维生素D与2型糖尿病微血管病变的研究进展
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摘要
既往研究已证实维生素D不足和2型糖尿病的发生有密切联系。2型糖尿病常有胰岛素抵抗、肝糖原生成增加以及β细胞衰竭等表现。维生素D代谢产物能直接通过组织中的维生素D受体或间接调节血钙水平来提高胰岛素敏感性、促进胰岛素胞吐作用。同时维生素D能通过减少炎性因子来减少胰岛素抵抗以及β细胞凋亡。多项研究证实维生素D和糖尿病长期并发症发生有密切联系,低水平维生素D会加剧糖尿病周围神经病变、肾脏病变、视网膜病变程度。糖尿病人群里维生素D不足广泛存在,但维生素D与糖尿病并发症是否有相关性仍有争议,本文将对维生素D和2型糖尿病微血管病变关系作一综述。
Increasing evidence suggests that vitamin D deficiency may play an important role in the pathogenesis of type 2 diabetes mellitus(T2 DM). T2 DM manifests as a result of insulin resistance,increased hepatic glucose production and β-cell failure. Vitamin D metabolites are thought to play an important role in increasing insulin sensitivity and facilitating insulin exocytosis which is mediated both by direct mechanism through the availability of vitamin D receptors in several tissues and indirect mechanism through the changes in calcium levels. Vitamin D has also been shown to decrease inflammatory cytokines which plays an important role in insulin resistance and β-cell apoptosis. Several studies have confirmed that vitamin D is closely related to the long-term complications of diabetes. Low levels of vitamin D can exacerbate diabetic peripheral neuropathy,nephropathy,and retinopathy. Although diabetic patients with vitamin D deficiency is widespread,the existence of vitamin D deficiency and diabetes complications is still controversial,this article will review the relationship between vitamin D and the microvascular complications of T2 DM.
Increasing evidence suggests that vitamin D deficiency may play an important role in the pathogenesis of type 2 diabetes mellitus(T2 DM). T2 DM manifests as a result of insulin resistance,increased hepatic glucose production and β-cell failure. Vitamin D metabolites are thought to play an important role in increasing insulin sensitivity and facilitating insulin exocytosis which is mediated both by direct mechanism through the availability of vitamin D receptors in several tissues and indirect mechanism through the changes in calcium levels. Vitamin D has also been shown to decrease inflammatory cytokines which plays an important role in insulin resistance and β-cell apoptosis. Several studies have confirmed that vitamin D is closely related to the long-term complications of diabetes. Low levels of vitamin D can exacerbate diabetic peripheral neuropathy,nephropathy,and retinopathy. Although diabetic patients with vitamin D deficiency is widespread,the existence of vitamin D deficiency and diabetes complications is still controversial,this article will review the relationship between vitamin D and the microvascular complications of T2 DM.
引文
[1] Alam U,Arul-Devah V,Javed S,et al. Vitamin D and Diabetic Complications:True or False Prophet?[J]. Diabetes Ther,2016,7(1):11-26. DOI:10. 1007/s13300-016-0159-x.
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[4] He S,Yu S,Zhou Z,et al. Effect of vitamin D supplementation on fasting plasma glucose,insulin resistance and prevention of type2 diabetes mellitus in non-diabetics:A systematic review and meta-analysis[J]. Biomed Rep,2018,8(5):475-484. DOI:10.3892/br. 2018. 1074.
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[7] Wimalawansa SJ. Associations of vitamin D with insulin resistance,obesity,type 2 diabetes,and metabolic syndrome[J]. J Steroid Biochem Mol Biol,2018,175:177-189. DOI:10. 1016/j.jsbmb. 2016. 09. 017.
[8] Li X,Liu Y,Zheng Y,et al. The Effect of Vitamin D Supplementation on Glycemic Control in Type 2 Diabetes Patients:A Systematic Review and Meta-Analysis[J]. Nutrients,2018,10(3).pii:E375. DOI:10. 3390/nu10030375.
[9] Chagas CE,Borges MC,Martini LA,et al. Focus on vitamin D,inflammation and type 2 diabetes[J]. Nutrients,2012,4(1):52-67. DOI:10. 3390/nu4010052.
[10] Oh YS. Bioactive Compounds and Their Neuroprotective Effects in Diabetic Complications[J]. Nutrients,2016,8(8). pii:E472.DOI:10. 3390/nu8080472.
[11] Alamdari A,Mozafari R,Tafakhori A,et al. An inverse association between serum vitamin D levels with the presence and severity of impaired nerve conduction velocity and large fiber peripheral neuropathy in diabetic subjects[J]. Neurol Sci,2015,36(7):1121-1126. DOI:10. 1007/s10072-015-2207-0.
[12] Esteghamati A,Fotouhi A,Faghihi-Kashani S,et al. Non-linear contribution of serum vitamin D to symptomatic diabetic neuropathy:A case-control study[J]. Diabetes Res Clin Pract,2016,111:44-50. DOI:10. 1016/j. diabres. 2015. 10. 018.
[13] He R,Hu Y,Zeng H,et al. Vitamin D deficiency increases the risk of peripheral neuropathy in Chinese patients with type 2 diabetes[J]. Diabetes Metab Res Rev,2017,33(2). DOI:10. 1002/dmrr.2820.
[14] Xue R,Gui D,Zheng L,et al. Mechanistic Insight and Management of Diabetic Nephropathy:Recent Progress and Future Perspective[J]. J Diabetes Res,2017,2017:1839809. DOI:10.1155/2017/1839809.
[15] Peng Y,Li LJ. Serum 25-hydroxyvitamin D level and diabetic nephropathy in patients with type 2 diabetes mellitus[J]. Int Urol Nephrol,2015,47(6):983-989. DOI:10. 1007/s11255-015-0983-3.
[16] Kondo M,Toyoda M,Miyatake H,et al. The Prevalence of 25-hydroxyvitamin D Deficiency in Japanese Patients with Diabetic Nephropathy[J]. Intern Med,2016,55(18):2555-2562. DOI:10. 2169/internalmedicine. 55. 6346.
[17] Xiao X,Wang Y,Hou Y,et al. Vitamin D deficiency and related risk factors in patients with diabetic nephropathy[J]. J Int Med Res,2016,44(3):673-684. DOI:10. 1177/0300060515593765.
[18] Momeni A,Mirhosseini M,Kabiri M,et al. Effect of vitamin D on proteinuria in type 2 diabetic patients[J]. J Nephropathol,2017,6(1):10-14. DOI:10. 15171/jnp. 2017. 03.
[19] Yi X,Sun J,Li L,et al. 1,25-Dihydroxyvitamin D3 Deficiency is Involved in the Pathogenesis of Diabetic Retinopathy in the Uygur Population of China[J]. IUBMB Life,2016,68(6):445-451.DOI:10. 1002/iub. 1501.
[20] Ren Z,Li W,Zhao Q,et al. The impact of 1,25-dihydroxy vitamin D3 on the expressions of vascular endothelial growth factor and transforming growth factor-β? in the retinas of rats with diabetes[J]. Diabetes Res Clin Pract,2012,98(3):474-480. DOI:10.1016/j. diabres. 2012. 09. 028.
[21] Gungor A,Ates O,Bilen H,et al. Retinal Nerve Fiber Layer Thickness in Early-Stage Diabetic Retinopathy With Vitamin D Deficiency[J]. Invest Ophthalmol Vis Sci,2015,56(11):6433-6437. DOI:10. 1167/iovs. 15-16872.
[22] Luo BA,Gao F,Qin LL. The Association between Vitamin D Deficiency and Diabetic Retinopathy in Type 2 Diabetes:A Meta-Analysis of Observational Studies[J]. Nutrients,2017,9(3):307.DOI:10. 3390/nu9030307.
[23] Bonakdaran S,Shoeibi N. Is there any correlation between vitamin D insufficiency and diabetic retinopathy?[J]. Int J Ophthalmol,2015,8(2):326-331. DOI:10. 3980/j. issn. 2222-3959. 2015.02. 20.
[24] Alam U,Amjad Y,Chan AW,et al. Vitamin D Deficiency Is Not Associated with Diabetic Retinopathy or Maculopathy[J]. J Diabetes Res,2016,2016:6156217. DOI:10. 1155/2016/6156217.
[2] Alam U,Najam O,Al-Himdani S,et al. Marked vitamin D deficiency in patients with diabetes in the UK:ethnic and seasonal differences and an association with dyslipidaemia[J]. Diabet Med,2012,29(10):1343-1345. DOI:10. 1111/j. 1464-5491.2012. 03692. x.
[3] Jung CH,Kim KJ,Kim BY,et al. Relationship between vitamin D status and vascular complications in patients with type 2 diabetes mellitus[J]. Nutr Res,2016,36(2):117-124. DOI:10. 1016/j. nutres. 2015. 11. 008.
[4] He S,Yu S,Zhou Z,et al. Effect of vitamin D supplementation on fasting plasma glucose,insulin resistance and prevention of type2 diabetes mellitus in non-diabetics:A systematic review and meta-analysis[J]. Biomed Rep,2018,8(5):475-484. DOI:10.3892/br. 2018. 1074.
[5] Ross AC,Manson JE,Abrams SA,et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine:what clinicians need to know[J]. J Clin Endocrinol Metab,2011,96(1):53-58. DOI:10. 1210/jc. 2010-2704.
[6] Rosen CJ,Abrams SA,Aloia JF,et al. IOM committee members respond to Endocrine Society vitamin D guideline[J]. J Clin Endocrinol Metab,2012,97(4):1146-1152. DOI:10. 1210/jc.2011-2218.
[7] Wimalawansa SJ. Associations of vitamin D with insulin resistance,obesity,type 2 diabetes,and metabolic syndrome[J]. J Steroid Biochem Mol Biol,2018,175:177-189. DOI:10. 1016/j.jsbmb. 2016. 09. 017.
[8] Li X,Liu Y,Zheng Y,et al. The Effect of Vitamin D Supplementation on Glycemic Control in Type 2 Diabetes Patients:A Systematic Review and Meta-Analysis[J]. Nutrients,2018,10(3).pii:E375. DOI:10. 3390/nu10030375.
[9] Chagas CE,Borges MC,Martini LA,et al. Focus on vitamin D,inflammation and type 2 diabetes[J]. Nutrients,2012,4(1):52-67. DOI:10. 3390/nu4010052.
[10] Oh YS. Bioactive Compounds and Their Neuroprotective Effects in Diabetic Complications[J]. Nutrients,2016,8(8). pii:E472.DOI:10. 3390/nu8080472.
[11] Alamdari A,Mozafari R,Tafakhori A,et al. An inverse association between serum vitamin D levels with the presence and severity of impaired nerve conduction velocity and large fiber peripheral neuropathy in diabetic subjects[J]. Neurol Sci,2015,36(7):1121-1126. DOI:10. 1007/s10072-015-2207-0.
[12] Esteghamati A,Fotouhi A,Faghihi-Kashani S,et al. Non-linear contribution of serum vitamin D to symptomatic diabetic neuropathy:A case-control study[J]. Diabetes Res Clin Pract,2016,111:44-50. DOI:10. 1016/j. diabres. 2015. 10. 018.
[13] He R,Hu Y,Zeng H,et al. Vitamin D deficiency increases the risk of peripheral neuropathy in Chinese patients with type 2 diabetes[J]. Diabetes Metab Res Rev,2017,33(2). DOI:10. 1002/dmrr.2820.
[14] Xue R,Gui D,Zheng L,et al. Mechanistic Insight and Management of Diabetic Nephropathy:Recent Progress and Future Perspective[J]. J Diabetes Res,2017,2017:1839809. DOI:10.1155/2017/1839809.
[15] Peng Y,Li LJ. Serum 25-hydroxyvitamin D level and diabetic nephropathy in patients with type 2 diabetes mellitus[J]. Int Urol Nephrol,2015,47(6):983-989. DOI:10. 1007/s11255-015-0983-3.
[16] Kondo M,Toyoda M,Miyatake H,et al. The Prevalence of 25-hydroxyvitamin D Deficiency in Japanese Patients with Diabetic Nephropathy[J]. Intern Med,2016,55(18):2555-2562. DOI:10. 2169/internalmedicine. 55. 6346.
[17] Xiao X,Wang Y,Hou Y,et al. Vitamin D deficiency and related risk factors in patients with diabetic nephropathy[J]. J Int Med Res,2016,44(3):673-684. DOI:10. 1177/0300060515593765.
[18] Momeni A,Mirhosseini M,Kabiri M,et al. Effect of vitamin D on proteinuria in type 2 diabetic patients[J]. J Nephropathol,2017,6(1):10-14. DOI:10. 15171/jnp. 2017. 03.
[19] Yi X,Sun J,Li L,et al. 1,25-Dihydroxyvitamin D3 Deficiency is Involved in the Pathogenesis of Diabetic Retinopathy in the Uygur Population of China[J]. IUBMB Life,2016,68(6):445-451.DOI:10. 1002/iub. 1501.
[20] Ren Z,Li W,Zhao Q,et al. The impact of 1,25-dihydroxy vitamin D3 on the expressions of vascular endothelial growth factor and transforming growth factor-β? in the retinas of rats with diabetes[J]. Diabetes Res Clin Pract,2012,98(3):474-480. DOI:10.1016/j. diabres. 2012. 09. 028.
[21] Gungor A,Ates O,Bilen H,et al. Retinal Nerve Fiber Layer Thickness in Early-Stage Diabetic Retinopathy With Vitamin D Deficiency[J]. Invest Ophthalmol Vis Sci,2015,56(11):6433-6437. DOI:10. 1167/iovs. 15-16872.
[22] Luo BA,Gao F,Qin LL. The Association between Vitamin D Deficiency and Diabetic Retinopathy in Type 2 Diabetes:A Meta-Analysis of Observational Studies[J]. Nutrients,2017,9(3):307.DOI:10. 3390/nu9030307.
[23] Bonakdaran S,Shoeibi N. Is there any correlation between vitamin D insufficiency and diabetic retinopathy?[J]. Int J Ophthalmol,2015,8(2):326-331. DOI:10. 3980/j. issn. 2222-3959. 2015.02. 20.
[24] Alam U,Amjad Y,Chan AW,et al. Vitamin D Deficiency Is Not Associated with Diabetic Retinopathy or Maculopathy[J]. J Diabetes Res,2016,2016:6156217. DOI:10. 1155/2016/6156217.