2型糖尿病患者血25羟维生素D的改变及其对糖代谢与骨密度的影响

目的 探讨2型糖尿病患者血25羟维生素D25(OH)D]的改变及其对糖代谢与骨密度的影响.方法 选择我院住院的2型糖尿病患者258例,以25(OH)D为50 nmol/L为临界值进行分组,分为维生素D缺乏组25 (OH)D＜50 nmol/L] 192例及维生素D相对不足组25 (OH)D为50 ～ 70nmol/L]66例.双能X线骨密度仪(DXA)测量患者腰椎L2～L4及股骨颈骨密度,取腰椎Total值、股骨颈Neck和Total值为判定指标,采用稳态模型评估胰岛素抵抗(HOMA-IR)程度,收集分析患者糖代谢与骨代谢相关指标数据并进行统计分析.结果 258例2型糖尿病患者中骨质疏松57例,占22.1％.其中维生素D缺乏组与维生素D相对不足组的糖尿病病程、空腹胰岛素和胰岛素抵抗指数差异均有统计学意义(7.98±1.09)、(3.77±1.21)年,(6.42±1.30)、(5.79±1.08) mU/L、(2.35±0.54)、(1.85±0.41),t值分别为4.849、3.871、2.705,P均＜0.05],而空腹血糖与糖化血红蛋白差异均无统计学意义(P均＞0.05),维生素D缺乏组与维生素D相对不足组的甲状旁腺激素、腰椎Total值、股骨颈Neck值、股骨颈Total值差异均有统计学意义(36.51±7.59)、(32.02±6.89) ng/L,(0.87±0.14)、(0.99±0.12) g/cm2,(0.70±0.10)、(0.79±0.11)g/cm2,(0.84±0.14)、(0.97±0.15) g/cm2,t值分别为2.008、2.799、2.564、2.340,P均＜0.05].结论 2型糖尿病患者中普遍存在维生素D缺乏,维生素D的水平将影响糖尿病患者胰岛素抵抗和血糖控制及骨密度水平,导致骨质疏松发病率明显增加.因此,对糖尿病患者应进行常规维生素D检测,并对维生素D缺乏的患者及时给予维生素D补充治疗.

Serum level of 25-hydroxyvitamin D and its impact on glucose metabolism and bone mineral density in type 2 diabetic patients

Objective To investigate the change of 25-hydroxyl vitamin D level and its impact on glucose metabolism and bone mineral density in type 2 diabetic patients. Methods Two hundred and fifty-eight cases of type 2 diabetic patients in our hospital were collected. In accordance with 25 （OH） D = 50 nmol/L for the critical values,they were grouped into vitamin D deficiency group （n = 192） and the relative lack of vitamin D group （ n = 66）. Dual-energy X-ray absorptiometry （DXA） measurement of the lumbar vertebrae L2 - IA and femoral neck bone mineral density were undertaking. Taking the total value of the lumbar spine, femoral neck and total value as judgment indicators, homeostasis model assessment of insulin resistance （ HOMA-IR）, we collected and statistically analyzed glucose metabolism and bone metabolism indicators in patients with diabetes. Results Among 258 cases of type 2 diabetes, there were 57 cases of osteoporosis accounting for 22. 1%. There was significant difference on the duration of diabetes （ 7. 98 ＋ 1.09 ） years old vs （ 3.77 ＋ 1.21 ） years old, t = 4. 849,P 〈 0. 05 ], FINS （6.42 ± 1.30）mU/L vs （5.79 ± 1.08）mU/L, t = 3. 871,P 〈 O. 05 ] and HOMA-IR （2. 35 ±0. 54） vs （ 1.85 ±0. 41 ） ,t =2. 705 ,P 〈0. 05 ] ,but no significant difference on the FPG and HbAlc （P〉 0. 05） between two groups. PTH （36. 51 ±7.59） ng/L vs （32. 02 ±6. 89） ng/L,t =2. 008,P 〈0. 05], bone mineral density in the lumbar total value （0. 87 ＋0. 14） g/cm2 vs （0. 99 ±0. 12） g/cm2 ,t =2. 799 ,P 〈 0. 05 ], femoral neck Neck （ 0.70 ±0. 10 ） g/cm2 vs （ 0. 79± 0. 11 ） g,/cm2, t = 2. 564, P 〈 0. 05 ] and Total （0. 84 ± 0. 14） g/cm2 vs （0. 97 ＋ 0. 15 ） g/cm2, t = 3. 340 P 〈 0.05 ] were statistically different, but no significant difference on the rest of the indicators. Conclusion The prevalence of vitamin D deficiency was found in patients with diabetes. Vitamin D level could affect insulin resistance and glycemic control and bone mineral density level. Therefore, routine vitamin D testing to the diabetic patients and giving vitamin D replacement therapy to vitamin D deficiency patients in a timely manner were necessary.