非肥胖2型糖尿病患者血清维生素D与炎性因子相关性研究  

Association between serum vitamin D level and inflammatory markers in non-obese patients with type 2 diabetes

作　　者：李元宾 李爽[1] 李欣[1] 王学杰[1] 檀小珍[1] 任文霞[1] 任艳杰[1] 郭文蓉 刘师伟 Li Yuanbin;Li Shuang;Li Xin;Wang Xuejie;Tan Xiaozhen;Ren Wenxia;Ren Yanjie;Guo Wenrong;Liu Shiwei(Department of the Second Endocrinology,Taiyuan Central Hospital,Taiyuan,Shanxi 030001 China;Department of Central Laboratory,Taiyuan Central Hospital,Taiyuan,Shanxi 030001,China)

机构地区：[1]太原市中心医院内分泌二科,山西省太原030001 [2]太原市中心医院中心实验室,山西省太原030001

出　　处：《中国基层医药》2018年第24期3129-3132,共4页Chinese Journal of Primary Medicine and Pharmacy

基　　金：国家自然科学基金项目(81471026).

摘　　要：目的观察非肥胖2型糖尿病(T2DM)患者血清25羟基维生素D3[25(OH)D3]水平与肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及高敏C反应蛋白(hs-CRP)等炎性因子的相关性。方法采用横断面研究选取2015年6~9月在太原市中心医院就诊的非肥胖T2DM患者120例(女性58例,男性62例)为T2DM组,并选取同期健康体检者96例(女性48例,男性48例)作为对照组。留取静脉血检测两组空腹血糖(FBG)、空腹胰岛素(INF)、糖化血红蛋白(HbA1c)、25(OH)D3和TNF-α、IL-6及hs-CRP等炎性因子的浓度。并运用HOMA稳态模型(HOMA-IR)评估胰岛素抵抗。分别观察非肥胖T2DM患者中维生素D缺乏组、维生素D不足组及维生素D正常组的临床及生化特点,并与hs-CRP、TNF-α及IL-6、HOMA-IR、INF、FBG、体质量指数(BMI)、腰臀比(WHR)等因素作相关分析,观察25(OH)D3与各因素的相关性。结果非肥胖T2DM患者25(OH)D3的浓度较对照组明显降低[(11.65±3.5)ng/mL比(18.44±5.21)ng/mL,t=-6.84,P=0.012],而非肥胖T2DM患者血清TNF-α及IL-6水平均明显高于对照组[(15.51±4.87)ng/L比(8.99±2.54)ng/L,t=7.95,P=0.017;(18.12±4.13)ng/L比(8.89±2.07)ng/L,t=10.04,P=0.007]。非肥胖T2DM患者中维生素D缺乏、不足和充足分别占60.83%、31.67%和7.50%,TNF-α及IL-6水平在三个亚组间差异均有统计学意义[(17.93±4.94)ng/L比(10.30±4.52)ng/L,F=6.897,P=0.026;(20.14±4.99)ng/L比(16.39±5.06)ng/L,F=10.589,P=0.017]。血清25(OH)D3浓度与HOMA-IR(r=-0.041,P=0.030)、TNF-α(r=-0.229,P=0.040)及IL-6(r=-0.299,P=0.032)具有相关性;而与炎性因子hs-CRP及FBG则无相关性。结论维生素D缺乏在非肥胖T2DM患者中非常普遍,血清25(OH)D3与HOMA-IR、TNF-α、IL-6有明显相关性,维生素D可能在T2DM胰岛素抵抗及慢性全身炎性反应中起作用。Objective To investigate the association between serum 25(OH)D3 and high sensitive C-reactive protein (hs-CRP),tumor necrosis factor-alpha (TNF-α),interleukin-6 (IL-6) inflammatory markers in non-obese patients with type 2 diabetes mellitus (T2DM). Methods From June 2015 to September 2015,in this cross-sectional study,120 non-obese patients with T2DM(female in 58 cases,male in 62 cases) in Taiyuan Central Hospital were selected as T2DM group,and 120 non-obese patients with T2DM and 96 healthy subjects(control group) were recruited.The serum concentrations of glucose,HbA1c,insulin,25(OH)D3 and inflammatory markers including TNF-α,IL-6 and hs-CRP were measured.A homeostatic model of insulin resistance (HOMA-IR) was also evaluated.The clinical and biochemical characteristics of T2DM were observed in the group of vitamin D deficiency group,vitamin D insufficiency group and vitamin D normal group.And the relativities were analyzed between it with hs-CRP,TNF-α,IL-6,HOMA-IR,INF,FBG,BMI,WHR,and so on.The relativities were observed between 25(OH)D3 with all the factors. Results The mean serum concentration of 25(OH)D3 in the non-obese T2DM group was (10.65±3.55)ng/mL,which was significantly lower than (18.44±5.21)ng/mL in the normal control group (t=-6.84,P=0.012).The levels of serum TNF-α and IL-6 in the T2DM group were (15.51±4.87)ng/L and (18.12±4.13)ng/L,respectively,which were significantly higher than those in the control group [(8.99±2.54)ng/L,(8.89±2.07)ng/L](t=7.95,10.04,P=0.017,0.007).The proportions of deficiency,insufficiency and normal of vitamin D in T2DM patients were 60.83%,31.67%and 7.50%,respectively .The levels of TNF-α and IL-6 in the serum 25(OH)D3 deficiency group were significantly higher than those in the normal 25(OH)D3 group [(17.93±4.94)ng/L vs.(10.30±4.52)ng/L,F=6.897,P=0.026;(20.14±4.99)ng/L vs.(16.39±5.06)ng/L,F=10.589,P=0.017].There was a significant correlation between serum 25(OH)D3 and HOMA-IR(r=-0.041;P=0.030),TNF-α(r=-0.229;P=0.040) and IL-6 levels (r=-0.299;P=0.032),but

关 键 词：糖尿病 2型 维生素D 血糖 肿瘤坏死因子Α 白细胞介素6 C反应蛋白质 人体质量指数 

分 类 号：R587.1[医药卫生—内分泌]