CAJ | 학술논문

目的观察2型糖尿病患者补充维生素D前后其代谢指标的变化及血维生素D水平和胰岛素抵抗的关系.方法胰岛素抵抗用胰岛素稳态模型评估(HOMA-IR)表示,选择山东省立医院内分泌科2013年1-6月门诊和病房的164例30 ～ 75岁的2型糖尿病患者,按随机数字法分为2组:试验组和对照组,试验组口服骨化三醇0.5 μg/d,共12周,对照组维持原治疗方案不变,在试验研究开始和结束时分别记录入组者的人体测量学数据,抽空腹血测血糖、胰岛素、糖化血红蛋白(HbA1C)、25(OH)D等水平.结果两组的基线数据差异无统计学意义;和基线水平相比,服用维生素D 12周后,试验组和对照组的体质指数(BMI)[(-0.7±1.7)kg/m2比(-0.4±1.4)kg/m2](P＜0.05)、腰围(WC)[(-1.3±1.3)cm比(-0.2±1.1)cm] (P ＜0.05)、空腹血糖(FBG)[(-1.2±2.3)mmol/L比(-0.6±2.8)mmol/L](P＜0.05)、空腹胰岛素(FPI)[(-1.6±2.2)μU/ml比(-0.32±1.49)μU/ml] (P＜0.05)、HbA1C[(-0.1±0.6)％比(-0.03±0.94)％](P＜0.05)、HOMA-IR[(-0.91±2.63)比(-0.15±1.78)](P＜0.05)、25(OH)D[(20±17) ng/ml比(1.0±3.3) ng/ml](P＜0.05)的改变差异有统计学意义.根据基线25(OH)D的水平分层,可以发现服用维生素D后,HOMA-IR在维生素D水平＜20 ng/ml组[(6±3)比(5±3)](P＜0.05)、20～30 ng/ml组[(6±3)比(5±3)](P＜0.05)、≥30 ng/ml组[(5±3)比(4±3)](P＜0.05)均明显下降,而BMI[(26±6)kg/m2比(26±4) kg/m2] (P＜0.05)、WC[(84±11) cm比(82±12) cm] (P＜0.05)、FPG[(8±4)mmol/L比(6±4) mmol/L] (P ＜0.05)、FPI[(17±4).μU/ml比(16±4).μU/ml] (P＜0.05)、HbA1C[(7.4±0.9)％比(7.0±1.2)％](P＜0.05)仅在维生素D水平为15—20 ng/ml组的下降差异有统计学意义.多变量回归分析显示:HOMA-IR是25(OH)D的显著独立危险因素(OR=13,95％CI=4 ～39,P＜0.05).结论补充维生素D后,患者的体质指数、腰围、空腹血糖、空腹胰岛素、HbA1C、HOMA-IR有显著改善,提示2型糖尿病患者补充维生素D可以降低胰岛素抵抗. 目的觀察2型糖尿病患者補充維生素D前後其代謝指標的變化及血維生素D水平和胰島素牴抗的關繫.方法胰島素牴抗用胰島素穩態模型評估(HOMA-IR)錶示,選擇山東省立醫院內分泌科2013年1-6月門診和病房的164例30 ～ 75歲的2型糖尿病患者,按隨機數字法分為2組:試驗組和對照組,試驗組口服骨化三醇0.5 μg/d,共12週,對照組維持原治療方案不變,在試驗研究開始和結束時分彆記錄入組者的人體測量學數據,抽空腹血測血糖、胰島素、糖化血紅蛋白(HbA1C)、25(OH)D等水平.結果兩組的基線數據差異無統計學意義;和基線水平相比,服用維生素D 12週後,試驗組和對照組的體質指數(BMI)[(-0.7±1.7)kg/m2比(-0.4±1.4)kg/m2](P＜0.05)、腰圍(WC)[(-1.3±1.3)cm比(-0.2±1.1)cm] (P ＜0.05)、空腹血糖(FBG)[(-1.2±2.3)mmol/L比(-0.6±2.8)mmol/L](P＜0.05)、空腹胰島素(FPI)[(-1.6±2.2)μU/ml比(-0.32±1.49)μU/ml] (P＜0.05)、HbA1C[(-0.1±0.6)％比(-0.03±0.94)％](P＜0.05)、HOMA-IR[(-0.91±2.63)比(-0.15±1.78)](P＜0.05)、25(OH)D[(20±17) ng/ml比(1.0±3.3) ng/ml](P＜0.05)的改變差異有統計學意義.根據基線25(OH)D的水平分層,可以髮現服用維生素D後,HOMA-IR在維生素D水平＜20 ng/ml組[(6±3)比(5±3)](P＜0.05)、20～30 ng/ml組[(6±3)比(5±3)](P＜0.05)、≥30 ng/ml組[(5±3)比(4±3)](P＜0.05)均明顯下降,而BMI[(26±6)kg/m2比(26±4) kg/m2] (P＜0.05)、WC[(84±11) cm比(82±12) cm] (P＜0.05)、FPG[(8±4)mmol/L比(6±4) mmol/L] (P ＜0.05)、FPI[(17±4).μU/ml比(16±4).μU/ml] (P＜0.05)、HbA1C[(7.4±0.9)％比(7.0±1.2)％](P＜0.05)僅在維生素D水平為15—20 ng/ml組的下降差異有統計學意義.多變量迴歸分析顯示:HOMA-IR是25(OH)D的顯著獨立危險因素(OR=13,95％CI=4 ～39,P＜0.05).結論補充維生素D後,患者的體質指數、腰圍、空腹血糖、空腹胰島素、HbA1C、HOMA-IR有顯著改善,提示2型糖尿病患者補充維生素D可以降低胰島素牴抗.
목적 관찰2형당뇨병환자보충유생소D전후기대사지표적변화급혈유생소D수평화이도소저항적관계.방법 이도소저항용이도소은태모형평고(HOMA-IR)표시,선택산동성립의원내분비과2013년1-6월문진화병방적164례30 ～ 75세적2형당뇨병환자,안수궤수자법분위2조:시험조화대조조,시험조구복골화삼순0.5 μg/d,공12주,대조조유지원치료방안불변,재시험연구개시화결속시분별기록입조자적인체측량학수거,추공복혈측혈당、이도소、당화혈홍단백(HbA1C)、25(OH)D등수평.결과 량조적기선수거차이무통계학의의;화기선수평상비,복용유생소D 12주후,시험조화대조조적체질지수(BMI)[(-0.7±1.7)kg/m2비(-0.4±1.4)kg/m2](P＜0.05)、요위(WC)[(-1.3±1.3)cm비(-0.2±1.1)cm] (P ＜0.05)、공복혈당(FBG)[(-1.2±2.3)mmol/L비(-0.6±2.8)mmol/L](P＜0.05)、공복이도소(FPI)[(-1.6±2.2)μU/ml비(-0.32±1.49)μU/ml] (P＜0.05)、HbA1C[(-0.1±0.6)％비(-0.03±0.94)％](P＜0.05)、HOMA-IR[(-0.91±2.63)비(-0.15±1.78)](P＜0.05)、25(OH)D[(20±17) ng/ml비(1.0±3.3) ng/ml](P＜0.05)적개변차이유통계학의의.근거기선25(OH)D적수평분층,가이발현복용유생소D후,HOMA-IR재유생소D수평＜20 ng/ml조[(6±3)비(5±3)](P＜0.05)、20～30 ng/ml조[(6±3)비(5±3)](P＜0.05)、≥30 ng/ml조[(5±3)비(4±3)](P＜0.05)균명현하강,이BMI[(26±6)kg/m2비(26±4) kg/m2] (P＜0.05)、WC[(84±11) cm비(82±12) cm] (P＜0.05)、FPG[(8±4)mmol/L비(6±4) mmol/L] (P ＜0.05)、FPI[(17±4).μU/ml비(16±4).μU/ml] (P＜0.05)、HbA1C[(7.4±0.9)％비(7.0±1.2)％](P＜0.05)부재유생소D수평위15—20 ng/ml조적하강차이유통계학의의.다변량회귀분석현시:HOMA-IR시25(OH)D적현저독립위험인소(OR=13,95％CI=4 ～39,P＜0.05).결론 보충유생소D후,환자적체질지수、요위、공복혈당、공복이도소、HbA1C、HOMA-IR유현저개선,제시2형당뇨병환자보충유생소D가이강저이도소저항.
Objective To explore the effects of oral vitamin D supplementation on anthropometric parameters and insulin resistance (IR) in type 2 diabetes mellitus (T2DM).Methods A total of 164 subjects with T2DM,aged 30-75 years,were randomly divided into two groups of intervention and control.The intervention group received a daily dose of 0.50 μg calcitriol while the control group maintained the original treatment regimen.At the beginning and end of 12-week supplementation trial,the demographic and anthropometric data were recorded and the serum levels of glucose,insulin,HbA1C and 25 (OH)D measured.IR was assessed by the homeostasis model approximation index.Results There was no significant inter-group difference at baseline.Compared with the baseline level,body mass index (BMI) ((-0.7±1.7) vs (-0.4±1.4) kg/m2)(P＜0.05),waist circumference (WC) ((-1.3±1.3) vs (-0.2±1.1) cm)(P＜0,05),fasting plasma glucose (FPG) ((-1.2±2.3) vs (-0.6±2.8) mmol/L),fasting plasma insulin (FPI) ((-1.6 ±2.2)vs(-0.32 ± 1.49) μU/ml) (P ＜0.05),HbA1C ((-0.1 ± 0.6) vs (-0.03±0.94))(P＜0.05),HOMA-IR ((-0.91 ±2.63)％ vs(-0.15 ±1.78)％)(P＜ 0.05) and 25 (OH)D ((20 ± 17) vs(1.0 ± 3.3)ng/ml) (P ＜ 0.05)decreased obviously in the intervention group at the end of study.After stratifying by different baseline serum levels of 25 (OH) D,HOMA-IR significantly decreased after supplementation in ＜ 20 ng/ml group ((6 ±3) vs(5 ±3)) (P ＜0.05),20-30 ng/ml group ((6±3) vs (5 ±3)) (P＜0.05)and ＞30 ng/ml group ((5 ±3)vs (4 ±3))(P＜0.05).AndBMI ((26±6) vs (26±4) kg/m2)(P＜0.05),WC ((84±11) vs (82±12) cm) (P＜0.05),FPG ((8±4) vs (6±4)mmol/L)(P＜0.05),FPI ((17 ±4) vs (16 ±4)μU/ml)(P＜0.05)and HbA1C ((7.4 ± 0.9) ％ vs (7.0 ± 1.2) ％) (P ＜ 0.05) decreased statistically significant only in 15-20 ng/ml group.Multivariate regression analysis showed that HOMA-IR was a significant independent risk factor for 25 (OH) D (OR =13,95％ CI =4-39,P ＜ 0.05).Conclusion There are significant improvements in BMI,WC,FPG,FPI,HbA1C and HOMA-IR after supplementation.Thus vitamin D supplementation may reduce insulin resistance in T2DM.