新诊断2型糖尿病患者血清25-羟维生素D水平及其与酮症倾向的关系

Relationship between serum 25-hydroxy vitamin D level and ketosis-prone in newly-diagnosed type 2 diabetes mellitus

目的:探讨新诊断2型糖尿病患者25-羟维生素D(25-hydroxy vitamin D,25OHD)营养状况及其与酮症倾向的关系。方法:纳入2017年1月至2019年6月在南方医科大学第三附属医院内分泌科住院的新诊断2型糖尿病患者134例(男性103例,女性31例)。根据有无酮症或酮症酸中毒将患者分为两组:其中酮症倾向的2型糖尿病患者36例、非酮症倾向的2型糖尿病患者98例。收集各组身高、体重、血压;检测血清25OHD水平、血尿酮体、胰岛素抗体、糖脂代谢指标以及胰岛功能等。结果:134例新诊断2型糖尿病患者中,维生素D缺乏者71例(52.99%),不足52例(38.81%),充足仅11例(8.20%)。酮症倾向的2型糖尿病患者血清25OHD水平显著低于非酮症倾向的2型糖尿病患者[(44.12±9.77)nmol/L对(55.35±15.31)nmol/L,P<0.01],其维生素D缺乏率较非酮症倾向的2型糖尿病高[(77.78%对43.88%),P<0.01]。不同维生素D的亚分组中,2型糖尿病合并酮症倾向的检出率差异有统计学意义(P<0.01)。Logistic回归分析显示低血清25OHD水平、较高的HbA 1C和三酰甘油以及更年轻为新诊断2型糖尿病患者出现酮症倾向的危险因素(P<0.01)。结论:新诊断2型糖尿病患者维生素D缺乏严重,以酮症倾向的2型糖尿病患者更为明显,维生素D缺乏可能是新诊断2型糖尿病患者酮症倾向的独立危险因素。

Objective To explore relationship between serum 25-hydroxy vitamin D(25OHD)level and ketosis-prone in patients with newly-diagnosed type 2 diabetes mellitus(T2DM).Methods One hundred and thirty-four patients with newly diagnosed T2DM(103 males,31 females)admitted in The Third Affiliated Hospital,Southern Medical University from January 2017 to January 2019 were enrolled into this study,including 36 patients with ketosis-prone(KPDM group)and 98 patients without ketosis(NKPDM group).Clinical characteristics,including height,weight,and history of hypertensive disease were collected.Serum 25OHD levels,lipid profile,islet function and glycosylated hemoglobin(HbA1C)levels,ICA,IAA,GAD-Ab,etc.,were measured.Results Among the 134 patients,the patients with vitamin D deficiency,insufficiency,and sufficiency were 71 cases(52.99%),52 cases(38.81%),and 11 cases(8.20%),respectively.KPDM group had significantly lower serum 25OHD level than NKPDM group[(44.12±9.77)nmol/L vs(55.35±15.31)nmol/L,P<0.01].The rate of vitamin D deficiency was significantly higher in KPDM group compared to that in NKPDM group[(77.78%vs 43.88%),P<0.01].The prevalence of KPDM varied significantly in different vitamin D status groups(P<0.01).Logistic regression analysis suggested that low serum 25OHD,younger age,high HbA1C,and triglyceride were risk factors to ketosis-prone in newly diagnosed T2DM(P<0.01).Conclusion Vitamin D deficiency is a common problem in newly diagnosed T2DM,especially in KPDM.Low serum 25OHD level seems to be an independent risk factor for ketosis-prone in patients with newly diagnosed T2DM.