（OH）D level.Serum 25-hydroxyvitamin D[25（OH）D],FPG,and FIns were tested.Postprandial venous blood samples were collected at 0.5 and 2 hours after OGTT to test glucose and insulin levels.IR was assessed by HOMA-IR and Matsuda insulin sensitivity index（Matsuda ISI）.Theβ-cell function was assessed by HOMA-βand the change in insulin divided by change in glucose from 0.5 to 2 hour（ΔI0～30/ΔG0～30）.Results Serum 25（OH）D level was significantly lower in T2DM subjects than in NC [（19.07±5.71）vs（15.36±6.68）ng/ml,P=0.005].With the increase in 25（OH）D level,HOMA-IR decreased（P=0.011）and Matsuda ISI increased（P=0.002）.The 25（OH）D level was correlated with HOMA-IR and Matsuda ISI（r=-0.288,P=0.002;r=0.259,P=0.005）,respectively.Regression analysis showed that 25（OH）D was an independent predictor for HOMA-IR and Matsuda ISI（P〈0.05）. ConclusionThe VitD level is significantly lower in T2 DM group than in NC group.The decreased VitD level may be involved in the increase of IR and decrease of IS in T2DM development.