男性糖尿病合并性腺功能减退症患者25羟维生素D3水平分析

Analysis of 25-hydroxyvitamin D3 levels in male diabetic patients with hypogonadism

目的探讨25羟维生素D3[25(OH)D3]与男性糖尿病患者性腺功能之间的相关性,为临床治疗男性糖尿病合并性腺功能减退症提供依据。方法于2015年1月至2017年12月选取温州医科大学附属第一医院内分泌科住院的120例男性糖尿病患者为研究对象,依据睾酮(T)水平分为性腺功能减退组(T≤12 nmol/L)和性腺功能正常组(T>12 nmol/L),各60例,另选取同期该院60例男性健康体检者作为对照组。收集3组患者一般情况,测量身高、体重和腰围等,检测3组患者血清25(OH)D3、卵泡刺激素(FSH)、黄体生成素(LH)、睾酮(T)、糖化血红蛋白(HbA1C)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、血清钙、甲状旁腺激素(PTH)等指标。采用SPSS17.0统计软件进行单因素方差分析和SNK检验,采用直线相关进行相关性分析,性腺功能减退症的影响因素采用多因素logistic回归分析。结果性腺功能减退组的25(OH)D3水平[(29.9±9.8)nmol/L]低于性腺功能正常组[(36.1±10.9)nmol/L]和对照组[(51.3±14.8)nmol/L],性腺功能正常组的25(OH)D3水平低于对照组,差异均有统计学意义(P<0.05)。性腺功能减退组的T、FSH和LH水平均低于性腺功能正常组与对照组,差异均有统计学意义(P<0.05)。相关性分析结果显示,T和25(OH)D3呈正相关(r=0.132,P<0.05)。多因素logistic回归分析结果显示,体质指数(OR=1.18,95%CI:1.01~1.34)、HbA1C(OR=1.58,95%CI:1.17~1.99)和25(OH)D3(OR=1.39,95%CI:1.04~1.74)与性腺功能减退症高风险相关,均有统计学意义(P<0.05)。结论男性糖尿病合并性腺功能减退者的25(OH)D3水平明显下降,患者在控制体重、血糖的同时,应适当补充维生素D,提高血清25(OH)D3和T水平,以改善生活质量。

Objective To explore the relationship between 25-hydroxyvitamin D3[25(OH)D3]and gonadal function in male diabetic patients,to provide the basis for clinical treatment of male diabetic patients with hypogonadism.Methods From January of 2015 to December of 2017,120 male diabetic inpatients of the endocrinology department of the first affiliated hospital of Wenzhou medical university were selected as the subjects,and the subjects were divided into hypogonadism group(60 cases,testosterone≤12 nmol/L)and normal gonadal function group(60 cases,testosterone>12 nmol/L)according to the testosterone(T)level.Another 60 male health examinees in the same period were served as the control group.The general conditions of the three groups were collected,the height,weight and waist circumference were measured,and the serum 25(OH)D3,follicle stimulating hormone(FSH),luteinizing hormone(LH),T,glycerogelatin hemoglobin(HbA1 C),total cholesterol(TC),triglyceride(TG),low density lipoprotein-cholesterol(LDL-C),high density lipoprotein-cholesterol(HDL-C),serum calcium,parathyroid hormone(PTH)were tested for 3 groups.One-way ANOVA,SNK test and linear correlation analysis were used to analyze the data and correlation.The multivariate logistic regression analysis was used to analyze the influencing factors of hypogonadism.The used software was SPSS 17.0.Results The level(29.9±9.8 nmol/L)of 25(OH)D3 in hypogonadism group was significantly lower than that(36.1±10.9 nmol/L)in normal gonadal function group and that(51.3±14.8 nmol/L)in control group,also the level of 25(OH)D3 in normal gonadal function group was significantly lower than that in control group(P<0.05).The levels of T,FSH and LH in hypogonadism group was significantly lower than that in normal gonadal function group and control group(P<0.05).The correlation analysis showed that T level was positively correlated to 25(OH)D3 level(r=0.132,P<0.05).The multivariate logistic regression analysis showed that BMI(OR=1.18,95%CI:1.01-1.34),HbA1 C(OR=1.58,95%CI:1.17-1.99)and 25(OH)D3(OR=1.39,95%CI:1.04-1.74)were the related factors for hypogonadism(P<0.05).Conclusion The level of 25(OH)D3 in male diabetic patients complicated with hypogonadism significantly decreased,suggesting that except for control of weight and blood glucose,the vitamin D should be supplemented to increase the serum 25(OH)D3 and T levels,and to improve the life quality of hypogonadism patients.