血清25羟维生素D3缺乏与2型糖尿病微血管并发症的相关性研究

摘要

目的 探讨血清25羟维生素D3[25(OH)D3]与2型糖尿病微血管病变(DMAP)的关系.方法 评估812例2型糖尿病患者的DMAP情况,包括糖尿病神经病变、糖尿病视网膜病变及糖尿病肾病,其中无DMAP 371例、单一DMAP 296例、复合DMAP 145例.采用电化学发光法测定血清25(OH)D3水平,并记录病程、血压、计算体质量指数,测定糖化血红蛋白、血脂、尿肌酐比值等指标.采用多元有序Logistic回归分析数据.结果 纳入的2型糖尿病患者中,67.5％维生素D缺乏,24.8％维生素D不足.单一DMAP组25(OH)D3水平[(16.95±6.97)ng/mL]及复合DMAP组25(OH)D3水平[(16.23±8.28)ng/mL]均显著低于无DMAP组[(19.41±8.13)ng/mL],差别均具有统计学意义(t=4.205,3.976,均P<0.01).多元有序Logistic回归分析显示,25(OH)D3与DMAP呈独立负相关(Est=-0.027,OR=0.947,95％CI:0.954～0.994,P=0.011).结论 血清25(OH)D3缺乏可能是2型糖尿病患者合并DMAP的独立危险因素,25(OH)D3水平越低越容易合并复合DMAP.%Objective To investigate the association between serum 25-hydroxyvitamin D3 [25(OH)D3] and diabetic microangiopathy(DMAP)in type 2 diabetes mellitus(T2DM)patients.Methods A total of 812 hospitalized type 2 diabetes patients were recruited.Participants were evaluated for diabetic peripheral neuropathy,retinopathy,and nephropathy.371 cases had no DMAP.Single DMAP was present in 296 cases,while the composite DMAP was present in 145 cases.Serum 25(OH)D3 levels were measured with electrochemiluminescence immunoassay for each participant.Clinical and biochemical characteristics including duration of diabetes,body mass index,blood pressure,lipid profiles,glycated hemoglobin A1c,fasting C-peptide,and albuminuria/creatinine ratio were collected.The associations between DMAP and clinical outcomes were examined with ordinal logistic regression analysis.Results Among all cases,67.5％had vitamin D deficiency,24.8％had vitamin D insufficiency.The mean level of 25(OH)D3 in composite DMAP group[(16.23±8.28)ng/mL] and single DMAP group[(16.95±6.97)ng/mL],were both lower than the group without any DMAP [(19.41±8.13)ng/mL](t=4.205 & 3.976,both with P<0.01).In ordinal logistic regression analysis,lower 25(OH)D3 levels were independently associated with the presence of microvascular complications(Est=-0.027,OR=0.947,95％CI: 0.954～0.994,P=0.011).Conclusions 25(OH)D3 deficiency may be an independent risk factor for microvascular complications in T2DM.Declining levels of vitamin D levels were significantly related to the presence of composite microvascular complications.