2型糖尿病周围神经病变患者血清维生素D水平变化及意义

Changes and significance of serum vitamin D level in patients with type 2 diabetic peripheral neuropathy

目的探讨2型糖尿病周围神经病变(DPN)者血清25羟维生素D_(3)水平变化及意义,为DPN的早期防治探索新的诊疗思路。方法选择2016年4月至2019年2月在我院住院的214例2型糖尿病(T2DM)患者为研究对象,通过临床回顾性观察研究,根据DPN诊疗指南分为DPN组(109例)和无DPN(NDPN)组(105例)。收集相关病例数据,ELISA法测定血清[25(OH)D_(3)]水平,检测空腹血糖(FPG)、空腹C肽、糖化血红蛋白(HbA1c)、C-反应蛋白(CRP)、血脂和尿酸(UA)等生化指标。25(OH)D_(3)与各指标分别作Pearson相关分析,目前多推荐血清25羟维生素D_(3)<20 ng/mL为维生素D缺乏;两组患者按此标准分为维生素D缺乏组及非维生素D缺乏组,比较两组间DPN的发病率。并行多元线性逐步回归分析,观察DPN的独立危险因素。结果NDPN组血清25羟维生素D_(3)水平(36.47±11.01)ng/mL显著高于DPN者(26.64±7.41)ng/mL,差异有统计学意义(P<0.01)。T2DM者血清25羟维生素D_(3)水平与空腹C肽呈正相关,与FPG、CRP呈负相关,相关系数分别为r=0.104,P<0.05;r=-0.049,P<0.05,r=-0.621,P<0.01。多元线性逐步回归分析示,血清25羟维生素D_(3)、CRP是DPN发生的独立影响因素(β=-0.093,P<0.01,β=0.354,P<0.05)。血清25羟维生素D_(3)缺乏组的T2DM者发生DPN的风险是非缺乏组患者的1.54倍(OR=1.54)。结论血清25羟维生素D_(3)水平降低可能增加DPN的发病风险,且糖尿病者血清25羟维生素D_(3)参与糖脂代谢及炎症反应,可能促进了DPN的发生。监测血清25羟维生素D_(3)水平有利于提前诊治DPN。

Objective To investigate the change and clinical significance of serum 25-hydroxyvitamin D_(3)[25(OH)D_(3)]level in peripheral neuropathy with type 2 diabetes mellitus(T2DM)and provides the diagnosis basis for early prevention and traetment of DPN.Methods A total of 214 patients with T2DM were admitted to The People Hospital of Wuxi City from April 2016 to February 2019 were geted into this study.Through clinical retrospective study,214 subjects were divided into 109 DPN group and 105 NDPN group according to the diagnostic criteria of DPN.The serum levels of 25(OH)D_(3) which were determined by ELISA.Fasting blood-glucose(FPG),Fasting C-peptide,blood lipids,glycated hemoglobin(HbA1c),and C-Reactive Protein(CRP),Biochemical indicators such as blood lipid and uric acid were detected in all objects of the study.The pearson correlation between 25(OH)D_(3) and each indicator was analyzed.The vitamin D deficiency is currently recommended to be less than 20 ng/mL,the subjects were splited into vitamin D deficiency and non-vitamin D deficiency groups on the basis of the criteria.To compare the morbidity of DPN between the two groups and multiple linear stepwise regression analysis was performed to observe independent risk elements for DPN.Results The standard of serum 25(OH)D_(3) was obviously higher in the NDPN group(36.47±11.01 ng/mL)than that in the DPN group(26.64±7.41ng/mL)(P<0.01),and the difference was statistically significant.The serum standard of 25(OH)D_(3) was positively correlated with Fasting C-peptide in T2DM,but negatively correlated with FPG、CRP(r=0.104,P<0.05;r=-0.049,P<0.05,r=-0.621,P<0.01);Multivariate regression analysis indicated that the 25(OH)D_(3) and CRP were the independent influencing elements of DPN.(β=-0.093,P<0.01,β=0.354,P<0.05).T2DM patients in the vitamin D deficiency groups had 1.54 times the risk of promoting DPN compared with those in the non-vitamin D deficiency groups(OR=1.54).Conclusion To reduce the standard of serum vitamin D may promote the risk of DPN.The serum vitamin D is involved in glucose and lipid metabolism and inflammatory response in T2DM patients which may promote the occurrence of DPN.Monitoring the standard of 25(OH)D_(3) is beneficial to the early diagnoisis and treatment of DPN.