血清维生素D与2型糖尿病视网膜病变关系的研究

摘要

目的 探讨2型糖尿病(type 2 diabetes mellitus,T2DM)患者视网膜病变(diabetic retinopathy,DR)与血清维生素D的关系.方法 选取2012年2月至2014年12月期间同时被纳入上海市闵行区疾病预防控制中心生物样本库和糖尿病管理系统的2型糖尿病患者310例,根据眼底检查分为DR组(n=105例)和正常眼底(non diabetic retinopathy,NDR)组(n=205例),收集患者的基本信息、疾病史和检验信息,并检测各组血清中的25-羟基维生素D[25(OH)D]水平.结果 单因素分析结果显示,与NDR组比较,DR组的25(OH)D水平降低(t=3.465,P＜0.001),25(OH)D缺乏率增高(x2=5.313,P=0.021),但是25(OH)D不足率差异无统计学意义(x2=0.990,P=0.320).二元Logistic回归分析结果表明,在校正一系列变量(基本特征、疾病史、空腹血糖、餐后血糖、甘油三酯和尿酸)后,25(OH)D水平与T2DM患者并发DR呈负相关(OR=0.954,95％ CI:0.926～0.983,P=0.002),25(OH)D缺乏的T2DM患者DR发病风险是25(OH)D不缺乏者的2.17倍(OR=2.171,95％CI:1.047～4.500,P=0.037).结论 血清25(OH)D水平与DR的发生呈负相关,25(OH)D缺乏可能与T2DM患者DR的发生有关.%Objective To investigate the relationship between diabetic retinopathy(DR) and serum vitamin D in patients with type 2 diabetes mellitus (T2DM).Methods A total of 310 patients with T2DM both managed in the bio-bank and the diabetes management system of Center for Disease Control and Prevention of Minhang District during Feb.,2012 to Dec.,2014 were selected.Then 205 patients were divided into non diabetic retinopathy group (NDR) and 105 patients into DR group according to the fundus examinations.The patients' demographical information,medical history and laboratory essays were collected,serum 25 (OH)D levels were detected.Results Single factor analysis indicated that,compared with NDR group,25(OH)D level of DR group decreased(t =3.465,P＜0.001),prevalence of 25(OH)D deficiency rose (x2 =5.313,P =0.021),however,prevalence of 25 (OH) D insufficiency showed no statistical significance (x2 =0.990,P =0.320).Binary Logistic regression analyses showed the inverse correlation between 25 (OH)D level and DR (OR =0.954,95％CI:0.926-0.983,P =0.002),in addition,the risk for DR in T2DM patients who were deficient in 25 (OH)D was 2.17 times than those who were not (OR =2.171,95％ CI:1.047-4.500,P =0.037),after adjusting for a number of variables (demographics,medical history,fasting plasma glucose,postprandial blood glucose,triglyceride and uric acid).Conclusions Serum 25 (OH)D level was negatively related with DR in patients with T2DM.25 (OH)D deficiency might be relevant to the risk of type 2 diabetic retinopathy.