摘要
目的探讨2型糖尿病(T2DM)患者血清25-羟维生素D3[25(OH)D3]水平与冠心病发病率的相关性,及阿法骨化醇治疗是否降低T2DM患者新发冠心病的发病率。方法选取本院门诊及住院的T2DM患者280例,纳入研究前未合并冠心病,用酶联免疫吸附测定(ELISA)法测定患者血清25(OH)D3的浓度,根据血清25(OH)D3浓度分为低浓度组(T组,<45nmol/L,198例),高浓度组(C组,≥45nmol/L,82例),其中T组患者根据是否接受维生素D治疗分为两亚组(T1组:阿法骨化醇治疗;T2组:不接受维生素D治疗)。随访5年,测定患者初始及5年后血清低密度脂蛋白胆固醇(LDL-C)、糖化血红蛋白C(HbA1c)、超敏C反应蛋白(hsCRP)、25(OH)D3、甲状旁腺素(iPTH)等指标,分析血清25(OH)D3浓度与冠心病的发病相关关系,并计算随访期间累计冠心病发病率。另外选取体检中心健康志愿者30例作为健康对照组(N)组,测定以上指标。结果在T2DM患者中,血清25(OH)D3明显低于N组,C组、T1组、T2组与N组分别为(52.8±7.1)nmol/L、(34.7±8.4)nmol/L、(35.1±9.6)nmol/L vs(72.3±15.5)nmol/L(P<0.01),T1组患者经维生素D治疗后,血清25(OH)D3水平明显升高(34.7±8.4)nmol/L vs(55.7±10.6)nmol/L(P<0.05)。与T1组相比,T2组糖尿病5年新发冠心病发病率明显升高(39.4%vs 13.1%,P<0.05),与T2组相比,T1组给予阿法骨化醇治疗新发冠心病发病率明显降低(13.1%vs 39.4%,P<0.05)。结论 T2DM患者血清25(OH)D3低水平是并发冠心病的独立危险因素,活性维生素D治疗可以降低T2DM患者新发冠心病发病率。
Objective To evaluate the correlation between serum 25-hydroxyvitamin [25 （OH）D3 ] D concentration and coronary heart disease morbidity, and the effects of vitamin D（vit D） on coronary heart disease morbidity change in type 2 diabetic（T2DM） patients. Methods A total of 280 T2DM patients were enrolled. Serum 25 （OH） D3 was measured by enzyme-linked immunosorbent assay （ELASA）. All patients were divided into group T （serum 25（OH）D3〈45 nmol/L, n =186） and group C （serum 25（OH）D3≥45 nmol/L, n =186）. And the patients of group T were randomly divided into group T1 which received vit D treatment and group T2 no vit D treatment. While 30 normal adults from medical examination were selected as healthy control group. Serum high sensitive C reactive protein （hsCRP）, glycosylated hemoglobin （ HbA1 c）, low density lipoprotein cholesterol （LDL-C） and 25 （OH） D3 were measured at the experiment onset and 5 years later in follow-up. And the new coronary heart disease morbidity was calculated. Results Compared to healthy（N group） people,the serum 25（OH）D3 level in T2DM patients was obviously decreased,C,T1,T2 and N group respectively （52.8±7.1） nmol/L,（34.7±8.4） nmol/L,（35.1±9.6） nmol/L vs （72.3±15.5） nmol/L（ P 〈0.05）. And the serum 25（OH）D3 level obviously increased in group T1 after treatment, （34.7±8.4） nmol/L vs （55.7± 10.6） nmol/L（ P 〈0.05）. The lower serum 25（OH）D3 level, the higher coronary heart disease morbidity（39.4 ± vs 13.1%, P 〈0.05）. Once vit D treatment, the coronary heart disease morbidity got decreased （13.1% vs 39.4 %, P 〈0.05）. Conclusion Serum 25（OH）D3 level is an independent risk factor of coronary heart disease,and vit D treatment can reduce the coronary heart disease morbidity in T2DM patients.
出处
《临床荟萃》
CAS
2013年第1期7-10,共4页
Clinical Focus
