CAJ | 학술논문

目的：研究2型糖尿病患者血25-羟维生素D[25（OH）D]水平的改变对血糖与骨量的影响。方法本研究收集621例复旦大学附属中山医院内分泌科2009年10月至2011年3月住院2型糖尿病患者的临床资料，将测得的血25（OH）D进行季节校正后纳入分析。以血25（OH）D等于50 nmol/L为界将患者分为25（OH）D缺乏组[25（OH）D＜50 nmol/L]及25（OH）D非缺乏组[25（OH）D≥50 nmol/L]两组，观察两组之间糖代谢指标[包括空腹血糖（FBS）、餐后2 h血糖（2 h PG）、糖化血红蛋白（HbA1c）、糖化白蛋白、空腹胰岛素（FINS）]及骨代谢指标[包括甲状旁腺激素（PTH）、碱性磷酸酶（ALP）、骨密度]的差异。结果（1）2型糖尿病患者25（OH）D的平均水平低于50 nmol/L，而且女性较男性更低（P＜0.001）；（2）维生素D缺乏组血空腹胰岛素水平高于维生素D非缺乏组（P＜0.05），胰岛素抵抗指数（HOMA-IR）也高于维生素D非缺乏组（P＜0.001）。FPG、HbA1c及胰岛素分泌指数（HOMA-B）两组间无明显统计学差异；（3）维生素D缺乏组PTH高于维生素D非缺乏组（P＜0.05）；维生素D缺乏组腰椎、股骨颈和全髋骨密度均低于维生素D非缺乏组（P＜0.05）；钙磷乘积及ALP两组间无统计学意义差异。结论2型糖尿病患者普遍存在维生素D缺乏，在2型糖尿病人群中，胰岛素抵抗、骨量流失可能与血25（OH）D水平降低有关。
목적：연구2형당뇨병환자혈25-간유생소D[25（OH）D]수평적개변대혈당여골량적영향。방법본연구수집621례복단대학부속중산의원내분비과2009년10월지2011년3월주원2형당뇨병환자적림상자료，장측득적혈25（OH）D진행계절교정후납입분석。이혈25（OH）D등우50 nmol/L위계장환자분위25（OH）D결핍조[25（OH）D＜50 nmol/L]급25（OH）D비결핍조[25（OH）D≥50 nmol/L]량조，관찰량조지간당대사지표[포괄공복혈당（FBS）、찬후2 h혈당（2 h PG）、당화혈홍단백（HbA1c）、당화백단백、공복이도소（FINS）]급골대사지표[포괄갑상방선격소（PTH）、감성린산매（ALP）、골밀도]적차이。결과（1）2형당뇨병환자25（OH）D적평균수평저우50 nmol/L，이차녀성교남성경저（P＜0.001）；（2）유생소D결핍조혈공복이도소수평고우유생소D비결핍조（P＜0.05），이도소저항지수（HOMA-IR）야고우유생소D비결핍조（P＜0.001）。FPG、HbA1c급이도소분비지수（HOMA-B）량조간무명현통계학차이；（3）유생소D결핍조PTH고우유생소D비결핍조（P＜0.05）；유생소D결핍조요추、고골경화전관골밀도균저우유생소D비결핍조（P＜0.05）；개린승적급ALP량조간무통계학의의차이。결론2형당뇨병환자보편존재유생소D결핍，재2형당뇨병인군중，이도소저항、골량류실가능여혈25（OH）D수평강저유관。
Objective To observe serum 25-hydroxy vitamin D levels in type 2 diabetic patients and its effect on blood glucose and bone mass. Methods Data of 621 type 2 diabetes mellitus (T2DM) patients admitted to Endocrine division of Zhongshan hospital affiliated to Fudan university were collected from 2009.10 to 2011.3. The patients were divided into vitamin D deficiency and non-deficiency groups according to serum 25(OH)D level. We analyzed data of glucose metabolism (FPG, HbA1c, FINS, HOMA-IR and HOMA-B) and bone metabolism (PTH, calcium-phosphorus product, ALP, total lumbar BMD, femoral neck BMD and total hip BMD) to observe the effect of serum levels of 25(OH)D in T2DM on glucose and bone metabolism. Results The average level of serum 25(OH)D in T2DM patients was below 50 nmol/L, the level for females being lower than that for males (P<0.001). Compared with vitamin D non-deficiency group, FINS values and HOMA-IR values were higher for vitamin D deficiency group (P<0.05). Compared with vitamin D non-deficiency group, PTH values were higher ,while total lumbar BMD, femoral neck BMD and total hip BMD were lower for vitamin D deficiency group (P<0.05). Conclusion Type 2 Diabetic patients have high morbidity of Vitamin D deficiency. The insulin resistance and the bone loss in type 2 diabetic patients may be related to the deficiency of Vitamin D.