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目的研究2型糖尿病(T2DM)患者血清25羟维生素D_3[25(OH)D_3]水平与糖尿病视网膜病变(DR)的相关性。方法选取T2DM患者249例和正常对照者100名,其中2型糖尿病患者分为单纯糖尿病无DR组(NDR,94例)、T2DM合并非增殖期DR组(NPDR,82例)及T2DM合并增殖期DR组(PDR,73例)。ELISA法测定25(OH)D_3水平,常规测定肝、肾功能,空腹血糖,HbA1c,血脂,尿微量白蛋白等指标。25(OH)D_3与各指标之间进行相关性分析。结果与正常对照组相比,NDR组、NPDR组及PDR组25(OH)D_3水平均明显降低,以PDR组最低,各组间差异均有统计学意义(F=138.516,P=0.000),且PDR组维生素D(VD)缺乏患者比例明显高于NPDR组及NDR组(χ~2=36.970,P=0.000)。VD水平与DR、糖尿病病程、年龄、性别、BMI、收缩压、空腹血糖、HbA1c、尿素氮、肌酐、24 h尿微量白蛋白、总胆固醇、低密度脂蛋白-胆固醇均呈显著负相关(r值分别为-0.763~-0.135,均P<0.05)。多元Logistic回归分析显示,VD缺乏是DR的独立危险因素(OR=9.214,95%CI:4.354~19.499,P=0.000)。结论 VD缺乏参与了T2DM及DR的发生、发展,可作为DR的独立危险因素。
Objective To investigate the relationship between the serum 25-hydroxyvitamin D3 [25 (OH) D_3] and diabetic retinopathy (DR) in type 2 diabetes mellitus (T2DM). Methods Totally 249 T2DM patients and 100 normal controls were included. Type 2 diabetic patients were divided into three groups: NDR (94 cases), T2DM with non-proliferative group (82 cases) and T2DM with proliferative phase DR group (PDR, 73 cases). The levels of 25 (OH) D_3 were determined by ELISA. The indexes of liver and kidney, fasting blood glucose, HbA1c, lipids and urine microalbumin were determined routinely. 25 (OH) D_3 and the correlation between the indicators. Results Compared with the normal control group, the levels of 25 (OH) D_3 in NDR group, NPDR group and PDR group were significantly lower than those in normal control group, and the lowest in PDR group. The differences among the groups were statistically significant (F = 138.516, P = 0.000) The proportion of patients with vitamin D deficiency in PDR group was significantly higher than that in NPDR group and NDR group (χ ~ 2 = 36.970, P = 0.000). There was a significant negative correlation between the level of VD and DR, duration of diabetes, age, sex, BMI, systolic blood pressure, fasting blood glucose, HbA1c, urea nitrogen, creatinine, 24 h urine microalbumin, total cholesterol and low density lipoprotein cholesterol Values were -0.763 ~ -0.135, all P <0.05). Multivariate Logistic regression analysis showed that VD deficiency was an independent risk factor for DR (OR = 9.214, 95% CI: 4.354-19.499, P = 0.000). Conclusion VD deficiency participates in the occurrence and development of T2DM and DR and may be used as an independent risk factor for DR.