维生素D缺乏与糖尿病周围神经病变的相关性分析

Analysis of the correlation between vitamin D deficiency and diabetic peripheral neuropathy

目的探讨维生素D缺乏与糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)的相关性以及DPN发病的危险因素。方法回顾性分析2016年4月至2017年5月武警河北省总队医院诊治的62例T2DM患者的临床资料,其中DPN患者31例(DPN组),单纯2型糖尿病(T2DM)患者31例(T2DM组),另选择同期查体健康者31名为健康对照组,比较3组研究对象的基本资料和血脂、血糖和肝、肾功能指标以及血钙、血磷、血清25羟维生素D[25-(OH)D]水平和维生素D缺乏率,应用Logistic回归模型分析DPN的危险因素。结果T2DM组和DPN组患者的体质量指数、腰臀比、空腹血糖、胰岛素抵抗指数、糖化血红蛋白水平均高于健康对照组,且DPN组体质量指数、腰臀比、糖尿病病程、糖化血红蛋白水平均高于T2DM组,差异均有统计学意义(P均<0.05)。DPN组和T2DM组血清25(OH)D浓度分别为(11±3)μg/L、(17±3)μg/L,均低于健康对照组(29±5)μg/L],且DPN组低于T2DM组,3组比较差异有统计学意义(F=5.969,P<0.001)。DPN组和T2DM组维生素D缺乏率均高于健康对照组[54.8%(17/31)、35.5%(11/31)比19.4%(6/31)],且DPN组高于T2DM组,3组比较差异有统计学意义(χ^2=2.207,P<0.05)。多因素Logistic回归分析结果显示,体质量指数、维生素D缺乏和病程大于10年是DPN的独立危险因素(OR=3.564、11.023、4.158,95%可信区间:1.923~6.411、5.988~26.204、2.619~6.937,P均<0.001)。结论DPN患者维生素D缺乏现象严重,体质量指数、维生素D缺乏和病程大于10年是发生DPN的危险因素。

Objective To investigate the relationship between vitamin D deficiency and diabetic peripheral neuropathy(DPN)and the risk factors of DPN.Methods From April 2016 to may 2017,the clinical data of 62 patients with T2DM diagnosed and treated in Hebei Provincial Corps Hospital of armed police were analyzed retrospectively.Among them,31 patients with DPN(DPN group),31 patients with T2DM(T2DM group),and 31 healthy subjects were selected as the control group.The basic data,blood lipid,blood glucose,liver and kidney function indexes,blood calcium,blood phosphorus,25 hydroxyvitamin d[25-(OH)D]level and vitamin D deficiency rate of the three groups were compared.The risk factors of DPN were analyzed by logistic regression model.Results The body mass index,waist-hip ratio,fasting blood glucose,insulin resistance index,glycosylated hemoglobin and blood calcium levels in T2DM group and DPN group were higher than those in healthy control group,and the body mass index,waist-hip ratio,course of diabetes mellitus and glycosylated hemoglobin levels in DPN group were higher than those in T2DM group,the differences were statistically significant(all P<0.05).The serum concentration of 25(OH)d in DPN group and T2DM group was(11±3)μg/L and(17±3)μg/L,respectively,which were lower than that in healthy control group(29±5)μg/L,and DPN group was lower than that in T2DM group.The difference between the three groups was statistically significant(F=5.969,P<0.001).The rate of vitamin D deficiency in DPN group and T2DM group was higher than that in healthy control group(54.8%(17/31),35.5%(11/31)vs.19.4%(6/31)),which was higher than that in T2DM group,the difference was statistically significant(χ^2=2.207,P<0.05).Multivariate logistic regression analysis showed that BMI,vitamin D deficiency and course of disease over 10 years were independent risk factors for diabetic peripheral neuropathy(OR=3.564,11.023,4.158,95%confidence interval:1.923-6.411,5.988-26.204,2.619-6.937,all P<0.001).Conclusion Vitamin D deficiency is serious in DPN patients.BMI,vitamin D deficiency and course of disease over 10 years are independent risk factors for DPN.