血清维生素 D 水平与 2 型糖尿病患者糖尿病微血管并发症的关系。
Relationship of serum vitamin D levels with diabetic microvascular complications in patients with type 2 diabetes mellitus.
机构信息
Department of Endocrinology and Metabolism, Shanghai Clinical Center for Metabolic Diseases, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
Shanghai Clinical Center for Metabolic Diseases, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Diabetes Institute, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
出版信息
Chin Med J (Engl). 2021 Feb 3;134(7):814-820. doi: 10.1097/CM9.0000000000001364.
BACKGROUND
Vitamin D deficiency has been reported to be associated with diabetic microvascular complications, but previous studies have only focused on the relationship between vitamin D and specific complications. Therefore, we aimed to explore the relationship between vitamin D level and diabetic microvascular complications in general, including diabetic retinopathy (DR), diabetic nephropathy (DN), and diabetic peripheral neuropathy (DPN).
METHODS
This was a cross-sectional study of 815 patients with type 2 diabetes mellitus (T2DM). Clinical information and laboratory results were collected from the medical records. The relationship between vitamin D and the three diabetic microvascular complications was investigated.
RESULTS
The serum 25-hydroxyvitamin D (25 [OH] D) level of patients with DPN and/or DN was significantly lower than that of T2DM patients without any microvascular complications (P < 0.01). Univariate analysis showed that the 25 (OH) D level was related to DPN and DN, but not DR. After adjustment, the 25 (OH) D level was confirmed to be an independent protective factor for DPN (odds ratio [OR]: 0.968, P = 0.004]) and DN (OR: 0.962, P = 0.006). The prevalence of DPN and DN increased significantly as the serum 25 (OH) D levels decreased. Furthermore, patients with both DPN and DN had the lowest concentration of serum 25 (OH) D (P < 0.001), and the prevalence of macroalbuminuria increased more abruptly than that of microalbuminuria across the 25 (OH) D tertiles. Among the patients with vitamin D insufficiency, those with DPN presented more comorbid macroalbuminuria than those without DPN (15.32% vs. 4.91%; P = 0.001).
CONCLUSIONS
Vitamin D deficiency is independently associated with higher risk of DPN and DN, but not DR, in T2DM patients. Further, it may be a potential predictor for both the occurrence and severity of DPN and DN.
背景
已有研究报道，维生素 D 缺乏与糖尿病微血管并发症相关，但既往研究仅关注维生素 D 与特定并发症的关系。因此，我们旨在探讨维生素 D 水平与糖尿病微血管并发症（包括糖尿病视网膜病变、糖尿病肾病和糖尿病周围神经病变）的总体关系。
方法
这是一项横断面研究，纳入 815 例 2 型糖尿病患者。从病历中收集临床信息和实验室结果。分析维生素 D 与三种糖尿病微血管并发症的关系。
结果
伴有糖尿病周围神经病变和（或）糖尿病肾病的患者血清 25-羟维生素 D [25（OH）D] 水平显著低于无任何微血管并发症的 2 型糖尿病患者（P<0.01）。单因素分析显示，25（OH）D 水平与糖尿病周围神经病变和糖尿病肾病相关，但与糖尿病视网膜病变无关。校正后，25（OH）D 水平被证实是糖尿病周围神经病变（比值比：0.968，P=0.004）和糖尿病肾病（比值比：0.962，P=0.006）的独立保护因素。随着血清 25（OH）D 水平降低，糖尿病周围神经病变和糖尿病肾病的患病率显著升高。此外，同时患有糖尿病周围神经病变和糖尿病肾病的患者血清 25（OH）D 水平最低（P<0.001），且随着血清 25（OH）D 三分位数的降低，大量白蛋白尿的患病率比微量白蛋白尿增加得更突然。在维生素 D 不足的患者中，伴有糖尿病周围神经病变的患者比无糖尿病周围神经病变的患者更易并发大量白蛋白尿（15.32%比 4.91%；P=0.001）。
结论
维生素 D 缺乏与 2 型糖尿病患者发生糖尿病周围神经病变和糖尿病肾病的风险增加独立相关，但与糖尿病视网膜病变无关。此外，它可能是糖尿病周围神经病变和糖尿病肾病发生和严重程度的潜在预测因子。
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