Feldkamp Joachim, Jungheim Karsten, Schott Matthias, Jacobs Beatrix, Roden Michael
Klinikum Bielefeld, Department of Endocrinology and Diabetes, Bielefeld, Germany.
Division for Specific Endocrinology, Medical Faculty, University Hospital Duesseldorf, Duesseldorf, Germany.
Horm Metab Res. 2018 Aug;50(8):615-619. doi: 10.1055/a-0648-8178. Epub 2018 Jul 5.
Diabetic foot ulcers are a severe complication in patients with diabetes mellitus. Vitamin D is associated with impaired β-cell function and insulin resistance, and is necessary for wound healing and bone metabolism. We measured the serum concentrations of 25-hydroxyvitamin D in 104 patients (63 inpatients, 41 outpatients) with diabetic foot ulcers and compared them to 99 healthy humans (control) and 103 patients with diabetes mellitus type 2 without diabetic foot ulcers. Calcium, creatinine, and parathyroid hormone were measured in patients with diabetic foot ulcers. The data were analysed together with glycosylated hemoglobin A1c and the severity of diabetic foot lesions according to the Armstrong classification. Levels of 25-hydroxyvitamin D were lower (11.8±11.3 ng/ml, p<0.001) in patients with diabetic foot ulcers (mean age 70±12 years) than in the control group (27.2±12.2 ng/ml). No difference was found between in- and outpatients. Fifty-eight (55.8%) of patients with diabetic foot ulcers had a severe 25-hydroxyvitamin D deficiency with levels below 10 ng/ml. Only 12% of the patients had 25-hydroxyvitamin D levels above 20 ng/ml. Secondary hyperparathyroidism was found in 27.9% of patients and 11.5% of the patients were hypocalcemic. There was a negative correlation (r=-0.241) (p<00.1) between Armstrong classification and 25-hydroxyvitamin D status. In conclusion, patients with diabetic foot syndrome are at high risk of 25-hydroxyvitamin D deficiency. Thus, any patient with diabetic foot syndrome should undergo 25-hydroxyvitamin D measurement and supplementation, if values are found to be decreased.
糖尿病足溃疡是糖尿病患者的一种严重并发症。维生素D与β细胞功能受损和胰岛素抵抗有关，是伤口愈合和骨代谢所必需的。我们测量了104例糖尿病足溃疡患者（63例住院患者，41例门诊患者）的血清25-羟基维生素D浓度，并将其与99名健康人（对照组）和103例无糖尿病足溃疡的2型糖尿病患者进行比较。对糖尿病足溃疡患者进行了钙、肌酐和甲状旁腺激素的检测。根据阿姆斯特朗分类法，将数据与糖化血红蛋白A1c以及糖尿病足病变的严重程度一起进行分析。糖尿病足溃疡患者（平均年龄70±12岁）的25-羟基维生素D水平（11.8±11.3 ng/ml，p<0.001）低于对照组（27.2±12.2 ng/ml）。住院患者和门诊患者之间未发现差异。58例（55.8%）糖尿病足溃疡患者存在严重的25-羟基维生素D缺乏，水平低于10 ng/ml。只有12%的患者25-羟基维生素D水平高于20 ng/ml。27.9%的患者出现继发性甲状旁腺功能亢进，11.5%的患者血钙过低。阿姆斯特朗分类与25-羟基维生素D状态之间存在负相关（r=-0.241）（p<0.01）。总之，糖尿病足综合征患者存在25-羟基维生素D缺乏的高风险。因此，任何糖尿病足综合征患者都应进行25-羟基维生素D检测，若发现值降低则应进行补充。
