目的：维生素 D 被认为在2型糖尿病（T2DM）患者的发病及糖代谢过程中发挥重要作用，本研究旨在观察小剂量长疗程补充α-骨化醇对 T2DM 患者胰岛细胞功能、胰岛素抵抗、糖脂代谢以及抗炎作用的影响。方法选取2011年2月—2013年10月于江苏省老年医院就诊的 T2DM 患者92例为研究对象。根据性别相同，年龄、病程相近原则，将患者随机分为治疗组和对照组，各46例。两组患者均接受口服降糖药物治疗，治疗组添加α-骨化醇0.25μg，1次/ d，口服；对照组添加安慰剂（膳食纤维）0.25μg，1次/ d，口服。干预措施持续18个月，对患者和研究实施者采用盲法。检测基线及干预3、6、12、18个月时血清维生素 D、C 肽、空腹胰岛素、糖化血红蛋白（HbA1c ）、极低密度脂蛋白胆固醇（VLDL-C）、低密度脂蛋白胆固醇（LDL-C）、脂蛋白 a〔Lp（a）〕、血钙、血磷、超敏 C 反应蛋白（hs-CRP）、同型半胱氨酸（Hcy）水平。结果基线时，两组体质指数（BMI）、维生素 D、C 肽、稳态胰岛素抵抗指数（HOMA-IR）、HOMA-β细胞功能指数、HbA1c、VLDL-C、LDL-C、Lp（a）、血钙、血磷、hs-CRP、Hcy 水平比较，差异均无统计学意义（P >0.05）。干预3个月时，治疗组HOMA-IR低于对照组，差异有统计学意义（P <0.05）。干预6个月时，治疗组 C 肽水平、HOMA-β细胞功能指数高于对照组，HOMA-IR、hs-CRP水平低于对照组，差异均有统计学意义（ P <0.05）。干预12个月时，治疗组 C 肽水平、HOMA-β细胞功能指数高于对照组，HOMA-IR、HbA1c、VLDL-C、LDL-C、hs-CRP、Hcy 水平低于对照组，差异均有统计学意义（ P <0.05）。干预18个月时，治疗组 C 肽、HOMA-β细胞功能指数高于对照组，HOMA-IR、HbA1c、VLDL-C、LDL-C、hs-CRP、Hcy 水平低于对照组，差异均有统计学意义（P <0.05）。结论小剂量长疗程补充α-骨化醇有助于促进 T2DM 患者胰岛素分泌，改善胰岛β细胞功能、胰岛素抵抗及糖脂代谢，降低炎性因子水平。%Objective Vitamin D is thought to play an important role in the pathogenesis and glycometabolism of type 2 diabetes patients. In the study,we observed the effect of small - dose and long - term supplement of α-calciferol supplement on the islet - β cell function,insulin resistance,glucolipid metabolism and anti - inflammatory action of type 2 diabetes patients. Methods From February 2011 to October 2013,we enrolled 92 T2DM patients who received treatment in the Geratic Hospital of Jiangsu Province. According to the principle of same gender,similar age and the course of disease,the patients were divided into treatment group and control group,with 46 patients in each group. The two groups both received orally - taken hypoglycemic agent;treatment group was orally given 0. 25 μg α-calciferol by one time per day,and control group was orally given 0. 25 μg placebo(dietary fiber)by one time per day. The intervention was given for 18 months continuously,and the double blind method was employed on the research subjects and research conductors. At baseline and after intervention for 3,6,12,18 months,fasting blood samples were taken,and the levels of vitamin D,C - peptide,fasting insulin,HbA1c ,VLDL-C, LDL-C,Lp(a),serum calcium,serum phosphate,hs-CRP and Hcy were detected. Results At baseline,no differences between the two groups were observed in BMI,vitamin D,C - peptide,HOMA-IR,HOMA-β cell function indexes,HbA1c , VLDL-C,LDL-C,Lp(a),serum calcium,serum phosphate,hs-CRP and Hcy levels(P > 0. 05). After intervention for 3 months,treatment group was lower in HOMA-IR than control group( P < 0. 05). After intervention for 6 months,treatment group was higher in C - peptide levels and HOMA-β cell function indexes and lower in HOMA-IR and hs-CRP levels than control group(P < 0. 05). After intervention for 12 months,treatment group was higher in C - peptide levels and HOMA-β cell function indexes and lower in HOMA-IR,HbA1c ,VLDL-C,LDL-C,hs-CRP and Hcy levels than control group(P < 0. 05). After intervention for 18 months,treatment group was higher in C - peptide level and HOMA-βcell function indexes and lower in HOMA-IR,HbA1c ,VLDL-C,LDL-C,hs-CRP and Hcy levels than control group( P < 0. 05). Conclusion Small - dose and long - term supplement of α-calciferol can faciliate the insulin secretion of T2DM patients,improve islet - β cell function, insulin resistance and glucolipid metabolism,and lower inflammatory factor level.
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