3C疗法治疗1型糖尿病儿童维生素D水平研究

目的：评估维生素D与1型糖尿病（T1DM）患儿的临床关系，为T1DM的防治提供新的依据。方法：选取我院2017-2018年新诊断及使用3C疗法治疗的T1DM患儿，分析T1DM患儿与健康体检患儿血清25-羟维生素D［25(OH)D］水平。根据25(OH) D水平，将T1DM患儿分为3组（缺乏组、不足组及充足组），比较三个亚组的性别、年龄、居住地、体质量指数（BMI）、空腹C肽、空腹血糖及胰岛素用量等情况，探讨不同tanner分期、性别、季节、有无合并糖尿病酮症酸中毒（DKA）与血清维生素D水平的关系。结果：T1DM组患儿血清25(OH)D水平为（42.31±22.01）nmol/L，较健康对照组的（50.37±22.28）nmol/L低，差异有统计学意义（P<0.05）。T1DM组患儿中，维生素D充足组的空腹C肽水平高于维生素D不足组及维生素D缺乏组（P<0.05）；维生素D缺乏组空腹血糖水平及单位体质量胰岛素用量高于维生素D充足组（P<0.05）。按血清25(OH)D水平测定时间不同分A组（1-3月、10-12月）和B组（4-9月），A组25(OH)D水平低于B组（P<0.05）；合并DKA组25(OH)D水平低于无DKA组（P<0.05）。结论：T1DM患儿普遍存在维生素D缺乏，尤其是合并DKA、及1-3月及10-12月的患儿；维生素D充足的T1DM患儿可减少胰岛素用量。临床上要加强T1DM患儿的维生素D的监测以及补充。

Effects of 3C Therapy on Vitamin D Levels of Children with Type 1 Diabetes Mellitus

Objectives: To evaluate the clinical correlation between vitamin D and children with type 1 diabetes mellitus (T1DM) and provide new basis for the prevention and treatment of T1DM. Methods: Children newly diagnosed with T1DM and treated with 3C therapy in our hospital from 2017 to 2018 were selected, the serum levels of 25-hydroxyvitamin D (25(OH)D) of children with T1DM and children with healthy physical examination were analyzed. According to the levels of 25(OH)D, children with T1DM were divided into 3 subgroups (deficient group, insufficient group and sufficient group). The gender, age, residence, body mass index (BMI), fasting C-peptide, fasting blood glucose and insulin dosage of three subgroups were compared. The correlation between different tanner stages, gender, season, presence or absence of diabetic ketoacidosis (DKA) and serum vitamin D levels was investigated. Results: The serum level of 25(OH)D in the T1DM group was (42.31±22.01) nmol/L, lower than that in the healthy control group (50.37±22.28) nmol/L, and the difference was statistically significant (P<0.05). In the T1DM group, the fasting C-peptide level of the vitamin D sufficient group was higher than that of the vitamin D insufficient group and the vitamin D deficient group (P<0.05). The fasting blood glucose level and the amount of insulin per body mass in the vitamin D deficit group were higher than those in the vitamin D sufficient group (P<0.05). According to the measurement time of 25(OH)D, all patients can be divided into the group A (from 1 to 3 months, from 10 to 12 months) and group B (from 4 to 9 months), the level of 25(OH)D in group A was lower than that in group B (P<0.05). The level of 25(OH)D in patients with DKA was lower than that in patients without DKA (P<0.05). Conclusion: Vitamin D deficiency is common in children with T1DM, especially in children with DKA and from 1 to 3 months and from 10 to 12 months. Children with T1DM with sufficient vitamin D can reduce the insulin dosage. It is necessary to strengthen the monitoring and supplement of vitamin D in children with T1DM.