补充维生素D对糖尿病足溃疡患者创面愈合、糖代谢、炎症及氧化应激的影响

Effects of Vitamin D Supplementation on Wound Healing,Glucose Metabolism,Inflammation and Oxidative Stress in Patients with Diabetic Foot Ulcer

目的:探讨补充维生素D对糖尿病足溃疡患者创面愈合、糖代谢、炎症及氧化应激的影响。方法:选取2018年8月至2019年7月在东营市人民医院治疗的糖尿病足溃疡患者186例,根据随机数字表法将患者分为维生素D组(n=93)和对照组(n=93)。维生素D组患者口服维生素D滴剂治疗,1次2000 IU,1日2次,连续口服12周;对照组患者服用安慰剂。检测并比较治疗前、治疗12周后两组患者25羟维生素D3[25(OH)D3]、溃疡、糖代谢、胰岛素、炎症、氧化应激和血脂指标水平,以评价补充维生素D对糖尿病足溃疡患者上述指标的影响。结果:治疗12周后,维生素D组患者25(OH)D3水平较对照组明显升高[(28.11±12.59)ng/ml vs.(18.47±8.55)ng/ml],差异有统计学意义(t=5.794,P<0.001)。治疗12周后,与对照组相比,维生素D组患者糖尿病足溃疡创面面积明显缩小,创面深度明显变浅,创面评分明显降低,空腹血糖、糖化血红蛋白、胰岛素、稳态模型胰岛素抵抗指数和稳态模型胰岛素分泌指数明显降低,定量胰岛素敏感性指数明显升高,差异均有统计学意义(P<0.05);维生素D组患者高敏C反应蛋白、红细胞沉降率、趋化因子5及丙二醛等炎症、氧化应激指标水平较对照组明显降低,差异均有统计学意义(P<0.05)。结论:糖尿病足溃疡患者补充维生素D可以显著改善糖尿病足溃疡修复期的创面情况,加速创面组织生长;可以显著改善葡萄糖稳态和血脂,抑制炎症反应,减少氧化应激。

OBJECTIVE:To probe into the effects of vitamin D supplementation on wound healing,glucose metabolism,inflammation and oxidative stress in patients with diabetic foot ulcer(DFU).METHODS:186 patients with DFU admitted into Dongying People’s Hospital from Aug.2018 to Jul.2019 were selected and divided into vitamin D group(93 cases)and control group(93 cases)via random number table.The vitamin D group was treated with Vitamin D drops orally,2000 IU each time and twice a day for continuous 12 weeks;while the control group was given placebo.Levels of 25-hydroxyl vitamin D3[25(OH)D3],ulcer,glycometabolism,insulin,inflammation,oxidative stress and blood lip were detected and compared between before treatment and after 12-week treatment,so as to evaluate the effects of vitamin D supplementation on the above indicators in patients with DFU.RESULTS:After 12-week treatment,the 25(OH)D3 level of vitamin D group was significantly higher than that of the control group[(28.11±12.59)ng/ml vs.(18.47±8.55)ng/ml],with statistically significant difference(t=5.794,P<0.001).After 12-week treatment,compared with the control group,the wound area of patients with DFU was significantly reduced,the depth of the wound was significantly shallower and the wound score was significantly reduced in vitamin D group;fasting blood glucose,glycosylated hemoglobin,insulin,homeostasis model insulin resistance index and homeostasis model insulin secretion index were significantly reduced steady-state,and its quantitative insulin sensitivity index was significantly increased,with statistically significant differences(P<0.05).Inflammatory and oxidative stress indicators of high-sensitivity C-reactive protein,erythrocyte sedimentation rate,chemokines-5 and malonaldehyde of vitamin D group were significantly lower than those of the control group,with statistically significant differences(P<0.05).CONCLUSIONS:Vitamin D supplementation in patients with DFU can significantly improve wound and accelerate the growth of wound tissue during DFU recovery;which can significantly improve glucose homeostasis and blood lipid,inhibit inflammation and reduce oxidative stress.