3C疗法治疗1型糖尿病儿童维生素D水平研究

Effects of 3C Therapy on Vitamin D Levels of Children with Type 1 Diabetes Mellitus

目的:评估维生素D与1型糖尿病(T1DM)患儿的临床关系,为T1DM的防治提供新的依据。方法:选取我院2017-2018年新诊断及使用3C疗法治疗的T1DM患儿,分析T1DM患儿与健康体检患儿血清25-羟维生素D[25(OH)D]水平。根据25(OH)D水平,将T1DM患儿分为三组(缺乏组、不足组及充足组),比较三个亚组的性别、年龄、居住地、体质量指数(BMI)、空腹C肽、空腹血糖及胰岛素用量等情况,探讨不同tanner分期、性别、季节、有无合并糖尿病酮症酸中毒(DKA)与血清维生素D水平的关系。结果:T1DM组患儿血清25(OH)D水平为(42.31±22.01)nmol/L,较健康对照组的(50.37±22.28)nmol/L低,差异有统计学意义(P<0.05)。T1DM组患儿中,维生素D充足组的空腹C肽水平高于维生素D不足组及维生素D缺乏组(P<0.05);维生素D缺乏组空腹血糖水平及单位体质量胰岛素用量高于维生素D充足组(P<0.05)。按血清25(OH)D水平测定时间不同分A组(1-3月、10-12月)和B组(4-9月),A组25(OH)D水平低于B组(P<0.05);合并DKA组25(OH)D水平低于无DKA组(P<0.05)。结论:T1DM患儿普遍存在维生素D缺乏,尤其是合并DKA、1-3月及10-12月的患儿;维生素D充足的T1DM患儿可减少胰岛素用量。临床上要加强T1DM患儿的维生素D的监测以及补充。

Objective:To evaluate the clinical correlation between vitamin D and children with type 1 diabetes mellitus(T1DM)and provide new basis for the prevention and treatment of T1DM.Methods:Children newly diagnosed with T1DM and treated with 3C therapy in our hospital from 2017 to 2018 were selected,the serum level of 25-hydroxyvitamin D(25(OH)D)of children with T1DM and children with healthy physical examination were analyzed.According to the levels of 25(OH)D,children with T1DM were divided into 3 subgroups(deficient group,insufficient group and sufficient group).The gender,age,residence,body mass index(BMI),fasting C-peptide,fasting blood glucose and insulin dosage of three subgroups were compared.The correlation between different tanner stages,gender,season,presence or absence of diabetic ketoacidosis(DKA)and serum vitamin D levels was investigated.Results:The serum level of 25(OH)D in the T1DM group was(42.31±22.01)nmol/L,lower than that in the healthy control group(50.37±22.28)nmol/L,and the difference was statistically significant(P<0.05).In the T1DM group,the fasting C-peptide level of the vitamin D sufficient group was higher than that of the vitamin D insufficient group and the vitamin D deficient group(P<0.05).The fasting blood glucose level and the amount of insulin per body mass in the vitamin D deficit group were higher than those in the vitamin D sufficient group(P<0.05).According to the measurement time of 25(OH)D,all patients can be divided into the group A(from Jan.to Mar.,from Oct.to Dec.)and group B(from Apr.to Sept.months),the level of 25(OH)D in group A was lower than that in group B(P<0.05).The level of 25(OH)D in patients with DKA was lower than that in patients without DKA(P<0.05).Conclusion:Vitamin D deficiency is common in children with T1DM,especially in children with DKA from Jan.to Mar.and from Oct.to Dec.Children with T1DM with sufficient vitamin D can reduce the insulin dosage.It is necessary to strengthen the monitoring and supplement of vitamin D in children with T1DM.