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血清维生素D与糖尿病足并发症

Serum vitamin D and diabetic foot complications.

作者信息

Greenhagen Robert M, Frykberg Robert G, Wukich Dane K

机构信息

Midwest Foot and Ankle Fellowship, Foot and Ankle Center of Nebraska, Omaha, NE, USA.

Midwestern University Program in Podiatric Medicine, Midwestern University, Fountain Hills, AZ, USA.

出版信息

Diabet Foot Ankle. 2019 Feb 19;10(1):1579631. doi: 10.1080/2000625X.2019.1579631. eCollection 2019.

Abstract

: Foot complications such as ulceration and neuropathy are common complications of diabetes mellitus (DM). Previous reports have demonstrated a possible increased risk of these complications in diabetic patients with low levels of serum vitamin D.: The purpose of this study is to compare serum vitamin D levels in diabetic patients with and without Charcot neuroarthropathy (CN), peripheral arterial disease (PAD), infection (DFI), ulceration (DFU), and peripheral neuropathy (DPN). : A retrospective chart review of all patients undergoing foot and ankle surgery with a history of DM over a 13 month period was performed. From this cohort, fifty subjects with CN were matched with 50 without CN and preoperative lab values were compared. A secondary evaluation was performed on the subjects' other comorbidities including PAD, DFI, DFU, and DPN. : Seventy-eight percent of our patients had vitamin D deficiency or insufficiency. Preoperative serum vitamin D levels were not significantly different between diabetic patients with and without CN (p = 0.55). Diabetic patients with PAD (p = 0.03), DFI (p = 0.0006), and DFU (p = 0.04) were all found to have significantly lower serum vitamin D levels than diabetic patients without these complications. Lower levels of serum albumin and higher serum creatinine were also noted with subjects with PAD, DFI, DPN, and DFU. While seasonal serum vitamin D level fluctuation was noted, this difference did not reach statistical significance with the numbers available. : We found various lower extremity complications to be associated with low serum vitamin D including PAD, DFI, and DFU. While other studies have questioned the role of vitamin D and CN, we were unable to identify any significant difference between diabetic patients with and without Charcot neuroarthropathy. : Level 2.

摘要

足部并发症如溃疡和神经病变是糖尿病(DM)的常见并发症。既往报告显示,血清维生素D水平低的糖尿病患者发生这些并发症的风险可能增加。

本研究的目的是比较患有和未患有夏科特神经关节病(CN)、外周动脉疾病(PAD)、感染(DFI)、溃疡(DFU)和外周神经病变(DPN)的糖尿病患者的血清维生素D水平。

对在13个月期间接受过足踝手术且有糖尿病病史的所有患者进行了回顾性病历审查。从该队列中,将50名患有CN的受试者与50名未患有CN的受试者进行匹配,并比较术前实验室值。对受试者的其他合并症进行了二次评估,包括PAD、DFI、DFU和DPN。

我们的患者中有78%存在维生素D缺乏或不足。患有和未患有CN的糖尿病患者术前血清维生素D水平无显著差异(p = 0.55)。发现患有PAD(p = 0.03)、DFI(p = 0.0006)和DFU(p = 0.04)的糖尿病患者的血清维生素D水平显著低于没有这些并发症的糖尿病患者。患有PAD、DFI、DPN和DFU的受试者还存在血清白蛋白水平较低和血清肌酐较高的情况。虽然注意到血清维生素D水平存在季节性波动,但根据现有数据,这种差异未达到统计学意义。

我们发现包括PAD、DFI和DFU在内的各种下肢并发症与血清维生素D水平低有关。虽然其他研究对维生素D与CN的关系提出了质疑,但我们未能发现患有和未患有夏科特神经关节病的糖尿病患者之间存在任何显著差异。

证据级别

2级

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/88e1/6383621/e3b70a1c801b/ZDFA_A_1579631_F0001_B.jpg

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