甲状旁腺素对血糖控制不良的糖尿病患者维生素D水平的反应性
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摘要
目的探讨甲状旁腺素对血糖控制不良的糖尿病患者维生素D水平的反应性。方法选取2016年6月至2017年5月就诊于四川大学华西医院的2型糖尿病患者463例作为研究对象,收集每位患者的糖化血红蛋白(HbA1c)、25(OH)D、PTH、Ca、Mg、P数据进行分组分析。结果按照HbA1c的水平将纳入对象分为三组,HbA1c<6.5%,6.5%≤HbA1c<8.4%和HbA1c≥8.4%。在这三组中,PTH、维生素D差异有统计学意义。在HbA1c<6.5%组中,PTH和维生素D水平的相关系数为-0.261(P<0.05);在6.5%≤HbA1c<8.4%组中,PTH和维生素D水平的相关系数为-0.143(P<0.05),在HbA1c≥8.4%组中,PTH和维生素D水平的相关系数为-0.126(P<0.05)。PTH和维生素D的交互作用在糖化血红蛋白较低组(HbA1c<6.5%)有更大的作用(P<0.05)。结论 2型糖尿病患者血糖控制不佳时,维生素D水平降低,PTH的水平与维生素D呈现负相关趋势,但这种趋势在较高的糖化血红蛋白组中有所下降。PTH和维生素D的交互作用在血糖控制较好组发挥更大作用。糖尿病患者的糖化血红蛋白水平越高,PTH对维生素D缺乏的反应性越弱。这可能对指导糖尿病人更好的进行血糖控制,有一定的指导意义。
Objective To investigate the reactivity of parathyroid on vitamin D levels in diabetic patients with poor glycemic control.Methods According to the inclusion and exclusion criteria,we collected 463 patients of type 2 diabetes from June,2016 to May,2017 in West China Hospital affiliated with Sichuan University.We collected the data of glycosylated hemoglobin,25(OH)vitD,PTH,Ca,Mg and P.Results According to the level of HbAl C,the subjects were divided into three groups as following:HbAl c<6.5 %(groupl),6.5 %≤HbAlc<8.4%(group2)and HbA1 c≥8.4%(group3).Among the three groups,the differences of PTH and vitamin D were statistically significant.In the group 1,the correlation coefficient of PTH and vitamin D level was-0.261(P<0.05);In the group 2,the correlation coefficient of PTH and vitamin D levels was-0.143(P<0.05);In the group 3,the correlation coefficient of PTH and vitamin D was-0.126(P<0.05).The interaction(the product)of PTH and vitD had a greater effect on the lower glycosylated hemoglobin group 1(P<0.05).Conclusion The level of vitamin D decreases in patients of type 2 diabetes with poor glucose control.The level of PTH has a negative correlation with vitamin D,and this trend decreases in the high glycosylated hemoglobin group.The interaction(the product)of PTH and vitD plays a greater role in the patients with better blood glucose control. The higher level of glycated hemoglobin in diabetic patients are,the weaker the PTH's responsiveness to vitamin D deficiency.This results could have a guiding significance for better controlling blood sugar for patients.
Objective To investigate the reactivity of parathyroid on vitamin D levels in diabetic patients with poor glycemic control.Methods According to the inclusion and exclusion criteria,we collected 463 patients of type 2 diabetes from June,2016 to May,2017 in West China Hospital affiliated with Sichuan University.We collected the data of glycosylated hemoglobin,25(OH)vitD,PTH,Ca,Mg and P.Results According to the level of HbAl C,the subjects were divided into three groups as following:HbAl c<6.5 %(groupl),6.5 %≤HbAlc<8.4%(group2)and HbA1 c≥8.4%(group3).Among the three groups,the differences of PTH and vitamin D were statistically significant.In the group 1,the correlation coefficient of PTH and vitamin D level was-0.261(P<0.05);In the group 2,the correlation coefficient of PTH and vitamin D levels was-0.143(P<0.05);In the group 3,the correlation coefficient of PTH and vitamin D was-0.126(P<0.05).The interaction(the product)of PTH and vitD had a greater effect on the lower glycosylated hemoglobin group 1(P<0.05).Conclusion The level of vitamin D decreases in patients of type 2 diabetes with poor glucose control.The level of PTH has a negative correlation with vitamin D,and this trend decreases in the high glycosylated hemoglobin group.The interaction(the product)of PTH and vitD plays a greater role in the patients with better blood glucose control. The higher level of glycated hemoglobin in diabetic patients are,the weaker the PTH's responsiveness to vitamin D deficiency.This results could have a guiding significance for better controlling blood sugar for patients.
引文
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[4]HUTCHINSON M S,FIGENSCHAU Y, NJOLSTAD I,et al.Serum25-hydroxyvitamin D levels are inversely associated with glycated haemoglobin(HbA(lc)).The Tromso Study[J].Scand J Clin Lab Invest,2011,71(5):399-406.
[5]LU Y,LI J,CHENG X,et al.Testosterone level in aging male with different glucose tolerance state and its association with osteocalcin[J].Aging Male,2018:1-6.2018.1481940.
[6]SUDA T,UENO Y,FUJII K,et al.Vitamin D and bone[J].J Cell Biochemistry,2002,88(2):259-266.
[7]SAHOTA O,MASUD T,SAN P,et al.Vitamin D insufficiency increases bone turnover markers and enhances bone loss at the hipsin patients with established osteoporosis[J].Clin Endocrinol,1999,51(2):217-221.
[8]LAMBERG-ALLARDT C,VON KNORRING J,SLATIS P,et al.Vitamin D status and concentrations of serum vitamin D metabolites and osteocalcin in elderly patients with femoral neck fracture:a follow-up study[J].Eur J Clin Nutr,1988,43(5):355-361.
[9]BISCHOFF-FERRARI H A,WILLETT W C,WONG J B,et al.Fracture prevention with vitamin D supplementation:a metaanalysis of randomized controlled trials[J].JAMA,2005,293(18):2257-2264.
[10]MITRI J,PITTAS A G.Vitamin D and diabetes[J].Endocrinol Metab Clin North Am,2014,43(1):205-232.
[11]PITTAS A G,DAWSON-HUGHES B.Vitamin D and diabetes[J].J Steroid Biochem Mol Biol,2010,121(1-2):425-429.
[12]PITTAS A G,LAU J,HU F B,et al.The role of vitamin D and calcium in type 2 diabetes:A systematic review and meta-analysis[J].J Clin Endocrinol Metab,2007,92(6):2017-2029.
[13]AL-SHOUMER K A,AL-ESSA T M.Is there a relationship between vitamin D with insulin resistance and diabetes mellitus?[J].World J Diabetes,2015,6(8):1057-1064.
[14]FLORKOWSKI C.HbAlc as a diagnostic test for diabetes mellitusreviewing the evidence[J].Clin Biochem Rev,2013,34(2):75-83.
[15]AL-DAGHRI N M,AL-SALEH Y,ALJOHANI N,et al.Vitamin D status correction in Saudi Arabia:an experts'consensus under the auspices of the European Society for Clinical and Economic Aspects of Osteoporosis,Osteoarthritis,and Musculoskeletal Diseases(ESCEO)[J].Arch Osteoporos,2017,12(1):1.
[16]WHITELAW D C,SCALLY A J,TUFFNELL D J,et al.Associations of circulating calcium and 25-hydroxyvitamin D with glucose metabolism in pregnancy:A cross-sectional study in European andSouth Asian women[J].J Clin Endocrinol Metab,2014,99(3):938-946.
[17]KRAMER C K,SWAMINATHAN B,HANLEY A J,et al.Prospective Associations of Vitamin D Status with-cell function,Insulin Sensitivity and Glycemia:The Impact of Parathyroid Hormone Status[J].Diabetes,2014,63(11):3868-3879.
[18]NGUYEN N U,DUMOULIN G,HENRIET M T,et al.Calcium phosphorushomeostasis during oral glucose load in man[J].Horm Metab Res,1984,16(5):264-266.
[19]D'ERASMO E,PISANI D,RAGNO A,et al.Calcium homeostasis during oral glucose load in healthy women[J].Horm Metab Res,1999,31(4):271-273.
[20]DING E L,SONG Y,MALIK V S, et al.Sex differences of endogenous sex hormones and risk of type 2 diabetes:a systematic review and meta-analysis.JAMA.2006,295(11):1288-1299.
[21]GOH V H,HART W G.Association of general and abdominal obesity with age,endocrine and metabolic factors in Asian men[J].Aging Male,2016,19(1):27-33.
[22]HEUFELDER A E,SAAD F,BUNCK M,et al.Fifty-two-week treatment with diet and exercise plus transdermal testosterone reverses the metabolic syndrome and improves glycemic control in men with newly diagnosed type 2 diabetes and subnormal plasma testosterone.J Androl,2009,30(6):726-733.
[23]GERDHEM P,ISAKSSON A,AKESSON K,et al.Increased bone density and decreased bone turnover,but no evident alteration of fracture susceptibility in elderly women with diabetes mellitus[J].Osteoporos Int,2005,16(12):1506-1512.
[24]POLYMERIS A D,DOUMOUCHTSIS K K,GIAGOURTA I,et al.Effect of an oral glucose load on PTH,250HD3, calcium,and phosphorus homeostasis in postmenopausal women[J].Endocr Res,2011,36(2):45-52.
[2]DeLUCA H F.Overview of general physiologic features and functions of vitamin D[J].Am J Clin Nutr,2004,80(6 Suppl):1689S-1696S.
[3]PITTAS A G,NELSON J,MITRI J,et al.Plasma 25-hydroxyvitamin D and progression to diabetes in patients at risk for diabetes:an ancillary analysis in the Diabetes Prevention Program[J].Diabetes Care,2012,35(3):565-573.
[4]HUTCHINSON M S,FIGENSCHAU Y, NJOLSTAD I,et al.Serum25-hydroxyvitamin D levels are inversely associated with glycated haemoglobin(HbA(lc)).The Tromso Study[J].Scand J Clin Lab Invest,2011,71(5):399-406.
[5]LU Y,LI J,CHENG X,et al.Testosterone level in aging male with different glucose tolerance state and its association with osteocalcin[J].Aging Male,2018:1-6.2018.1481940.
[6]SUDA T,UENO Y,FUJII K,et al.Vitamin D and bone[J].J Cell Biochemistry,2002,88(2):259-266.
[7]SAHOTA O,MASUD T,SAN P,et al.Vitamin D insufficiency increases bone turnover markers and enhances bone loss at the hipsin patients with established osteoporosis[J].Clin Endocrinol,1999,51(2):217-221.
[8]LAMBERG-ALLARDT C,VON KNORRING J,SLATIS P,et al.Vitamin D status and concentrations of serum vitamin D metabolites and osteocalcin in elderly patients with femoral neck fracture:a follow-up study[J].Eur J Clin Nutr,1988,43(5):355-361.
[9]BISCHOFF-FERRARI H A,WILLETT W C,WONG J B,et al.Fracture prevention with vitamin D supplementation:a metaanalysis of randomized controlled trials[J].JAMA,2005,293(18):2257-2264.
[10]MITRI J,PITTAS A G.Vitamin D and diabetes[J].Endocrinol Metab Clin North Am,2014,43(1):205-232.
[11]PITTAS A G,DAWSON-HUGHES B.Vitamin D and diabetes[J].J Steroid Biochem Mol Biol,2010,121(1-2):425-429.
[12]PITTAS A G,LAU J,HU F B,et al.The role of vitamin D and calcium in type 2 diabetes:A systematic review and meta-analysis[J].J Clin Endocrinol Metab,2007,92(6):2017-2029.
[13]AL-SHOUMER K A,AL-ESSA T M.Is there a relationship between vitamin D with insulin resistance and diabetes mellitus?[J].World J Diabetes,2015,6(8):1057-1064.
[14]FLORKOWSKI C.HbAlc as a diagnostic test for diabetes mellitusreviewing the evidence[J].Clin Biochem Rev,2013,34(2):75-83.
[15]AL-DAGHRI N M,AL-SALEH Y,ALJOHANI N,et al.Vitamin D status correction in Saudi Arabia:an experts'consensus under the auspices of the European Society for Clinical and Economic Aspects of Osteoporosis,Osteoarthritis,and Musculoskeletal Diseases(ESCEO)[J].Arch Osteoporos,2017,12(1):1.
[16]WHITELAW D C,SCALLY A J,TUFFNELL D J,et al.Associations of circulating calcium and 25-hydroxyvitamin D with glucose metabolism in pregnancy:A cross-sectional study in European andSouth Asian women[J].J Clin Endocrinol Metab,2014,99(3):938-946.
[17]KRAMER C K,SWAMINATHAN B,HANLEY A J,et al.Prospective Associations of Vitamin D Status with-cell function,Insulin Sensitivity and Glycemia:The Impact of Parathyroid Hormone Status[J].Diabetes,2014,63(11):3868-3879.
[18]NGUYEN N U,DUMOULIN G,HENRIET M T,et al.Calcium phosphorushomeostasis during oral glucose load in man[J].Horm Metab Res,1984,16(5):264-266.
[19]D'ERASMO E,PISANI D,RAGNO A,et al.Calcium homeostasis during oral glucose load in healthy women[J].Horm Metab Res,1999,31(4):271-273.
[20]DING E L,SONG Y,MALIK V S, et al.Sex differences of endogenous sex hormones and risk of type 2 diabetes:a systematic review and meta-analysis.JAMA.2006,295(11):1288-1299.
[21]GOH V H,HART W G.Association of general and abdominal obesity with age,endocrine and metabolic factors in Asian men[J].Aging Male,2016,19(1):27-33.
[22]HEUFELDER A E,SAAD F,BUNCK M,et al.Fifty-two-week treatment with diet and exercise plus transdermal testosterone reverses the metabolic syndrome and improves glycemic control in men with newly diagnosed type 2 diabetes and subnormal plasma testosterone.J Androl,2009,30(6):726-733.
[23]GERDHEM P,ISAKSSON A,AKESSON K,et al.Increased bone density and decreased bone turnover,but no evident alteration of fracture susceptibility in elderly women with diabetes mellitus[J].Osteoporos Int,2005,16(12):1506-1512.
[24]POLYMERIS A D,DOUMOUCHTSIS K K,GIAGOURTA I,et al.Effect of an oral glucose load on PTH,250HD3, calcium,and phosphorus homeostasis in postmenopausal women[J].Endocr Res,2011,36(2):45-52.