2型糖尿病患者血清25羟维生素D3缺乏及高龄与低蛋白血症的相关性研究

The Relationship Between Serum 25-Hydroxyvitamin D3 Deficiency and Aging on Hypoproteinemia in Type 2 Diabetes Mellitus

目的探讨2型糖尿病(T2DM)患者血清25羟维生素D3[25(OH)D3]缺乏和高龄对低蛋白血症的影响。方法选取2011年1月至2017年10月在安徽省立医院老年科住院的成人T2DM患者278例作为研究对象,检测其血清白蛋白、25(OH)D3等水平,先根据血清白蛋白水平分为正常白蛋白组(212例)和低蛋白血症组(血清白蛋白<35 g/L,共66例)两组比较其一般特征。在此基础上根据血清25(OH)D3水平分为A1、A2、A33组[A1(0nmol/L≤25(OH)D3<15nmol/L),A2(15nmol/L≤25(OH)D3<30nmol/L),A3(30nmol/L≤25(OH)D3≤45nmol/L)],根据年龄分为B1、B2、B33组[B1(40岁≤年龄<60岁),B2(60岁≤年龄<80岁),B3(80岁≤年龄≤100岁)],基于多变量广义线性回归模型(GLMS)分析25(OH)D3缺乏及高龄与低蛋白血症间的关联性。结果(1)低蛋白血症组年龄偏大、25(OH)D3偏低,差异有统计学意义(P<0.001);(2)血清25(OH)D3水平与低蛋白血症存在显著的线性关系,随血清25(OH)D3水平升高,发生低蛋白血症的风险下降,差异有统计学意义(P=0.009);血清白蛋白水平与年龄呈显著的负相关关系,随年龄增加,发生低蛋白血症的风险增加,差异有统计学意义(P<0.001)。年龄和25(OH)D3存在明显的联合效应,80岁以上同时合并有25(OH)D3缺乏者发生低蛋白血症的风险急剧上升,是80岁以下且不伴有25(OH)D3缺乏人群的6.462倍(OR=6.462,95%CI=2.187~18.759)。结论25(OH)D3缺乏合并高龄的T2DM患者是低蛋白血症的高危人群。

Objective To investigate the effect of 25-hydroxyvitamin D3[25(OH)D3]deficiency and aging on hypoproteinemia in patients with type 2 diabetes mellitus(T2DM).Methods From Jan.2011 to Oct.2017,278 adult patients with T2DM were enrolled from the geriatrics department of the First Affiliated Hospital of the University of Science and Technology of China.The serum albumin,25(OH)D3,fasting blood glucose and glycated hemoglobin were measured in all patients.According to the level of serum albumin,these patients was divided into the normal albumin group(212 cases)and hypoproteinemia group(defined as serum albumin lower than 35g/L,66 cases)to compare their general characteristics.Furthermore,patients were divided into A1,A2,A3 groups according to serum 25(OH)D3 level[A1(0nmol/L≤25(OH)D3<15nmol/L),A2(15nmol/L≤25(OH)D3<30nmol/L),A3(30nmol/L≤25(OH)D3≤45nmol/L)],as well as B1,B2,B3 groups by age[B1(40 years≤age<60 years),B2(60 years≤age<80 years),B3(80 years≤age≤100 years)].A multivariate generalized linear regression model(GLMS)was used to analyze the relationship between 25(OH)D3 deficiency along with aging on hypoproteinemia.Results(1)The difference was statistically significant in the hypoproteinemia group(P<0.001);(2)There was a significant linear relationship between serum 25(OH)D3 level and hypoalbuminemia,and the risk of hypoalbuminemia decreased with the increase of serum 25(OH)D3 level(P=0.009).Serum albumin level was also negatively correlated with age,with a significant increase in the risk of hypoalbuminemia with aging(P<0.001).There was also a significant joint effect between age and 25(OH)D3.The risk of hypoproteinemia increased significantly in patients over 80 years of age and with 25(OH)D3 deficiency,which was 6.462 times higher than in patients under 80 years of age but without 25(OH)D3 deficiency(OR=6.462,95%CI=2.187-18.759).Conclusion 25(OH)D3 deficiency in elderly T2DM patients is a high risk group for hypoproteinemia.