2型糖尿病患者血清25-羟维生素D水平与糖代谢及其他代谢指标相关性分析

Correlation Between Serum 25-Hydroxyvitamin D Level and Glycometabolism or Other Metabolic Parameters in Patients with Type 2 Diabetes Mellitus

目的探讨2型糖尿病(T2DM)患者血清25-羟维生素D[25(OH)D]水平与代谢指标的相关性。方法收集266例T2DM患者的临床资料,测定血清25(OH)D、糖化血红蛋白(HbA1 C)及其他生化指标,并行精氨酸试验评估胰岛B细胞功能。以血清25(OH)D<50 nmol/L为维生素D缺乏,50 nmol/L≤25(OH)D<75 nmol/L为维生素D不足,25(OH)D≥75 nmol/L为维生素D充足。采用单因素方差分析,比较不同维生素D水平组间的糖代谢及其他代谢指标的差异,并采用多元线性回归分析糖尿病患者HbA1C水平的影响因素。结果维生素D充足者仅占9.02%,而维生素D缺乏和不足者占90.98%;维生素D充足者的HbA1C最低,维生素D缺乏者的HbA1C最高,维生素D不足者的HbA1C处于中间水平(P=0.04),而胰岛B细胞功能和其他代谢指标均无显著差异(P>0.05);多元线性回归提示,血清25(OH)D与HbA1C独立相关[β=-0.023,95%CI(-0.037^-0.008),P<0.01];按性别分层分析显示,血清25(OH)D与HbA1C的相关性仅存在男性患者中。结论T2DM患者普遍存在维生素D不足,血清25(OH)D水平与HbA1C水平呈负相关,提示糖尿病患者维生素D营养状态与血糖控制水平密切相关,且此种相关性存在性别差异。

Objective To investigate the correlation between serum 25-hydroxyvitamin D[25(OH)D]level and metabolic parameters in patients with type 2 diabetes mellitus(T2 DM).Methods The clinical data of 266 patients with T2 DM were collected.The serum 25(OH)D,glycosylated hemoglobin(HbA1 C)and other biochemical parameters of patients were determined,and the function of islet B cells was evaluated by arginine test.Serum 25(OH)D<50 nmol/L was defined as vitamin D deficiency,50 nmol/L≤25(OH)D<75 nmol/L was defined as vitamin D insufficiency,and 25(OH)D≥75 nmol/L was defined as vitamin D sufficiency.The differences in glycometabolism and other metabolic parameters among groups with different vitamin D levels were analyzed by one-way ANOVA.The influencing factors of HbA1 C level in patients with T2 DM were analyzed by multivariate linear regression.Results Only 9.02%of the patients belonged to the group of vitamin D sufficiency,while 90.98%of the patients belonged to the groups of vitamin D insufficiency or vitamin D deficiency.The HbA1 C in the group of vitamin D sufficiency was the lowest,while that in the group of vitamin D deficiency was the highest,and that in the group of vitamin D insufficiency was in the middle level(P=0.04).There was no significant difference in the function of islet B cell and other metabolic parameters among the groups with different vitamin D levels(P>0.05).Multivariate linear regression showed that serum 25(OH)D was independently correlated with HbA1 C[P=-0.023,95%CI(-0.037,-0.008),P<0.01].Stratified analysis by sex showed the correlation between serum 25(OH)D and HbA1 Cexisted only in male patients.Conclusion Vitamin D insufficiency is common in patients with T2 DM.Serum 25(OH)D level is negatively correlated with HbA1 C,which suggests that vitamin D nutritional status is closely related to control the level of blood sugar in patients with diabetes mellitus,and gender differences exist underlying this correlation.