2型糖尿病老年患者血清维生素D水平与周围神经病变的关系

Association between level of vitamin D in serum and peripheral neuropathy in elderly patients with type 2 diabetes

目的·研究2型糖尿病老年患者维生素D水平与糖尿病周围神经病变(DPN)的关系,探讨其在DPN临床中的应用价值,为早期筛查及预防DPN提供依据。方法·选取2型糖尿病老年患者188例进行横断面研究,按照DPN诊断标准分为DPN组(100例)和无DPN组(88例)。收集所有患者临床资料,检测血清25羟维生素D_3[25(OH)D_3]水平,糖化血红蛋白(Hb A1c),血脂,肝、肾功能等。25(OH)D_3与各指标间进行相关性分析,并对DPN的危险因素行Logistic回归分析。结果·DPN患者血清25(OH)D_3水平中位数为34.95 nmol/L,显著低于无DPN患者(52.6 nmol/L)(P<0.01)。25(OH)D_3水平与患者年龄、Hb A1c和空腹血糖呈负相关(r=-0.37,-0.53和-0.29,均P<0.01)。多因素Logistic回归分析结果显示,血清25(OH)D_3水平降低是DPN发病的独立危险因素,血清25(OH)D_3处于下四分位数以下水平的糖尿病老年患者发生DPN的风险是上四分位数以上水平患者的15.50倍(OR=15.50,95%CI=2.00~119.62)。结论·血清25(OH)D_3水平降低可能增加DPN的患病风险,监测25(OH)D_3水平有助于早期发现DPN患者。

Objective·To investigate association between serum25-hydroxyvitamin D3[25(OH)D3]level and diabetic peripheral neuropathy(DPN)in elderly patients with type2diabetes mellitus and explore its value in clinical practice for early screening and prevention of DPN.Methods·A total of188elderly patients with type2diabetes mellitus were enrolled in this cross-sectional study,including100cases with DPN and88cases without.Clinical data was collected and serum levels of25(OH)D3,glycosylated hemoglobin(HbA1c),blood lipids and hepatic and renal functions were determined in all patients.Spearman correlation analysis was used to evaluate relationship between each index and25(OH)D3,and Logistic regression was used for statistical analysis of risk factors for DPN.Results·The median of serum25(OH)D3level was significantly lower in the patients with DPN(34.95nmol/L)than that of the patients without DPN(52.6nmol/L)(P<0.01).Spearman correlation analysis showed that there existed a negative correlation between the level of25(OH)D3and age,HbA1c and fasting blood glucose(r=-0.37,-0.53,and-0.29,respectively,P<0.01).The multiple Logistical regression analysis revealed that the25(OH)D3level was an independent risk factor for DPN.The odds ratio of serum25(OH)D3was15.5(OR=15.50,95%CI=2.00～119.62)for the lowest quartile versus the highest quartile.Conclusion·The decreased level of25(OH)D3may increase risks for the occurrence of DPN in the elders with type2diabetes mellitus and monitoring the level of25(OH)D3contributes to early detection of DPN.