维生素D水平与2型糖尿病患者并发糖尿病视网膜病变的关系  

Relationship between serum vitamin D levels and diabetes retinopathy in type 2 diabetes mellitus patients

作　　者：朱燕妮[1] 左国进[1] 王琦[1] 朱炎华[1] 

机构地区：[1]长江大学附属第一人民医院眼科,中国湖北省荆州市434002

出　　处：《国际眼科杂志》2013年第3期539-541,共3页International Eye Science

摘　　要：目的:观察2型糖尿病(T2DM)患者血清25-羟维生素D3[25-(OH)D3]及1,25-(OH)2D3水平与新发糖尿病视网膜病变(DR)发病率的关系,以及骨化三醇治疗是否降低T2DM患者新发DR发病率。方法:选取本院内分泌科门诊及住院的T2DM患者360例,测定其血清25-(OH)D3水平,并根据其四分位数将患者分为三组,血清25-(OH)D3水平<Q1(14.3ng/mL)患者为L组,87例;水平≥Q1(14.3ng/mL)且<Q3(19.4ng/mL)为M组,176例;水平≥Q3(19.4ng/mL)为H组,89例。另外L组患者按照随机数字表随机分为2组,其中L1组44例患者,常规降糖药物治疗,L2组43例患者,在L1组的基础上给予骨化三醇0.25μg隔日口服治疗,观察以上各组患者5年后发展到糖尿病视网膜病变的比率以及患者血清25-(OH)D3、1,25-(OH)2D3、钙、磷、甲状旁腺素(PTH)等水平变化。结果:H,M,L1组患者随访结束时其血清25-(OH)D3、1,25-(OH)2D3、钙水平明显下降(P<0.05),血清磷、PTH水平上升(P<0.05)。L2组患者以上指标的紊乱明显减轻(P<0.05)。且H,M,L1组患者DR发病率依次增高(13.48%,21.59%,45.45%,P<0.05),而L2组患者DR发生率较L1组明显降低(18.6%vs45.45%,P<0.05)。结论:相对低下血清维生素D水平的T2DM患者伴随较高的糖尿病视网膜病变发生率,骨化三醇治疗可以降低T2DM患者新发糖尿病视网膜病变的发生。· AIM： To evaluate the relationship between serum vitamin D levels and diabetes retinopathy（DR） in patients with type 2 diabetes mellitus（T2DM）. · METHODS： Totally 360 T2DM patients were chosen. Serum 25-（OH） D3 and 1,25-（ OH ）2 D3 were measured by radioimmunoassay. All patients were divided into 3 groups according to the serum 25-（OH）D3 level quartile, group L （the lowest quartile, serum 25-（OH） D3〈 14.3ng/mL, n=87）, group M （the middle two quartiles, serum 25-（OH） D3 ≥14.3ng/mL, and serum 25-（OH） D3〈 19.4ng/mL, n=176） and group H （the highest quartile, serum 25-（OH） D3 ≥ 19. 4 ng/mL, n= 89）. Then the patients of group L were randomly divided into Group L1 which received routine drug treatment without VitD and Group L2 with VitD treatment. Serum and 25-（OH）D3, 1, 25-（ OH ） 2 D3, calcium （ Ca）, phosphorus （ P）, Parathyroid Hormone（PTH） were measured at the experiment onset and at the end of follow-up visit. The new DR morbidity was calculated, too. · RESULTS： At the end of follow-up visit, serum 25-（OH）D3,1,25-（OH）2D3 and Ca levels in Group H, M, L1 were all decreased compared with their own levels at the experiment onset （ P〈0.05）, and serum P and PTH levels were increased （P〈0.05）. The above indexes disorder get improved in Group L2 at the end of follow- up visit （ P〈 0. 05）. The lower serum 25-（OH）D3 level, the higher DR morbidity（ Group H, M, L1 13. 48%, 21. 59%, 45. 45% respectively, P〈0.05）, Once Vitamin D treatment, the DR morbidity get decreased （18.6% vs45.45%, P〈0.05）. · CONCLUSION. Serum 25-（OH）D3 level is an risk factor of T2DM morbidity, and vitamin D treatment can reduce the DR morbidity in type 2 diabetic patients.

关 键 词：糖尿病 25-羟维生素D 视网膜病变 

分 类 号：R774.1[医药卫生—眼科] R587.1[医药卫生—临床医学]