维生素D与糖尿病心脏自主神经病变关系的研究进展

Progress of researches on the association between vitamin D and diabetic cardiac autonomic neuropathy

心脏自主神经病变是糖尿病常见且易被忽视的并发症,因早期无明显症状,发现时多为疾病的进展期,往往会造成不良心血管事件。维生素D除调节钙磷代谢,还具有调节糖脂代谢、改善胰岛素抵抗等骨骼外效应。近年的研究显示,维生素D缺乏与糖尿病患者心脏自主神经病变的发生发展相关。糖尿病患者维生素D缺乏时可出现心血管反射试验及心率变异性异常,尤以LF/HF及E/I比值异常多见,表现为心脏交感和副交感神经功能失衡,而补充维生素D可改善这种失衡。维生素D缺乏时,可能通过糖代谢紊乱促进内皮功能障碍,激活氧化应激/炎症反应,减低神经生长因子水平,导致神经元代谢紊乱等潜在机制致心脏自主神经受损,补充维生素D治疗可能对糖尿病患者心脏自主神经病变有一定程度的改善,但目前此类研究仍较少,其具体影响尚需要更多的基础和临床研究来证实。

Cardiac autonomic neuropathy(CAN)is a common and easily overlooked complication of diabetes.Due to lack of obvious symptoms in the early stage,diagnosis is often delayed until the progressive stage of the disease,leading to adverse cardiovascular events.Vitamin D can not only regulate calcium and phosphorus metabolism,but also regulate glucose and lipid metabolism and improve insulin resistance.Recent studies have shown that vitamin D deficiency is related to the occurrence and development of CAN in diabetic patients.Abnormal cardiovascular reflex test and heart rate variability can occur in diabetic patients with vitamin D deficiency.Abnormal LF/HF and E/I ratios are especially common,indicating imbalance of sympathetic and parasympathetic nerve function,and can be improved with vitamin D supplementation.Potential mechanism of vitamin D deficiency-mediated cardiac autonomic nerve damage includes disturbance of glucose metabolism,promotion of endothelial dysfunction,activation of oxidative stress and inflammatory reaction,reduction of nerve growth factor level,and disorder of neuronal metabolism.Vitamin D supplementation may improve CAN in diabetic patients to some extent,but such studies are still scanty,warranting more fundamental and clinical studies on the specific effects of vitamin D.