2型糖尿病患者血清25-羟维生素D浓度与颈动脉内膜中层厚度的关系  

Serum 25-hydroxyvitamin D concentration is negatively related to carotid artery intima-media thickness in type 2 diabetic patients

作　　者：刘金霞[1] 项洁[1] 卜瑞芳[1] 吴文君[1] 沈泓[1] 王霞娟[1] 

机构地区：[1]南京医科大学附属无锡市人民医院内分泌科,214023

出　　处：《中华心血管病杂志》2012年第2期115-119,共5页Chinese Journal of Cardiology

摘　　要：目的 探讨在2型糖尿病（T2DM）患者中25-羟维生素D[25（OH）D]浓度同颈动脉内膜中层厚度（IMT）的关系,及25 （OH）D可否作为T2DM患者临床前期动脉粥样硬化的预测指标.方法 入选300例T2DM患者,检测血脂、糖化血红蛋白C（HbA1c）、C反应蛋白（CRP）等血液生化指标,用ELISA法测定血清25（OH）D的浓度,用彩色多普勒超声测量颈动脉IMT.根据血清25 （OH）D浓度的四分位数分为4组：Q1组（＜26.17 nmol/L,74例）,Q2组（26.17 ～32.75 nmol/L,76例）,Q3组（32.75 ～42.93 nmol/L,78例）,Q4组（＞42.93 nmol/L,72例）,分析25 （OH）D浓度与颈动脉IMT的关系.结果 在T2DM患者中,血清25（OH）D低浓度组与高浓度组相比,颈动脉IMT、颈动脉斑块发生率、糖尿病病程、HbA1c、CRP、甲状旁腺素（PTH）差异均有统计学意义（P均＜0.05）.Q1、Q2组颈动脉IMT明显高于Q4组（1.03±0.21比0.90± 0.20,1.01±0.26比0.90±0.20,P均＜0.05）,而与Q3组比较差异无统计学意义；Q1组的颈动脉斑块发生率[50.0％ （37/74）]明显高于Q3[29.5％（23/78）]和Q4组[16.7％ （12/72）,P均＜0.05]；有斑块组的25（OH）D浓度明显低于无斑块组[ （28.31 ±4.91） nmol/L比（36.31±4.31） nmol/L,P＜0.01].Pearson相关分析显示颈动脉IMT与年龄、吸烟、体质指数、HbA1c、CRP、低密度脂蛋白胆固醇及PTH/25 （OH）D比值呈正相关（P均＜0.05）,与25（OH）D浓度呈负相关（r=-0.51,P＜0.01）.多元回归分析显示颈动脉IMT与25（OH）D浓度具有独立相关性（β=-0.39,P＜0.01）.结论 T2DM患者血清25（OH）D浓度是颈动脉IMT增加的独立危险因素,25（OH）D浓度可作为全身动脉粥样硬化的预测指标.Objective To evaluate the relationship between 25-hydroxy vitamin D [ 25 （OH）D ]and carotid artery intimal medial thickness （IMT） in type 2 diabetic （T2DM） patients.Methods Serum 25 （OH） D and carotid IMT were measured in 300 T2DM patients.Patients were divided into four quartile groups according to the serum 25 （OH） D levels（ Q1：〈 26.17 nmol/L,74 cases; Q2：26.17 - 32.75nmol/L,76 cases; Q3：32.75 -42.93 nmol/L,78 cases; Q4 〉42.93 nmol/L,72 cases）.Results Carotid IMT,carotid artery plaque prevalence,duration of diabetes,HbA1c,CRP and PTH were significantly higher in subjects with low 25 （OH）D compared subjects with high 25 （OH）D （P 〈 0.05 ）.Carotid artery IMT in Q1 and Q2 groups were significantly higher than that in Q4 group （ 1.03 ± 0.21 vs.0.90 ± 0.20,1.01 ±0.26 vs.0.90 ±0.20,P 〈 0.05）,was similar among Q1 and Q2 and Q3 groups.Prevalence of carotid atherosclerotic plaque in Q1 group （50.0%） was also significantly higher than in Q3 （29.5%,P 〈0.05 ） and Q4 （ 16.7 %,P 〈 0.05 ）.Similarly,25 （OH） D concentration was significantly lower in patients with carotid plaque compared patients without carotid plaque [ （28.31 ±4.91 ） nmol/L vs.（36.31 ±4.31 ）nmol/L,P 〈 0.01 ].Pearson correlation analysis showed that carotid IMT was positively correlated with age,smoking,BMI,HbA1 c,CRP,LDL-C,PTH/25 （OH） D ratio （P 〈 0.05 ）,and was negatively correlated with 25 （OH） D （ r =- 0.51,P 〈 0.01 ）.Multivariate regression analysis showed that 25 （OH） D concentration was an independent predictor of carotid IMT in this cohort （ β =- 0.39,P 〈 0.01 ）.Conclusion Serum 25 （OH） D concentration is negatively correlated with carotid IMT and low 25 （OH） D level is a risk factor for preclinical atherosclerosis in T2DM patients.

关 键 词：糖尿病 2型 25-羟维生素D 超声检查 多普勒 

分 类 号：R587.1[医药卫生—内分泌]