不同体重的住院2型糖尿病患者血清维生素D水平与血脂之间的关系

The relationship between serum vitamin D levels and lipid profile in hospitalized type 2 diabetic patients with different body weights

目的:探讨不同体重的住院2型糖尿病患者血清维生素D水平对脂代谢的影响及其临床意义。方法:选择2015年1月至2016年12月住院的2型糖尿病患者446例,测量身高、体重,计算体重指数,检测25-羟维生素D(25-OHD)、空腹血糖、HbA 1C、空腹胰岛素、总胆固醇、三酰甘油、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇水平。根据体重指数将2型糖尿病患者分为正常体重人群和超重/肥胖人群,根据25-OHD水平采用四分位法将患者分为4组,比较两种人群间以及组间糖脂代谢等指标的差异。采用多元线性回归法分析25-OHD与血脂及其他指标之间的相关性。 结果:超重/肥胖2型糖尿病患者的25-OHD、HDL-C水平显著低于体重正常组,而三酰甘油、稳态模型评估的胰岛素抵抗指数则显著高于体重正常组( P<0.05或 P<0.01)。以25-OHD水平分层,正常体重的2型糖尿病患者中25-OHD更高的组有较低的总胆固醇和三酰甘油;超重/肥胖的2型糖尿病患者中25-OHD更高的组有较低的三酰甘油( P<0.05或 P<0.01)。在多元线性回归分析中,仅超重/肥胖组的25-OHD与三酰甘油呈独立负相关关系( P<0.01)。正常体重组的25-OHD与三酰甘油的负相关关系在校正总胆固醇、HDL-C、尿微量白蛋白/肌酐(ACR)、总睾酮和性激素结合球蛋白(SHBG)后消失。2组人群中,25-OHD与总胆固醇的负相关关系和与HDL-C的正相关关系,在校正血脂、ACR、总睾酮和SHBG后消失( P>0.05)。 结论:在住院超重/肥胖2型糖尿病患者中,25-OHD与三酰甘油呈独立负相关关系。超重/肥胖的2型糖尿病患者应增加日晒,注重维生素D的补充。

Objective This study aimed to explore the effect of serum vitamin D level on lipid metabolism in hospitalized type 2 diabetic patients with different body weights and its clinical significance.Methods We performed a study among 446 type 2 diabetes mellitus(T2DM)patients who were hospitalized from January 2015 to December 2016.They were all enrolled with the height,weight,body mass index calculated,and 25-hydroxyvitamin D(25-OHD),fasting blood glucose,HbA1C,fasting insulin,total cholesterol,triglyceride,high density lipoprotein-cholesterol(HDL-C),low density lipoprotein-cholesterol levels measured.T2DM patients were divided into normal weight group and overweight/obese group according to body mass index,and patients were further divided into four groups according to 25-OHD level by the quartet-method,and the differences in glucose and lipid metabolism and other indicators between the two groups were compared.The correlations between 25-OHD and serum lipids and other indicators were analyzed by multivariate linear regressions.Results The levels of 25-OHD and HDL-C in T2DM patients in overweight/obesity group were significantly lower than those in normal weight group,while the levels of triglyceride and homeostasis model assessment for insulin resistance were significantly higher than in normal weight group(P<0.05 or P<0.01).In the analysis grouped by 25-OHD levels,T2DM patients with normal weight had lower total cholesterol and triglyceride in the higher 25-OHD group;While in overweight/obese T2DM patients,the higher 25-OHD group had lower triglyceride(P<0.05 or P<0.01).In multivariate linear regression analysis,only 25-OHD and triglyceride in the overweight/obese group had an independent negative correlation(P<0.01).The negative correlation between 25-OHD and triglyceride in normal body weight group disappeared after correction of total cholesterol,HDL-C,urine microalbumin/creatinine(ACR),total testosterone,and sex hormone binding globulin(SHBG).In both groups,the negative correlation between 25-OHD and total cholesterol,and the positive correlation between HDL-C disappeared after correction of blood lipid indexes,ACR,total testosterone,and SHBG(P>0.05).Conclusions In hospitalized overweight/obese T2DM patients,25-OHD was independently negatively correlated with triglyceride.Overweight/obese patients with T2DM should increase sun exposure and focus on vitamin D supplementation.