25羟维生素D3联合利拉鲁肽对2型糖尿病微血管并发症患者血糖代谢、VEGF、IGF-1、sTNFR1指标水平的影响

Effects of 25 hydroxyvitamin D3 combined with liraglutide on blood glucose metabolism,VEGF,IGF-1 and sTNFR1 levels in patients with type 2 diabetes mellitus with microvascular complications

目的探究25羟维生素D3联合利拉鲁肽对2型糖尿病微血管并发症患者血糖代谢、血管内皮生长因子(VEGF)、胰岛素样生长因子(IGF-1)、可溶性蜕膜组织受体1(sTNFR1)指标水平的影响。方法回顾性选取2020年1月至2020年6月份秦皇岛市第二医院内分泌科就诊的25(OH)D缺乏的2型糖尿病微血管并发症患者100例进行研究,根据治疗方案将其分为对照组(n=50)、观察组(n=50)。对照组接受利拉鲁肽治疗,观察组在对照组治疗方案基础上加施25羟维生素D3。比较两组治疗后血糖代谢、VEGF、IGF-1、sTNFR1指标水平、骨代谢指标[骨碱性磷酸酶(BAP)、骨保护素、碱性磷酸酶(ALP)、骨钙素]水平以及并发症情况。结果治疗后,观察组三酰甘油、总胆固醇、空腹血糖、餐后2 h血糖水平均低于对照组,差异均有统计学意义(P<0.05)。治疗后观察组VEGF、IGF-1、sTNFR1指标水平为(82.36±8.54)ng/L、(93.84±7.86)μg/L、(23.52±4.01)pg/mL,均低于对照组[(118.42±12.04)ng/L、(117.64±12.45)μg/L、(27.88±4.17)pg/mL],差异均有统计学意义(P<0.05)。治疗后观察组ALP为(4.02±0.81)U/L,低于对照组[(5.44±0.98)U/L],BAP、骨保护素、OC指标水平为(43.28±7.11)μg/L、(323.15±17.40)ng/L、(8.49±0.92)μg/L,均高于较对照组[(37.04±6.02)μg/L、(301.22±14.73)ng/L、(7.50±0.84)μg/L],差异均有统计学意义(P<0.05)。两组治疗后骨质疏松症、周围神经病变症、眼底病、糖尿病肾病等发病率为14.00%,较对照组的38.00%低,差异有统计学意义(P<0.05)。结论25羟维生素D3联合利拉鲁肽可改善2型糖尿病微血管并发症患者血糖代谢指标水平,调节VEGF、IGF-1、sTNFR1指标水平及骨代谢指标水平,减少并发症发生率,值得推广应用。

Objective To explore the effects of 25 hydroxyvitamin D3 combined with liraglutide on blood glucose metabolism,vascular endothelial growth factor(VEGF),insulin-like growth factor(IGF-1)and soluble decidua receptor 1(sTNFR1)in patients with type 2 diabetes mellitus with microvascular complications.Methods A total of 100 patients with microvascular complications of type 2 diabetes mellitus(T2DM)with 25(OH)D deficiency who visited the Endocrinology Department of Qinhuangdao Second Hospital from January 2020 to June 2020 were retrospectively selected for study.According to the treatment regimen,the patients were divided into control group(n=50),observation group(n=50),the control group received the treatment of liraglutide,and the observation group was given 25 hydroxyvitamin D3 on the basis of the treatment regimen of the control group.Blood glucose metabolism,VEGF,IGF-1,sTNFR1 index levels,bone metabolism[bone alkaline phosphatase(BAP),osteoprotegerin(OPG),alkaline phosphatase(ALP),osteocalcin(OC)]and complications were compared between the two groups.Results After treatment,the levels of triacylglycerol,total cholesterol,fasting blood glucose,2 h postprandial blood glucose in the observation group were significantly lower than those in the control group,the differences were statistically significant(P<0.05).After treatment,the levels of VEGF,IGF-1 and sTNFR1 in the observation group were(82.36±8.54)ng/L,(93.84±7.86)μg/L,(23.52±4.01)pg/mL,which were significantly lower than those in the control group[(118.42±12.04)ng/L,(117.64±12.45)μg/L,(27.88±4.17)pg/mL],the differences were statistically significant(P<0.05).After treatment,ALP in the observation group was(4.02±0.81)U/L,,which was lower than that in the control group[(5.44±0.98)U/L],and the levels of BAP,OPG and OC were(43.28±7.11)μg/L,(323.15±17.40)ng/L,(8.49±0.92)μg/L,which were shigher than those in the control group[(37.04±6.02)μg/L,(301.22±14.73)ng/L,(7.50±0.84)μg/L],the differences were statistically significant(P<0.05).The incidence of osteoporosis,peripheral neuropathy,fundus disease and diabetic nephropathy in the two groups was 14.00%,which was lower than in the control group(38.00%)7,the difference was statistically significant(P<0.05).Conclusion 25 hydroxyvitamin D3 combined with liraglutide can improve the level of blood glucose metabolism in patients with type 2 diabetes mellitus with microvascular complications,regulate the levels of VEGF,IGF-1,sTNFR1 and bone metabolism indicators,and reduce the incidence of complications,which is worthy of popularization and application.