1 型糖尿病患者的维生素 D 状态与非酒精性脂肪性肝病。
Vitamin D status and non-alcoholic fatty liver disease in patients with type 1 diabetes.
机构信息
Division of Metabolic Diseases, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
, Solagna, Italy.
出版信息
J Endocrinol Invest. 2019 Sep;42(9):1099-1107. doi: 10.1007/s40618-019-01031-8. Epub 2019 Mar 7.
PURPOSE
In patients with type 1 diabetes (T1D), the prevalence of non-alcoholic fatty liver disease (NAFLD) ranges from 10 to 53% and contrasting evidence suggests that vitamin D deficiency may favor liver fat accumulation. Here, we investigated the association between vitamin D status and NAFLD in adults with T1D.
METHODS
220 consecutive adult T1D patients on multiple daily injections or continuous subcutaneous insulin infusion and not taking calcium or vitamin D supplements were included. Patient characteristics, 25(OH)D serum levels, and metabolic parameters were analyzed. Vitamin D status was defined as sufficiency ( ≥ 75 nmol/L; 30 ng/ml), insufficiency (50-75 nmol/L; 20-30 ng/ml), or deficiency ( < 50 nmol/L; 20 ng/ml). NAFLD was diagnosed at ultrasound examination and graded 0-3.
RESULTS
NAFLD was present in 57 patients (29.5%): 51 grade 1, 5 grade 2, and 1 grade 3. Median 25(OH)D levels were 53 nmol/L (IQR 38-70) in patients with NAFLD and 50 nmol/L (34-69) in patients without (p = 0.46). At multivariable analysis, NAFLD was not associated with 25(OH)D levels (p = 0.42) or vitamin D deficiency (p = 0.55), while BMI (OR 1.16, 95% CI 1.07-1.27) and serum triglycerides (OR 1.02, 95% CI 1.01-1.03) were independently associated with NAFLD.
CONCLUSIONS
Vitamin D status appears to have no link with low-grade NAFLD in patients with type 1 diabetes.
目的
在 1 型糖尿病（T1D）患者中，非酒精性脂肪性肝病（NAFLD）的患病率为 10%至 53%，而对比证据表明，维生素 D 缺乏可能有利于肝脏脂肪堆积。在此，我们研究了维生素 D 状态与 T1D 成人患者中 NAFLD 的关系。
方法
纳入了 220 名接受多次皮下注射或连续皮下胰岛素输注且未服用钙或维生素 D 补充剂的连续成年 T1D 患者。分析了患者特征、25(OH)D 血清水平和代谢参数。维生素 D 状态定义为充足（ ≥ 75 nmol/L；30 ng/ml）、不足（50-75 nmol/L；20-30 ng/ml）或缺乏（ < 50 nmol/L；20 ng/ml）。NAFLD 通过超声检查诊断，并分为 0-3 级。
结果
57 名患者（29.5%）存在 NAFLD：51 级 1 例，5 级 2 例，1 级 3 例。NAFLD 患者的中位 25(OH)D 水平为 53 nmol/L（IQR 38-70），无 NAFLD 患者的中位 25(OH)D 水平为 50 nmol/L（34-69）（p = 0.46）。多变量分析显示，NAFLD 与 25(OH)D 水平无关（p = 0.42），与维生素 D 缺乏无关（p = 0.55），而 BMI（OR 1.16，95% CI 1.07-1.27）和血清甘油三酯（OR 1.02，95% CI 1.01-1.03）与 NAFLD 独立相关。
结论
维生素 D 状态似乎与 1 型糖尿病患者的低度 NAFLD 无关。
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