血清25（OH）D3与胰岛素抵抗及尿微量白蛋白的相关性研究

目的：观察2型糖尿病及糖调节受损患者血清25（OH）D3与胰岛素抵抗及尿微量白蛋白的相关性。方法：对820例健康体检人员进行筛查,共筛选出104例2型糖尿病患者（T2DM组）,其中初发糖尿病患者40例,既往诊断2型糖尿病患者64例,同时筛选出糖调节受损患者（IGR组）94例,选择同期170例非糖尿病血糖正常体检者为对照组（NGT组）。所有参与者记录身高、体重计算体重指数（ BMI）、并行口服糖耐量及胰岛素释放试验检测；留取血清,运用ELISA法检测血清25（OH）D3水平；放免法检测尿微量白蛋白（尿MA）；分析血清25（OH）D3与胰岛素抵抗及尿MA的相关性。结果：T2DM组及IGR组中25（OH）D3水平与对照组相比明显降低（P＜0.05）,2型糖尿病中有63.16%的患者维生素D缺乏,较非糖尿病患者（42.35%）明显增高（P＜0.05）；相关分析显示,血清25（OH）D3水平与空腹胰岛素呈正相关,而与年龄、BMI、空腹血糖水平、HOMA-IR、尿微量白蛋白呈负相关。结论：2型糖尿病患者血清维生素D缺乏非常严重,维生素D缺乏可能会加重胰岛素抵抗及促进尿微量白蛋白分泌。维生素D缺乏可能是2型糖尿病及糖尿病肾病发病中重要的危险因素。

The Correlation Study between Insulin Resistance,Urine Micro-albumin and Serum Vitamin D

Objective： This study is to investigate the relationship between 25-Hydroxyvitamin D,insulin resistance and Urine micro-albumin under different glucose tolerance statuses. Methods：Subjects included total 820,（455 males,365 females）. aged 40-65 years. Serum25（OH）D3,Ca2＋,P3-,Parathyroid hormone（PTH）,Fasting plasma glucose（FPG）,2hPBG,INS. TG,TC were measured by ELISA and electrochemiluminescence, respectively. , Urine micro -albumin were measured by RIA. Homeostasis model （ Homa-IR） assessment,insulin acuity index （ IAI） were determined for insulin resistance. The current study has been carried out to assess association of serum 25-hydroxyvitamin D and the function of the insulin resistance and urine micro-albumin. Results：The levels of 25（OH）D3,in the T2DM group and IGR group were significantly lower than that in NGT group （P〈0. 05）. 63. 16% of the patients with T2DM had 25（OH）D3 deficiency （≤15 ng/ml） as compared to non-diabetic population of which 42. 35% patients had 25（OH）D3 deficiency. Multiple stepwise regression analysis showed that 25（OH）D3 was one of the influential factors of insulin resistance in patients with type 2 diabetes mellitus and Diabetic nephropathy. Conclusion：Our results suggest that 25（OH）D3 is close-ly related with insulin resistance and urine micro-albumin;It is maybe one of the influential factors of T2DM and diabetic nephropa-thy.