2型糖尿病患者25羟维生素D水平与心功能相关性的研究

Relationship between 25-hydroxyvitamin D and left ventricular diastolic dysfunction in patients with type 2 diabetes mellitus

目的 探讨T2DM患者25羟维生素D[25(OH)D]与左心室舒张功能不全(LVDD)的相关性。方法 选取2018年8月至2020年8月于上海交通大学附属第六人民医院南院内分泌代谢科住院治疗的T2DM患者510例,根据25(OH)D四分位数分为G1组[25(OH)D<12.30 ng/ml,n=128]、G2组[12.30≤25(OH)D<16.55 ng/ml,n=127]、G3组[16.55≤25(OH)D<22.57 ng/ml,n=128]及G4组[25(OH)D≥22.57 ng/ml,n=127],比较各组心脏功能和生化指标。结果 随着25(OH)D升高,LVDD患病率降低(P<0.05)。Spearman相关分析显示,25(OH)D与年龄、BMI、TG、FIns、HOMA-IR、B型利钠肽(BNP)、左心房内径及二尖瓣口舒张早期血流峰值速度/二尖瓣环舒张早期运动峰值速度呈负相关(P<0.05或P<0.01)。Logistic回归分析显示,校正性别、年龄、BMI、DM病程、高血压病程、脉压、吸烟史、饮酒史、HDL-C、LDL-C、甲状旁腺激素、HbA1c、BNP、HOMA-IR后,25(OH)D升高是T2DM患者LVDD的保护因素。随着25(OH)D降低,LVDD风险升高。结论 25(OH)D降低与T2DM患者LVDD密切相关,临床应早期评估低水平25(OH)D患者的心脏功能。

Objective To exploring the correlation between 25-hydroxyvitamin D[25(OH)D]and left ventricular diastolic dysfunction(LVDD)in type 2 diabetes mellitus(T2DM)patients.Methods 510 T2DM patients hospitalized in The Endocrine Metabolism Department of South Hospital,Sixth People’s Hospital of Shanghai Jiao Tong University from August 2018 to August 2020 were selected.According to the 25(OH)D quartile,they were divided into G1 group[25(OH)D<12.30 ng/ml,n=128],G2 group[12.30≤25(OH)D<16.55 ng/ml,n=127],G3 group[16.55≤25(OH)D<22.57 ng/ml,n=128]and G4 group[25(OH)D≥22.57 ng/ml,n=127].Results As 25(OH)D increases,the incidence of LVDD decreases(P<0.05).Spearman correlation analysis showed that 25(OH)D was negatively correlated with age,BMI,TG,FIns,HOMA-IR,B-type natriuretic peptide(BNP),left atrial diameter and peak velocity of early diastolic blood flow at the mitral valve opening/peak velocity of early diastolic motion of the mitral annulus(P<0.05 or P<0.01).Logistic regression analysis showed that after adjusting for gender,age,BMI,duration of DM,duration of hypertension,PP,smoking history,drinking history,HDL-C,LDL-C,PTH,HbA1c,BNP and HOMA-IR,elevated 25(OH)D was a protective factor for LVDD in T2DM patients. As 25(OH)D levels decreased,the risk of LVDD increased. Conclusion Reduced 25(OH)Dis associated with LVDD in T2DM patients. Clinical evaluation of cardiac function in patients with 25(OH)Ddeficiency should be carried out early.