2型糖尿病患者维生素D缺乏的调查分析

目的 调查分析2型糖尿病患者血清25羟维生素D3[25（OH）D3]的水平和缺乏程度,初步了解维生素D缺乏与糖尿病病程和糖化血红蛋白（HbA1c）的关系.方法 选择天津医科大学总医院2型糖尿病患者140例,其中男60例,女80例,年龄21～89岁,平均（58.25±13.76）岁.分析不同年龄组即＜50岁、≥50且＜70岁、≥70岁者,不同检测季节组即冬春季和夏秋季两组,不同糖尿病病程组即＜10年、≥10且＜20年、≥20年,及不同HbA1c水平组即＜7％、≥7％且＜10％、≥10％的血清25（OH）D3水平.结果 （1）140例患者血清25（OH）D3水平均明显降低[（40.07±16.12）nmol/L],维生素D严重缺乏者占13.57％,缺乏者占67.86％,充足者仅占4.29％,不同性别患者维生素D水平和缺乏程度的差异均无统计学意义（t =0.803,x2=0.189,P均＞0.05）.（2）男性≥50且＜70岁组25（OH）D3水平较＜50岁组明显降低（F=2.362,P＜0.05）;女性≥50岁的两组患者25（OH）D3水平均较＜50岁组明显降低（F =3.928,P＜0.05）,维生素D缺乏者的比例均较＜50岁组显著增多（x2=10.036,P ＜0.01）.（3）冬春季组25（OH）D3水平显著低于夏秋季组（t=-4.681,P＜0.01）,严重缺乏者和缺乏者的比例也明显增加（x2=18.202,P＜0.01）.（4）病程≥10年的两组患者25（OH）D3水平均较＜10年组明显下降（F =5.489,P＜0.05）,≥20年组严重缺乏者的比例也多于＜10年组（x2=7.284,P＜0.05）.（5）HbA1c≥7％的两组患者25（OH）D3水平均较＜7％组明显下降（F=3.963,P均＜0.01）,其严重缺乏者和缺乏者的比例也较＜7％组明显增加（x2=6.712,P＜0.05）.结论 2型糖尿病患者普遍存在维生素D缺乏,尤其是病程长和持续血糖控制不佳者,特别需加强冬季维生素D的检测和补充.

Analysis of vitamin D deficiency in patients with type 2 diabetes mellitus

Objective To analyze the serum level of 25-hydroxy vitamin D3 and the degree of vitamin D deficiency in the patients with type 2 diabetes mellitus,and the relationships between the degree of vitamin D deficiency,durations of diabetes and glycosylated hemoglobin A1c （HbA1c） levels were also investigated.Methods 140 patients with type 2 diabetes mellitus （60 male and 80 female） were selected from the Department of Endocrinology of The General Hospital of Tianjin Medical University,aged 21 to 89,with an average age of （58.25 ± 13.76） years old.Serum 25-hydroxy vitamin D3 levels between different age groups （〈50,≥ 50 and 〈70,≥70years old group） and tested season groups （winter and spring,summer and autumn group）,different duration of diabetes groups （〈 10,≥ 10 and 〈20,≥ 20 years group） and different HbA l c level groups （〈 7%,≥7% and〈 10%,≥ 10%） were compared.Results （1）The serum 25（OH）D3 levels of these 140 patients were all below normal range,and the average levels was （40.07 ± 16.12） nmol/L.The prevalence of severe vitamin D deficiency,deficiency and sufficiency were 13.57%,67.86% and 4.29%,respectively.But there was no significant difference between male and female both in the serum 25（OH）D3 levels and the degree of vitamin D deficiency（t =0.803,x2=0.189,both P 〉0.05）.（2） The serum 25（OH）D3 levels of patients aged ≥ 50 and〈70 were lower than that of the subjects aged 〈50 in male （F =2.362,P 〈0.05）.In female,the serum 25 （OH）D3 levels of patients aged ≥ 50 were lower than that of the subjects aged 〈50 （F =3.928,P 〈 0.05）,and the percentages of vitamin D deficiency were also greater than that in patients younger than 50 years （x2=10.036,P 〈0.01）.（3）The serum 25（OH）D3 levels in winter and spring were lower than that in summer and autumn （t =-4.681,P 〈0.01）,and the percentage of severe vitamin D deficiency and deficiency were increased as well （x2=18.202,P 〈 0.01）.（4）The serum 25（OH）D3 levels in patients whose durations of diabetes were more than 10 years were lower than that of patients with diabetic duration less than 10 years （F =5.489,P 〈0.05,P 〈0.01）,and the percentage of severe vitamin D deficiency in patients whose durations were more than 20 years was higher than that of patients with diabetic duration less than 10 years （x2=7.284,P 〈0.05）.（5）The serum 25 （OH）D3 levels in patients whose HbA l c were more than 7% were lower than those with HbAlc lower than 7%（F =3.963,P 〈0.01）,and the percentages of severe vitamin D deficiency and deficiency were higher than that of patients with HbAlc lower than 7% as well （x2=6.712,P 〈0.05）.Conclusion Vitamin D deficiency is common in patients with type 2 diabetes,especially in patient with long durations and continuously poor blood glucose control.The assessment and supplement of vitamin D should be strengthened in patients with diabetes especially in winter.