2019 年第 8 期 第 14 卷

维生素D在2型糖尿病患者中的临床价值

Clinical value of vitamin D in patients with type 2 diabetes mellitus

作者：王莹吴东红程瑶梁桂敏马晶

英文作者：

单位：150010哈尔滨市第一医院内分泌科一病房

英文单位：

关键词：2型糖尿病；维生素D；血糖

英文关键词：

• 摘要：

• 【摘要】目的    观察2型糖尿病(T2DM)患者体内血清25-羟基维生素D［25-(OH)D］水平，并探讨补充维生素D对T2DM患者血糖水平、胰岛β细胞功能及胰岛素抵抗的影响。方法    选取2018年3—10月哈尔滨市第一医院T2DM患者72例，根据血清25-(OH)D水平筛选其中合并维生素D缺乏或不足患者60例，完全随机分为观察组（30例）和对照组（30例）；另选取同期本院36例健康体检者（健康组）。对照组采用常规降糖治疗，观察组在常规治疗基础上加服骨化三醇。分析比较治疗前后空腹血糖、餐后2 h血糖、空腹胰岛素、糖化血红蛋白、稳态模型胰岛素抵抗指数(HOMA-IR)及稳态模型胰岛β细胞功能指数(HOMA-β)指标的变化。结果    本组T2DM患者体内维生素D缺乏或不足者占83.3%（60/72）。治疗前，观察组和对照组患者空腹血糖、餐后2 h血糖、糖化血红蛋白、空腹胰岛素、HOMA-IR明显高于健康组，25-(OH)D水平、HOMA-β明显低于健康组（均P＜0.05）。治疗后，观察组和对照组空腹血糖、餐后2 h血糖、糖化血红蛋白、空腹胰岛素、HOMA-IR较治疗前明显降低，25-(OH)D、HOMA-β较治疗前明显升高，且观察组明显优于对照组［（6.4±1.9）mmol/L比（7.1±1.4）mmol/L、（12.4±3.6）mmol/L比（14.8±2.9）mmol/L、（6.2±1.2）%比（7.9±1.1）%、（9.7±3.5）mIU/L比（13.4±3.0）mIU/L、（3.2±2.6）比（4.1±2.3）、（32±4）μg/L比（25±5）μg/L、（5.8±0.5）比（5.3±0.4）］，差异均有统计学意义（均P＜0.05）。结论    T2DM患者体内普遍存在25-(OH)D缺乏，补充维生素D有助于T2DM患者的血糖控制。

• 【Abstract】Objective    To observe the level of serum 25-hydroxy-vitamin D［25-(OH)D］in patients with type 2 diabetes mellitus(T2DM） and to analyze the effect of vitamin D supplementation on blood glucose, islet β cell function and insulin resistance. Methods    From March to October 2018, 72 T2DM patients admitted to the First Hospital of Harbin were included; 60 patients with vitamin D lack or deficiency defined by serum 25-(OH)D content were randomly divided into observation group and control group, with 30 patients in each group; 36 healthy people were enrolled as healthy group. The control group had routine hypoglycemic therapy; the observation group took calcitriol on the basis of routine therapy. Fasting blood glucose, postprandial 2 h blood glucose, fasting insulin, glycosylated hemoglobin, homeostasis model assessment insulin resistance index(HOMA-IR) and islet β-cell function index(HOMA-β) were analyzed. Results    Vitamin D lack or deficiency took a percentage of 83.3%（60/72） in T2DM patients. Before therapy, fasting blood glucose, postprandial 2 h blood glucose, glycosylated hemoglobin, fasting insulin and HOMA-IR in observation group and control group were significantly higher than those in healthy group; serum 25-(OH)D level and HOMA-β in observation group and control group were significantly lower than those in healthy group（all P＜0.05）. After therapy, fasting blood glucose, postprandial 2 h blood glucose, glycosylated hemoglobin, fasting insulin and HOMA-IR significantly decreased and 25-(OH)D level and HOMA-β significantly increased in T2DM patients; the changes were more significant in observation group［（6.4±1.9）mmol/L vs （7.1±1.4）mmol/L, （12.4±3.6）mmol/L vs （14.8±2.9）mmol/L, （6.2±1.2）% vs （7.9±1.1）%, （9.7±3.5）mIU/L vs （13.4±3.0）mIU/L, （3.2±2.6） vs （4.1±2.3）, （32±4）μg/L vs （25±5）μg/L, （5.8±0.5） vs （5.3±0.4）］（all P＜0.05）. Conclusion    Insufficiency of 25-(OH)D is common in patients with T2DM; vitamin D supplementation can improve blood glucose regulation.