2型糖尿病患者25-羟维生素D水平与糖尿病微血管病变及骨代谢指标相关性分析

目的分析2型糖尿病患者25-羟维生素D［25-（OH）D］水平与糖尿病微血管病变及骨代谢指标相关性。 方法选择2019年8月至2020年7月于呼伦贝尔市人民医院收治的2型糖尿病患者286例进行调查分析，调查患者一般资料并检测患者生化指标、25-（OH）D及骨代谢指标，并按照患者是否合并糖尿病视网膜病变（DR）或（和）糖尿病肾病（DN）分为微血管病变组和非微血管病变组。分析2型糖尿病患者25-（OH）D水平与糖尿病微血管病变及骨代谢指标［β-胶原特殊序列（β-CTX）、Ⅰ型胶原氨基酸延长肽（PINP）和N-端骨钙素（N-MID）］相关性。 结果286例2型糖尿病患者中，男171例，女115例；年龄（65.9±12.0）岁；维生素D不足者251例（87.76%），维生素D正常者35例（12.24%）；发生微血管病变患者125例（43.71%），无微血管病变患者161例（56.29%）。维生素D不足组女性比例高于维生素D正常组，空腹血糖（FPG）、餐后2 h血糖（2hPG）、糖化血红蛋白（HbA1c）和胰岛素（FINS）等均高于维生素D正常组，差异均有统计学意义（均P＜0.05）。微血管病变组患者25-（OH）D水平显著低于无微血管病变组（P＜0.05）。维生素D正常患者血清β-CTX显著低于维生素D不足患者（P＜0.05），而维生素D正常患者与维生素D不足患者PINP、N-MID差异均无统计学意义（均P＞0.05）。相关性分析显示，2型糖尿病患者血清25-（OH）D水平与β-CTX呈负相关（r=-0.536，P＜0.05），而与PINP、N-MID表达无相关性（r=-0.087，0.064，均P＞0.05）。 结论2型糖尿病患者维生素D不足较为严重，患者血清25-（OH）D水平与糖尿病微血管病变及骨代谢情况有关，改善患者维生素D不足可能对患者疾病进展及骨代谢状况有积极影响。

Correlation of 25-hydroxyvitamin D level with diabetic microangiopathy and bone metabolism indexes in patients with type 2 diabetes mellitus

ObjectiveTo analyze the correlation of 25-hydroxyvitamin D [25-(OH)D] level with diabetic microangiopathy and bone metabolism indexes in type 2 diabetic patients. MethodsA total of 286 patients with type 2 diabetes admitted to Hulunbuir City People's Hospital from August 2019 to July 2020 were selected for investigation and analysis. The general information of the patients was investigated and the biochemical indexes, 25-(OH)D, and bone metabolism indexes of the patients were detected. According to whether the patients were complicated with diabetic retinopathy (DR) or (and) diabetic nephropathy (DN), the patients were divided into either a microvascular disease group or a non-microvascular disease group. The correlation of 25-(OH)D levels with diabetic microangiopathy and bone metabolism indicators [β-collagen specific sequence (β-CTX), type I collagen amino acid extension peptide (PINP), and N-terminal osteocalcin (N-MID)] was analyzed in patients with type 2 diabetes mellitus. ResultsAmong the 286 patients with type 2 diabetes, there were 171 males and 115 females, with a mean age of (65.9±12.0) years. A total of 251 (87.76%) patients were vitamin D deficient, and 35 (12.24%) had normal vitamin D; 125 (43.71%) had microvascular disease, and 161 (56.29%) had no microvascular disease. The proportion of women in the vitamin D insufficiency group was significantly higher than that in the normal vitamin D group, and the fasting blood glucose (FPG), 2-h postprandial blood glucose (2hPG), glycated hemoglobin (HbA1c), and insulin (FINS) were significantly higher than those in the normal vitamin D group (P＜0.05). The level of 25-(OH)D in the microvascular disease group was significantly lower than that in the non-microvascular disease group (P＜0.05). TSerum β-CTX in patients with normal vitamin D was significantly lower than that in patients with vitamin D insufficiency (P＜0.05), while there was no significant differences in PINP or N-MID between patients with normal vitamin D and those with vitamin D insufficiency (P＞0.05). Correlation analysis showed that serum 25-(OH)D level in patients with type 2 diabetes was significantly negatively correlated with β-CTX (r=-0.536, P＜0.05), but it had no correlation with the expression of PINP or N-MID (P＞0.05). ConclusionVitamin D deficiency is more serious in patients with type 2 diabetes. Serum 25-(OH)D level is related to diabetic microangiopathy and bone metabolism in these patients. Improvement of vitamin D deficiency in type 2 diabetes patients may have a positive effect on disease progression and bone metabolism.