血清25-羟维生素D3水平对糖耐量受损和/或空腹血糖受损肥胖儿童3年临床转归影响的多中心随访研究

Impact of Serum 25-hydroxy Vitamin D3 Level on Clinical Outcome in Obese Children with Impaired Glucose Tolerance and/or Impaired Fasting Glucose:a 3-year Multicenter Follow-up Study134111

背景 糖耐量受损(IGT)及空腹血糖受损(IFG)是正常糖耐量向糖尿病转化的过渡阶段且该阶段可逆,因此探讨IGT及IFG进展为糖尿病的影响因素具有重要现实意义。目的 探讨血清25-羟维生素D3〔25-(OH)D3〕水平对IGT和/或IFG肥胖儿童3年临床转归的影响。方法 选取2011年10月—2014年10月在保定市儿童医院、河北省儿童医院、贵阳市儿童医院及济宁医学院附属医院就诊的IGT和/或IFG肥胖儿童123例,其中单纯IGT儿童38例(A组)、单纯IFG儿童54例(B组)、IGT并IFG儿童31例(C组);另选取同期单纯肥胖儿童48例作为对照组。比较4组儿童基线血脂指标〔包括总胆固醇(TC)、三酰甘油(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-(OH)D3水平,A组、B组、C组儿童随访3年临床转归,不同临床转归儿童基线及随访3年血清25-(OH)D3水平;血清25-(OH)D3水平与IGT和/或IFG肥胖儿童空腹血糖、口服葡萄糖耐量(OGTT)试验后2h血糖(2hPG)的相关性分析采用Pearson相关分析。结果 (1)随访期间29例儿童失访,失访率为23.6%,其中A组9例、B组10例、C组10例。(2)4组儿童基线TC、TG、HDL-C及LDL-C水平比较,差异无统计学意义(P>0.05)。A组、B组、C组儿童基线血清25-(OH)D3水平低于对照组,A组、B组儿童基线血清25-(OH)D3水平高于C组(P<0.05)。(3)Pearson相关分析结果显示,血清25-(OH)D3水平与IGT和/或IFG肥胖儿童空腹血糖、2hPG呈负相关(r值分别为-0.26、-0.33,P<0.05)。(4)随访3年,C组儿童临床转归劣于A组和B组(P<0.05)。(5)IGT和/或IFG和糖尿病肥胖儿童基线及随访3年血清25-(OH)D3水平低于正常糖耐量肥胖儿童,糖尿病肥胖儿童基线及随访3年血清25-(OH)D3水平低于IGT和/或IFG肥胖儿童(P<0.05)。结论 血清25-(OH)D3水平与IGT和/或IFG肥胖儿童空腹血糖、2hPG呈负相关,且血清25-(OH)D3水平较低的IGT和/或IFG肥胖儿童进展为糖尿病的风险较高。

Background Impaired glucose tolerance(IGT)and impaired fasting glucose(IFG)are considered to be transitional stage from normal glucose tolerance to diabetes mellitus(DM)that is reversible,therefore,investigation on influencing factors of IGT and IFG progression to DM is great clinical significance.Objective To investigate the impact of serum 25-hydroxy vitamin D3〔25-(OH)D3〕level on 3-year clinical outcome in obese children with IGT and/or IFG.Methods This study was conducted in 171 obese children selected from Baoding Children's Hospital,Children's Hospital of Hebei Province,Guiyang Children's Hospital,and the Affiliated Hospital of Jining Medical College during October 2011 to October 2014,including 38 cases with IGT(served as A group),54 cases with IFG(served as B group),31 cases with IGT and IFG(served as C group)and 48 cases without IGT or IFG(served as control group).Baseline blood lipid parameters(including TC,TG,HDL-C and LDL-C)and serum 25-(OH)D3 level were compared in the four groups,3-year clinical outcome was compared in groups A,B and C,baseline and 3-year serum 25-(OH)D3 level was compared in obese children with different clinical outcome;Pearson correlation analysis was used to analyze the correlations of serum 25-(OH)D3 level with FBG and 2 h PG in obese children with IGT and/or IFG.Results(1)During the follow-up period,29 cases(accounting for 23.6%)were lost to follow-up,including 9 cases in A group,10 cases in B group and 10 cases in C group.(2)There was no statistically significant difference in baseline TC,TG,HDL-C or LDL-C in the four groups(P>0.05).Baseline serum 25-(OH)D3 level in groups A,B and C was statistically significantly lower than that in control group,respectively,while baseline serum 25-(OH)D3 level in groups A and B was statistically significantly higher than that in C group(P<0.05).(3)Pearson correlation analysis results showed that,serum 25-(OH)D3 level was negatively correlated with FBG(r=-0.26)and 2 h PG(r=-0.33)in obese children with IGT and/or IFG(P<0.05).(4)After 3-year follow-up,clinical outcome in C group was statistically significantly worse than that in groups A and B(P<0.05).(5)Baseline and 3-year serum 25-(OH)D3 level in obese children with IGT and/or IFG,with DM was statistically significantly lower than that in obese children with normal glucose tolerance,respectively,meanwhile baseline and 3-year serum 25-(OH)D3 level in obese children with DM was statistically significantly lower than that in obese children with IGT and/or IFG(P<0.05).Conclusion Serum 25-(OH)D3 level is significantly negatively correlated with FBG and 2 h PG in obese children with IGT and/or IFG,respectively,and decreased serum 25-(OH)D3 level may increase the risk of IGT and/or IFG progression to DM in obese children.