2型糖尿病患者25(OH)D水平与血糖、胰岛功能、季节及节气的关系  

Study on the correlations between 25(OH)D levels and blood glucose, islet function, seasons, and solar terms in patients with type 2 diabetes mellitus

作　　者：瞿佳嫣 陆静波[2] 孟彩萍 荣丽媛[4] QU Jia-yan;LU Jing-bo;MENG Cai-ping;RONG Li-yuan(Department of Endocrinology,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China;不详)

机构地区：[1]上海中医药大学附属岳阳中西医结合医院内分泌科,上海200437 [2]上海中医药大学附属岳阳中西医结合医院护理部,上海200437 [3]上海中医药大学附属岳阳中西医结合医院胃肠镜室,上海200437 [4]上海中医药大学附属岳阳中西医结合医院介入中心,上海200437

出　　处：《广东医学》2025年第1期138-144,共7页Guangdong Medical Journal

基　　金：上海中医药大学后备卓越中医人才项目(RY411.40.08);优秀青年人才育苗计划基金资助(RY411.34.02)。

摘　　要：目的探究2型糖尿病(T2DM)住院患者血清25羟维生素D[25(OH)D]的影响因素,分析25(OH)D与血糖、糖化血红蛋白、胰岛素、胰岛素抵抗指数(HOMA2-IR)、胰岛β细胞功能指数(HOMA2-β)、胰岛素敏感性(HOMA2-IS)、发病季节及节气的关系。方法选取2022年7月至2023年2月上海中医药大学附属岳阳中西医结合医院T2DM住院患者871例,记录患者的性别、年龄、体质指数(body mass index,BMI)、糖尿病病程、发病季节及节气。检测糖化血红蛋白,空腹、餐后1 h、餐后2 h的血糖,C肽及胰岛素等实验室指标。采用改良HOMA公式计算HOMA2-IR、HOMA2-β及HOMA2-IS。将T2DM患者根据25羟维生素D水平分为维生素D充足组(>75 nmol/L)、维生素D不足组(50~75 nmol/L)、维生素D缺乏组(25~<50 nmol/L)、维生素D严重缺乏组(<25 nmol/L)。结果BMI、糖化血红蛋白值、餐后1 h血糖值、空腹胰岛素、空腹C肽、HOMA2-IR值与25(OH)D水平呈负相关,HOMA2-β、HOMA2-IS与25(OH)D水平呈正相关;不同年龄段男性患者、不同BMI女性血清25(OH)D水平差异有统计学意义(P<0.05);男性及女性血清25(OH)D水平在春季均最低;男性患者在白露时血清25(OH)D水平最高,在小寒时血清25(OH)D水平最低;女性患者在立冬时血清25(OH)D水平最高,在大雪时血清25(OH)D水平最低。结论高血糖、低胰岛功能、不同年龄、性别、BMI、季节、节气是影响2型糖尿病患者25(OH)D水平的因素,为今后2型糖尿病患者骨质疏松的防治工作提供数据参考。Objective To investigate factors influencing serum 25-hydroxyvitamin D[25(OH)D]levels in hospitalized patients with type 2 diabetes mellitus(T2DM),and to analyze its relationship with blood glucose,glycated hemoglobin(HbA1C),insulin,HOMA2-IR,HOMA2-β,HOMA2-IS,seasons,and solar terms.Methods A total of 871 hospitalized T2DM patients from Yueyang Hospital of Integrated Traditional Chinese and Western Medicine between July 2022 and February 2023 were enrolled.Patient demographics(sex,age,BMI,diabetes duration,season,and solar term of disease onset)were recorded.Laboratory measurements included HbA1C,fasting blood glucose(FBG),postprandial blood glucose(1-hour and 2-hour),fasting insulin,and C-peptide.The modified HOMA formula was used to calculate HOMA2-IR(insulin resistance),HOMA2-β(β-cell function),and HOMA2-IS(insulin sensitivity).Patients were categorized into four groups based on their 25(OH)D levels:sufficient(>75 nmol/L),insufficient(50-75 nmol/L),deficient(25-<50 nmol/L),and severely deficient(<25 nmol/L).Results BMI,HbA1C,postprandial 1-hour glucose,fasting insulin,fasting C-peptide,and HOMA2-IR were negatively correlated with 25(OH)D levels,while HOMA2-βand HOMA2-IS were positively correlated.Significant differences in 25(OH)D levels were observed across different age groups in men and BMI categories in women(P<0.05).Both men and women had the lowest 25(OH)D levels during spring.Among men,25(OH)D levels peaked at the solar term Bailu and were lowest at Xiaohan;in women,levels were highest at Lidong and lowest at Daxue.Conclusion Hyperglycemia,reduced islet function,age,sex,BMI,seasons,and solar terms are key factors influencing 25(OH)D levels in T2DM patients.These findings provide a reference for preventing and managing osteoporosis in T2DM patients.

关 键 词：2型糖尿病 25羟维生素D 血糖 胰岛功能 季节 

分 类 号：R587.1[医药卫生—内分泌] R34[医药卫生—内科学]