血清25-羟维生素D3改变与糖调节受损对2型糖尿病患者神经损害程度的影响

Changes of serum^(2)5-hydroxyvitamin D3 and impaired glucose regulation on nerve of T2DM patients influence of damage degree.

目的探讨血清25-羟维生素D3[25-(OH)D3]改变与糖调节生电受损对2型糖尿病患者神经损害程度的影响。方法回顾性选取2018年2月至2020年12月安徽医科大学附属六安医院收治的59例2型糖尿病患者为观察组,选取同期健康成年人61例为对照组。对比两组患者25-(OH)D3、血糖[空腹血糖(FBG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)]、神经传导速度、炎症介质[肿瘤坏死因子α(TNF-α)、血清白细胞介素6(IL-6)和人可溶性IL-4受体(sIL-4R)、骨桥蛋白(OPN)、C反应蛋白(CRP)]水平变化。结果观察组血清25-(OH)D3为(35.89±5.46)nmol/L,显著低于对照组[(50.37±6.41)nmol/L],FPG、2 h PG、HbA1c为(7.16±0.52)mmol/L、(13.01±1.29)mmol/L、(6.12±0.32)%,显著高于对照组[(4.56±0.31)mmol/L、(8.11±0.11)mmol/L、(3.71±0.39)%],差异均有统计学意义(P<0.05)。观察组左侧正中神经、右中神经、左腓神经和右腓神经传导速度分别为(39.22±3.41)、(41.21±2.21)、(35.32±3.12)、(33.51±2.67)m/s,显著低于对照组[(49.12±2.36)、(48.91±3.01)、(45.24±2.13)、(45.66±3.38)m/s],差异均有统计学意义(P<0.05)。观察组IL-6、TNF-α、sIL-4R、OPN、CRP水平分别为(32.9±13.4)pg/mL、(51.2±11.9)pg/mL、(48.9±5.9)pg/mL、(5489.5±382.6)pg/mL、(4.6±2.1)mg/mL,均高于对照组[(19.3±12.3)pg/mL、(40.9±13.1)pg/mL、(37.1±8.6)pg/mL、(4105.6±463.2)pg/mL、CRP(2.3±1.1)mg/mL],差异均有统计学意义(P<0.05)。结论观察组患者血清25-(OH)D3水平降低显著,且影响血糖水平,促使机体炎症因子激活,加重机体神经损害,临床治疗过程中应予以足够重视。

Objective To explore the influence of the changes of serum^(2)5-hydroxyvitamin D3[25-(OH)D3]and impaired glucose regulation on nerve damage in patients with type 2 diabetes mellitus.Methods A total of 59 patients with T2DM treated in Lu'an People's Hospital from February 2018 to December 2020 were retrospectively selected as the observation group,and 61 healthy adults were selected as the control group.The levels of 25-(OH)D3,blood glucose[fasting blood glucose(FBG),2 h postprandial glucose(2 h PG),hemoglobin A1C(HbA1c)],nerve conduction velocity,inflammatory mediators[tumor necrosis factor alpha(TNF-α),serum interleukin 6(IL-6)and human soluble IL-4 receptor(sIL-4R),osteopontin(OPN),C-reactive protein(CRP)]changes were compared between the two groups.Results The levels of serum^(2)5-(OH)D3 in the observation group was(35.89±5.46)nmol/L,which was significantly lower than that in the control group[(50.37±6.41)nmol/L],FPG,2 h PG,HbA1c were(7.16±0.52)mmol/L,(13.01±1.29)mmol/L,(6.12±0.32)%,which were significantly higher than those in the control group[(4.56±0.31)mmol/L,(8.11±0.11)mmol/L,(3.71±0.39)%],the differences were statistically significant(P<0.05).The conduction velocities of the left median nerve,right median nerve,left peroneal nerve and right peroneal nerve in the observation group were(39.22±3.41),(41.21±2.21),(35.32±3.12),(33.51±2.67)m/s,which were significantly lower than those in the control group[(49.12±2.36),(48.91±3.01),(45.24±2.13),(45.66±3.38)m/s],the differences were statistically significant(P<0.05).The levels of IL-6,TNF-α,sIL-4R,OPN and CRP in the observation group were(32.9±13.4)pg/mL,(51.2±11.9)pg/mL,(48.9±5.9)pg/mL,(5489.5±382.6)pg/mL,(4.6±2.1)mg/mL,which were higher than those in the control group[(19.3±12.3)pg/mL,(40.9±13.1)pg/mL,(37.1±8.6)pg/mL,(4105.6±463.2)pg/mL,CRP(2.3±1.1)mg/mL],the differences were statistically significant(P<0.05).Conclusion In the observation group,the serum^(2)5-(OH)D3 is obviously decreasing,which affects the blood sugar level,promotes the activation of inflammatory factors and aggravates the nerve damage of the body,which should be paid enough attention to during the clinical treatment.