Stockholm CF Centre, B 59, Karolinska Institutet, Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden.
Diabetologia. 2011 Dec;54(12):3007-15. doi: 10.1007/s00125-011-2287-1. Epub 2011 Sep 7.
AIMS/HYPOTHESIS: Many cystic fibrosis patients are vitamin D-insufficient. Cystic fibrosis-related diabetes is a major complication of cystic fibrosis. The literature suggests that vitamin D might possess certain glucose-lowering properties. We aimed to assess the relationship between vitamin D and cystic fibrosis-related glucose intolerance.
We enrolled 898 cystic fibrosis patients from Sweden, Norway and Denmark. Vitamin D intake was assessed using a seven-day food record. Serum 25-hydroxyvitamin D (s25OHD) and HbA(1c) were measured, and an OGTT was carried out. Multiple linear and logistic regressions were used for HbA(1c) and cystic fibrosis-related diabetes/OGTT result as outcome variables, respectively. Each model was controlled for country, and for known cystic fibrosis-related diabetes risk factors: age, sex, genotype, liver dysfunction, long-term corticosteroid treatment, and lung and pancreatic function.
Degree of vitamin D insufficiency (OR 1.36; p = 0.032) and s25OHD < 30 nmol/l (OR 1.79; p = 0.042) were significant risk factors for cystic fibrosis-related diabetes. Accordingly, HbA(1c) value was positively associated with s25OHD < 30 nmol/l and < 50 nmol/l, as well as with degree of vitamin D insufficiency (adjusted R (2) = 20.5% and p < 0.05 in all). In subgroup analyses, s25OHD < 30 nmol/l determined the HbA(1c) value in paediatric patients (adjusted R (2) = 20.2%; p = 0.017), but not in adults.
CONCLUSIONS/INTERPRETATION: Vitamin D status is associated with HbA(1c) and diabetes in cystic fibrosis, particularly in children. The study justifies prospective studies on the proposed role of vitamin D deficiency in the pathophysiology of diabetes mellitus.
目的/假设：许多囊性纤维化患者存在维生素 D 不足。囊性纤维化相关性糖尿病是囊性纤维化的主要并发症。文献表明，维生素 D 可能具有一定的降血糖作用。我们旨在评估维生素 D 与囊性纤维化相关葡萄糖耐量之间的关系。
我们从瑞典、挪威和丹麦招募了 898 名囊性纤维化患者。使用七天食物记录评估维生素 D 摄入量。测量血清 25-羟维生素 D（s25OHD）和糖化血红蛋白（HbA(1c)），并进行口服葡萄糖耐量试验（OGTT）。使用多元线性和逻辑回归分别将 HbA(1c)和囊性纤维化相关糖尿病/OGTT 结果作为因变量进行分析。每个模型均控制了国家以及已知的囊性纤维化相关糖尿病危险因素：年龄、性别、基因型、肝功能障碍、长期皮质类固醇治疗以及肺和胰腺功能。
维生素 D 不足程度（OR 1.36；p = 0.032）和 s25OHD<30 nmol/l（OR 1.79；p = 0.042）是囊性纤维化相关糖尿病的显著危险因素。因此，HbA(1c)值与 s25OHD<30 nmol/l 和 s25OHD<50 nmol/l 以及维生素 D 不足程度呈正相关（所有调整后 R(2)均为 20.5%，p<0.05）。在亚组分析中，s25OHD<30 nmol/l 决定了儿科患者的 HbA(1c)值（调整后 R(2)为 20.2%；p=0.017），但在成人中则不然。
结论/解释：维生素 D 状态与囊性纤维化中的 HbA(1c)和糖尿病相关，尤其是在儿童中。该研究证明了维生素 D 缺乏在糖尿病发病机制中的潜在作用值得进一步进行前瞻性研究。
