·胰岛素抵抗及其相关疾病·

　　【摘要】 目的 评估老年T2DM患者血清25羟维生素D[25(OH)D]水平与代谢的关系。 方法 选取141例住院的老年T2DM患者，测定血清25(OH)D，并比较缺乏组(<25 nmol/l)和不足组(25～74 nmol/l)之间BMI、WC、FBG、HbA1c、FIns、胰岛素抵抗指数(HOMA-IR)、β细胞分泌指数(HOMA-β)、血脂及CRP的差异。将患者分为肥胖组和非肥胖组，分别以25(OH)D为因变量，与上述各变量进行Pearson相关分析，并以25(OH)D 缺乏为因变量行Logistic回归分析。 结果 94%的老年T2DM患者存在25(OH)D水平下降。25(OH)D缺乏组BMI、HbAlc、HOMA-IR、CRP高于25(OH)D不足组，缺乏组HDL-C低于不足组(P<0.05)。肥胖的老年T2DM患者血清25(OH)D与FBG、HbA1c、HOMA-IR、CRP呈负相关，与HOMA-β、HDL-C呈正相关;而非肥胖组25(OH)D仅与HbA1c、CRP呈负相关，与HDL-C呈正相关(P<0.05)。与25(OH)D缺乏相关的独立危险因素分别是HbAlc和CRP(P<0.05)。 结论 25(OH)D水平下降在老年T2DM患者十分普遍，25(OH)D下降与多种代谢异常关系密切，补充25(OH)D可能使患者获益。

　　【关键词】 糖尿病，2型;25羟维生素D;胰岛素分泌;胰岛素抵抗

Relationship between the serum 25-hydroxyvitamin D profile and metabolism in elderly T2DM patients WANG Fang, TIAN Dong-mei, TONG ping, et al. Department of Endocrinology, People's Hospital of Shanghai Putuo District, Shanghai 210060, China

Corresponding author: TIAN Dong-mei, E-mail: tian_zili@hotmail.com

　　【Abstract】Objective To evaluate the 25-hydroxy-vitamin D [25(OH)D] profile in elderly T2DM patients and its relationship with energy metabolism. Methods The 141 hospitalized T2DM patients were enrolled in this study, whose serum 25(OH)D levels were measured. Patients with low 25(OH)D levels were divided into deficient group (<25nmol/l) and insufficient group (25～74nmol/l), between which the body mass index ( BMI), waist circumference (WC), fasting blood glucose (FBG), HbA1c, fasting insulin (FIns), HOMA-IR, HOMA-β, total cholesterol (TC), triglyceride (TG), HDL-C, LDL-C, and C-reactive protein (CRP) were compared. Patients were divided into obese and non-obese groups based on their body weight, and Pearson correlation coefficient was used to assess the association of 25(OH) D with variables mentioned above in both groups respectively. Logistic regression analysis was performed using 25(OH)D deficiency (<25nmol/L) as the dependent variable. Results Serum 25(OH)D was lower than normal in 94% of all elderly T2DM patients. BMI, HbAlc, HOMA-IR, and CRP were higher, while HDL-C was lower in the deficient group than in the insufficient group (P<0.05). In obese group, 25(OH)D was negatively correlated with FBG, HbA1c, HOMA-IR, and CRP, but positively correlated with HOMA-IR and HDL-C. In non-obese group, 25(OH)D was negatively correlated only with HbA1c and CRP, and positively related with HDL-C only (P<0.05). HbAlc and CRP were independent risk factors for 25(OH)D deficiency (P<0.05). Conclusions Decline of 25(OH)D level is prevalent in elderly T2DM patients, which is correlated with metabolic disorders. These patients would benefit from supplementation of 25(OH)D.

　　【Keywords】 Diabetes mellitus, type 2; 25-hydroxy-vitamin D [25(OH)D] profile; Insulin secretion; Insulin resistance