妊娠期糖尿病患者血清25羟基维生素D与胰岛素抵抗、代谢性指标的关系

Relationship between serum 25-hydroxyvitamin D and insulin resistance and metabolic indicators in patients with gestational diabetes mellitus

目的探究妊娠期糖尿病患者血清25羟基维生素D[25-(OH)D]与胰岛素抵抗、代谢性指标的关系。方法选取2021年1月至2022年4月于新余市人民医院妇产科建档的120例妊娠期糖尿病患者作为研究对象。根据患者维生素D水平分为维生素D不足组(62例)、维生素D正常组(58例)。比较两组一般资料、口服葡萄糖耐量试验结果(空腹、糖负荷1、2 h)、胰岛素相关指标[空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、胰岛β细胞分泌指数(HOMA-β)、胰岛素敏感指数(ISI)]、血脂四项[三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]差异,采用Pearson相关系数分析有差异单因素与患者血清25-(OH)D水平的相关性,采用logistic回归分析患者维生素D不足的危险因素。随访至患者妊娠,记录妊娠结局。结果维生素D不足组62例,维生素D正常组58例,两组的一般资料比较,差异无统计学意义(P>0.05);维生素D不足组的空腹、糖负荷1、2 h时血糖、HOMA-IR、FINS、TG、LDL-C均高于维生素D正常组,HOMA-β、ISI、HDL-C低于维生素D正常组,差异有统计学意义(P<0.05)。两组的TC水平比较,差异无统计学意义(P>0.05);Pearson相关系数分析空腹、糖负荷1、2 h时血糖、HOMA-IR、FINS、LDL-C水平与血清25-(OH)D水平负相关(P<0.05),HOMA-β、ISI、HDL-C水平与血清25-(OH)D水平正相关(P<0.05);多因素分析结果提示,空腹血糖(β=1.356,OR=3.881,95%CI=1.890~7.967)、FINS(β=1.633,OR=5.119,95%CI=1.186~22.091)、HOMA-IR(β=0.797,OR=2.219,95%CI=1.400~3.517)是维生素D不足的危险因素(P<0.05),HOMA-β(β=-0.613,OR=0.542,95%CI=0.310~0.945)、ISI(β=-1.413,OR=0.243,95%CI=0.067~0.882)是维生素D不足的保护因素(P<0.05)。结论妊娠糖尿病患者血清25-(OH)D水平与胰岛素抵抗及代谢功能相关。

Objective To explore the relationship between serum 25-hydroxyvitamin D(25-[OH]D)and insulin resistance and metabolic indicators in patients with gestational diabetes mellitus.Methods A total of 120 patients with gestational diabetes mellitus who were registered in department of obstetrics and gynecology of Xinyu People's Hospital from January 2021 to April 2022 were enrolled as the research subjects,and were divided into vitamin D deficiency group(n=62)and normal vitamin D group(n=58)according to the vitamin D level.General data,oral glucose tolerance test results(fasting,1 h and 2 h glucose load),insulin related indicators(fasting insulin[FINS],homeostasis model assessment of insulin resistance[HOMA-IR],isletβcell secretion index[HOMA-β],insulin sensitivity index[ISI])and four indicators of blood lipids(triacylglycerol[TG],total cholesterol[TC],high-density lipoprotein cholesterol[HDL-C],low-density lipoprotein cholesterol[LDL-C])were compared between the two groups.Pearson correlation coefficient analysis was used to analyze the correlation between the single factors with differences and serum 25-(OH)D level of patients.Risk factors of vitamin D deficiency were analyzed by logistic regression analysis.Follow-up was performed until pregnancy and pregnancy outcomes were recorded.Results There were 62 cases in vitamin D deficiency group and 58 cases in normal vitamin D group.There were no statistical differences in general data between the two groups(P>0.05).Fasting blood glucose,blood glucose at 1 and 2 h glucose load,HOMA-IR,FINS,TG and LDL-C in vitamin D deficiency group were higher than those in normal vitamin D group while HOMA-β, ISI and HDL-C were lower than those in normal vitamin D group, with statistically significant differences (P<0.05), but there was no statistical significance in TC level between the two groups (P>0.05). Pearson correlation coefficient analysis showed that fasting and 1 and 2 h glucose load blood glucose, HOMA-IR, FINS and LDL-C were negatively correlated with serum 25-(OH) D level (P<0.05), and HOMA-β, ISI and HDL-C were positively correlated with serum 25-(OH) D level (P<0.05). Multivariate analysis results suggested that fasting blood glucose (β=1.356, OR=3.881, 95%CI=1.890-7.967), FINS (β=1.633, OR= 5.119, 95%CI=1.186-22.091) and HOMA-IR (β=0.797, OR=2.219, 95%CI=1.400-3.517) were risk factors of vitamin D deficiency (P<0.05), and HOMA-β (β=-0.613, OR=0.542, 95%CI=0.310-0.945) and ISI (β=-1.413, OR=0.243, 95%CI=0.067-0.882) were protective factors of vitamin D deficiency (P<0.05). Conclusion The level of serum 25-(OH) D is associated with insulin resistance and metabolic function in patients with gestational diabetes mellitus.