2型糖尿病患者血25-羟维生素D水平的改变及其对血糖与骨量的影响

目的：研究2型糖尿病患者血25-羟维生素D[25（OH）D]水平的改变对血糖与骨量的影响。方法本研究收集621例复旦大学附属中山医院内分泌科2009年10月至2011年3月住院2型糖尿病患者的临床资料，将测得的血25（OH）D进行季节校正后纳入分析。以血25（OH）D等于50 nmol/L为界将患者分为25（OH）D缺乏组[25（OH）D＜50 nmol/L]及25（OH）D非缺乏组[25（OH）D≥50 nmol/L]两组，观察两组之间糖代谢指标[包括空腹血糖（FBS）、餐后2 h血糖（2 h PG）、糖化血红蛋白（HbA1c）、糖化白蛋白、空腹胰岛素（FINS）]及骨代谢指标[包括甲状旁腺激素（PTH）、碱性磷酸酶（ALP）、骨密度]的差异。结果（1）2型糖尿病患者25（OH）D的平均水平低于50 nmol/L，而且女性较男性更低（P＜0.001）；（2）维生素D缺乏组血空腹胰岛素水平高于维生素D非缺乏组（P＜0.05），胰岛素抵抗指数（HOMA-IR）也高于维生素D非缺乏组（P＜0.001）。FPG、HbA1c及胰岛素分泌指数（HOMA-B）两组间无明显统计学差异；（3）维生素D缺乏组PTH高于维生素D非缺乏组（P＜0.05）；维生素D缺乏组腰椎、股骨颈和全髋骨密度均低于维生素D非缺乏组（P＜0.05）；钙磷乘积及ALP两组间无统计学意义差异。结论2型糖尿病患者普遍存在维生素D缺乏，在2型糖尿病人群中，胰岛素抵抗、骨量流失可能与血25（OH）D水平降低有关。

Serum 25-hydroxy vitamin D level in diabetic patients and its effect on blood glucose and bone mass

Objective To observe serum 25-hydroxy vitamin D levels in type 2 diabetic patients and its effect on blood glucose and bone mass. Methods Data of 621 type 2 diabetes mellitus （T2DM） patients admitted to Endocrine division of Zhongshan hospital affiliated to Fudan university were collected from 2009.10 to 2011.3. The patients were divided into vitamin D deficiency and non-deficiency groups according to serum 25（OH）D level. We analyzed data of glucose metabolism （FPG, HbAlc, FINS, HOMA-IR and HOMA-B） and bone metabolism （PTH, calcium-phosphorus product, ALP, total lumbar BMD, femoral neck BMD and total hip BMD） to observe the effect of serum levels of 25（OH）D in T2DM on glucose and bone metabolism. Results The average level of serum 25（OH）D in T2DM patients was below 50 nmol/L, the level for females being lower than that for males （P〈0.001）. Compared with vitamin D non-deficiency group, FINS values and HOMA-IR values were higher for vitamin D deficiency group （P〈0.05）. Compared with vitamin D non-deficiency group, PTH values were higher ,while total lumbar BMD, femoral neck BMD and total hip BMD were lower for vitamin D deficiency group （P〈0.05）. Conclusion Type 2 Diabetic patients have high morbidity of Vitamin D deficiency. The insulin resistance and the bone loss in type 2 diabetic patients may be related to the deficiency of Vitamin D.