2型糖尿病合并视网膜病变患者血清维生素D水平变化及意义

Changes and Significance of Serum Vitamin D Levels in Patients with Type 2 Diabetes and Retinopathy

目的探讨2型糖尿病合并视网膜病变(DR)患者血清维生素D水平变化及意义,为DR的早期防治提供诊断依据。方法选取2012年1月—2019年1月于该院内分泌科住院的2型糖尿病患者219例进行研究,分为T2DM不伴DR(NDR)组73例、T2DM伴非增殖期DR(BDR)组69例和T2DM伴增殖期DR(PDR)组77例。收集所有患者临床资料,ELISA法测定血清25羟维生素D3[25(OH)D3]水平,检测各组空腹血糖(FPG)、糖化血红蛋白(HbA1c)、空腹C肽、血脂,C-反应蛋白(CRP)和肝、肾功能等生化指标。将25(OH)D3与各指标间进行相关性分析,并将25(OH)D3按照国际诊断标准,分为维生素D缺乏组[25(OH)D3<20 ng/mL]及非维生素D缺乏组[25(OH)D3≥20 ng/mL],比较两组间DR的发病率及风险,并进一步对DR的危险因素行Logistic回归分析。结果T2DM各组血清25(OH)D3水平由低到高依次为PDR组<BDR组<NDR组[(20.96±4.78)ng/mL vs(32.73±3.16)ng/mL vs(45.79±7.59)ng/mL];T2DM组血清25(OH)D3水平与FPG、CRP、病程呈负相关(r=-0.054,P<0.05;r=-0.661,P<0.05;r=-0.032,P<0.05);血清25(OH)D3与空腹C肽呈正相关(r=0.10,P<0.05),多元回归分析示,血清25(OH)D3、CRP、病程是DR发病的独立危险因素(P<0.05)。血清25(OH)D3缺乏组的糖尿病患者发生DR的风险是非缺乏组患者的1.57倍(OR=1.57)。结论血清25(OH)D3水平降低可能增加DR的患病风险,且T2DM患者血清25(OH)D3与炎症反应密切相关,可能参与了DR的发生、发展。监测25(OH)D3水平有助于早期防治DR。

Objective To investigate the changes and significance of serum vitamin D levels in patients with type 2 diabetes and retinopathy(DR),and to provide diagnostic evidence for the early prevention and treatment of DR.Methods A total of 219 patients with type 2 diabetes who were hospitalized in the Department of Endocrinology in the hospital from January 2012 to January 2019 were selected for the study.They were divided into T2DM without DR(NDR)group,73 cases,T2DM with non-proliferative DR(BDR)group 69 cases and T2DM with proliferative DR(PDR)group 77 cases.Collect clinical data of all patients,measure serum 25-hydroxyvitamin D3[25(OH)D3]levels by ELISA method,detect fasting blood glucose(FPG),glycosylated hemoglobin(HbA1c),fasting C peptide,blood lipids,and C-reactive protein(CRP)and biochemical indicators such as liver and kidney function in each group.Analyze the correlation between 25(OH)D3 and various indicators,and divide 25(OH)D3 into vitamin D deficiency group[25(OH)D3<20 ng/mL]and non-vitamin D deficiency group[25(OH)D3≥20 ng/mL]according to international diagnostic standards,compare the incidence and risk of DR between the two groups,and perform Logistic regression analysis on the risk factors of DR.Results Serum 25(OH)D3 levels in T2DM groups from low to high were PDR group<BDR group<NDR group[(20.96±4.78)ng/mL vs(32.73±3.16)ng/mL vs(45.79±7.59)ng/mL];Serum 25(OH)D3 levels in the T2DM group were negatively correlated with FPG,CRP,and disease course(r=-0.054,P<0.05;r=-0.661,P<0.05;r=-0.032,P<0.05);Serum 25(OH)D3 was positively correlated with fasting C-peptide(r=0.10,P<0.05),multiple regression analysis shows that serum 25(OH)D3,CRP course of disease was an independent risk factor for the onset of DR(P<0.05).Diabetes patients in the serum 25(OH)D3 deficiency group had 1.57 times the risk of developing DR than those in the non-deficiency group(OR=1.57).Conclusion Decreased serum 25(OH)D3 levels may increase the risk of DR,and serum 25(OH)D3 in T2DM patients is closely related to inflammatory response,and may be involved in the occurrence and development of DR.Monitoring 25(OH)D3 levels can help prevent DR early.