2型糖尿病患者的维生素D状态、维生素D受体多态性与微血管并发症风险：一项前瞻性研究
Vitamin D Status, Vitamin D Receptor Polymorphisms, and Risk of Microvascular Complications Among Individuals With Type 2 Diabetes: A Prospective Study.
作者信息
Chen Xue, Wan Zhenzhen, Geng Tingting, Zhu Kai, Li Rui, Lu Qi, Lin Xiaoyu, Liu Sen, Chen Liangkai, Guo Yanjun, Shan Zhilei, Liu Liegang, Pan An, Manson JoAnn E, Liu Gang
机构信息
Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
出版信息
Diabetes Care. 2023 Feb 1;46(2):270-277. doi: 10.2337/dc22-0513.
OBJECTIVE
Evidence is limited regarding the associations between vitamin D status and microvascular complications in individuals with type 2 diabetes (T2D), among whom vitamin D deficiency or insufficiency is particularly common. In this study we aimed to prospectively investigate the associations of serum 25-hydroxyvitamin D [25(OH)D] and vitamin D receptor (VDR) polymorphisms with risk of diabetic microvascular complications.
RESEARCH DESIGN AND METHODS
This analysis included 14,709 participants with T2D who were free of microvascular complications from the UK Biobank. Incidence of diabetic microvascular complications was ascertained via electronic health records. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs.
RESULTS
Median serum 25(OH)D concentration was 40.7 nmol/L (interquartile range 27.5, 56.4). During a median of 11.2 years of follow-up, 1,370 people developed diabetic microvascular complications. Compared with participants with 25(OH)D <25 nmol/L, individuals with 25(OH)D ≥75 nmol/L had a multivariable-adjusted HR of 0.65 (95% CI 0.51, 0.84) for composite diabetic microvascular complications, 0.62 (0.40, 0.95) for diabetic retinopathy, 0.56 (0.40, 0.79) for diabetic nephropathy, and 0.48 (0.26, 0.89) for diabetic neuropathy. In addition, in comparisons with participants with 25(OH)D <25 nmol/L and minor allele homozygotes (TT of rs1544410 and GG of rs731236), the multivariable-adjusted HRs of composite diabetic microvascular complications were 0.54 (0.38, 0.78) and 0.55 (0.38, 0.80) for participants with serum 25(OH)D ≥50 nmol/L and major allele homozygotes (CC and AA), respectively, although no significant interaction was observed.
CONCLUSIONS
Higher serum 25(OH)D concentrations were significantly associated with lower risk of diabetic microvascular complications, including diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy. Our findings suggest a potential beneficial role of maintaining adequate vitamin D status in the prevention of diabetic microvascular complications.
目的
关于2型糖尿病（T2D）患者维生素D状态与微血管并发症之间的关联，证据有限，而在这些患者中维生素D缺乏或不足尤为常见。在本研究中，我们旨在前瞻性地调查血清25-羟基维生素D[25(OH)D]和维生素D受体（VDR）基因多态性与糖尿病微血管并发症风险之间的关联。
研究设计与方法
该分析纳入了英国生物银行中14709例无微血管并发症的T2D患者。通过电子健康记录确定糖尿病微血管并发症的发生率。采用Cox比例风险回归模型来估计风险比（HRs）和95%置信区间（CIs）。
结果
血清25(OH)D浓度中位数为40.7nmol/L（四分位间距27.5，56.4）。在中位11.2年的随访期间，1370人发生了糖尿病微血管并发症。与25(OH)D<25nmol/L的参与者相比，25(OH)D≥75nmol/L的个体发生复合糖尿病微血管并发症的多变量调整后HR为0.65（95%CI0.51，0.84），糖尿病视网膜病变为0.62（0.40，0.95），糖尿病肾病为0.56（0.40，0.79），糖尿病神经病变为0.48（0.26，0.89）。此外，与25(OH)D<25nmol/L且为次要等位基因纯合子（rs1544410的TT和rs731236的GG）的参与者相比，血清25(OH)D≥50nmol/L且为主要等位基因纯合子（CC和AA）的参与者发生复合糖尿病微血管并发症的多变量调整后HR分别为0.54（0.38，0.78）和0.55（0.38，0.80），尽管未观察到显著的相互作用。
结论
较高的血清25(OH)D浓度与较低的糖尿病微血管并发症风险显著相关，包括糖尿病视网膜病变、糖尿病肾病和糖尿病神经病变。我们的研究结果表明维持充足的维生素D状态在预防糖尿病微血管并发症中具有潜在的有益作用。
Zotero 插件