老年2型糖尿病患者周围神经病变与维生素D的相关性研究

Relationship between peripheral neuropathy and vitamin D in elderly patients with type 2 diabetes

目的探讨老年糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)患者维生素D水平及相关性。方法回顾性病例对照研究,收集2016年6月至2017年9月入住我院内分泌科849例老年2型糖尿病患者临床资料,按照DPN诊断标准分为非DPN组542例和DPN组307例。检查血清25(OH)维生素D[25(OH)vitamin D,25(OH)VD]水平和血生化指标。分析DPN组与非DPN组间各指标差异,并对DPN的危险因素进行Logistic回归分析和绘制受试者工作特征(ROC)曲线。结果849例患者25(OH)VD水平为(43.9±19.4)nmol/L,DPN组患者25(OH)VD水平(40.9±20.4)nmol/L低于非DPN组患者(45.7±18.6)nmol/L(P<0.05),DPN组患者25(OH)VD缺乏率为72.3%(222例),高于非DPN组患者的64.6%(350例)(P<0.05)。二元Logistic回归分析结果显示,DPN独立保护因素为25(OH)VD(OR=0.980,95%CI:0.964~0.995,P<0.05),危险因素为病程(OR=1.048,95%CI:1.027~1.070,P<0.001)。ROC曲线显示发生DPN的25(OH)VD诊断界点值为37.5 nmol/L,约登指数0.17,灵敏度0.65,特异度0.52。结论糖尿病患者维生素D水平偏低,尤以DPN患者为重。较高水平25(OH)VD可能是老年2型糖尿病患者DPN的保护因素,且维生素D可作为预测DPN发生的潜在生物标志物之一。

Objective To investigate the levels of vitamin D and the correlation between DPN and vitamin D in elderly patients with diabetic peripheral neuropathy(DPN).Methods A total of 849 patients aged 60 years and over admitted into endocrinology department from June 2016 to September 2017 were enrolled in this retrospective case-control study.According to DPN diagnostic criteria,patients were divided into the non-DPN group(n=542)and the DPN group(n=307).The 25(OH)-vitamin D[25(OH)D]level and blood biochemical parameters were determined and compared between the two groups.The risk factors for DPN were analyzed using logistic regression analysis and plotting receiver operating characteristic(ROC)curves.Results The mean of serum 25(OH)D level in the 849 patients was 43.9±19.4 nmol/L.Serum 25(OH)D level was lower in the DPN patients than in the non-DPN patients[(40.9±20.4)nmol/L vs.(45.7±18.6)nmol/L,P<0.05].The incidence of 25(OH)D deficiency was higher in the DPN group than in the non-DPN group(72.3%or 222/307 vs.64.6%or 350/542,P<0.05).Binary logistic regression analysis indicated that 25(OH)D was a protective factor for DPN(OR=0.980,95%CI:0.964~0.995,P<0.05)and the disease duration was a risk factor for DPN(OR=1.048,95%CI:1.027~1.070,P<0.001).ROC analysis indicated that the diagnostic cut-off value of serum 25(OH)D for predicting DPN was 37.5nmol/L,with a Youden index of 0.17,sensitivity of 0.65 and specificity of 0.52.Conclusions The 25(OH)D level is much lower in diabetic patients,especially in DPN patients.Higher 25(OH)VD level might be a protective factor for DPN,and vitamin D might be one of potential biomarkers for DPN in diabetic patients.