维生素D与2型糖尿病患者血糖控制相关的Meta分析及其调查研究

发布时间：2018-06-09 20:57

本文选题：2型糖尿病 + 维生素D　；参考：《青岛大学》2017年硕士论文

【摘要】：目的综合评价维生素D补充对2型糖尿病患者空腹血糖、糖化血红蛋白、胰岛素抵抗及胰岛β细胞功能的影响,为临床2型糖尿病患者补充维生素D辅助控制血糖提供依据。方法通过计算机检索Cochrane图书馆(2015年第12期)、Pub Med、Web of Science、Science Direct Online、维普、中国知网、万方数据库、中国生物医学文献(CBM)数据库,搜索从建库到2015年12月,有关对2型糖尿病患者补充维生素D的随机对照试验(RCT)。由2名研究者独立筛选文献、提取资料并对纳入的研究进行偏移风险评价,然后使用Rev Man5.3及Stata12.0软件进行Meta分析。结果共纳入19篇文献(因3篇文献中各含2个RCT,共包括22个RCT),1756例糖尿病患者,其中试验组889例,对照组867例。Meta分析结果显示,维生素D补充组较对照组,胰岛素抵抗(HOMA-IR)显著改善(SMD=-0.68,95%CI=-1.23~-0.12,P=0.02),但在空腹血糖(FPG)(MD=-3.64,95%CI=-11.41~4.13,P=0.36)、糖化血红蛋白(Hb A1c)(MD=-0.04,95%CI=-0.16~0.09,P=0.55)和胰岛β细胞功能(HOMA-β)(SMD=-0.17,95%CI=-1.39~1.04,P=0.78)方面,两组并无显著差异。进一步按照人种、性别、体质指数等进行亚组分析的结果显示,维生素D补充组较对照组在中东人群、随访时间≤3个月的亚组中,FPG水平(中东人:MD=-8.83,95%CI=-15.12~-2.54,P=0.006;随访≤3月:MD=-7.94,95%CI=-13.39~-2.50,P=0.004)和HOMA-IR指标(中东人:SMD=-0.94,95%CI=-1.80~-0.09,P=0.03;随访≤3月:SMD=-1.02,95%CI=-1.95~-0.10,P=0.03)方面作用效果更明显。结论当前研究表明,维生素D补充可改善2型糖尿病患者的胰岛素抵抗,但对血糖控制和胰岛β细胞功能的影响并不明显。故维生素D补充对2型糖尿病患者血糖控制、改善胰岛素抵抗和胰岛β细胞功能的证据尚不充足,仍需大量高质量的研究支持。目的通过计算每日维生素D的摄入量,探讨其与2型糖尿病患者血糖控制的相关性,为2型糖尿病的防治提供依据。方法采用便利抽样的方法选取青岛市某三甲医院住院的2型糖尿病患者200例作为试验组,选取同期在该院体检中心查体的健康志愿者200例作为对照组。采用24小时膳食回顾法调查研究对象就诊前1天的饮食及服用补充剂的情况,并采用富含维生素D食物频率表对患者过去1个月内富含维生素D的食物及补充剂的摄入频率进行调查,计算患者每日维生素D摄入量及过去1个月平均每周富含维生素D食物及补充剂的摄入频次,并对患者年龄、体质指数、血糖、血脂、血压、户外活动时间、每日维生素D摄入量与糖化血红蛋白进行相关性分析,通过Logistic回归分析血糖控制与各相关变量间的关系。结果2型糖尿病患者每日维生素D的摄入量为(202.86±85.87)IU,低于健康对照组(282.55±59.80)IU,差异有统计学意义(P0.05);且2型糖尿病患者每周富含维生素D的食物及补充剂的摄入频次小于对照组,差异有统计学意义(P0.05)。相关分析显示,影响2型糖尿病患者血糖控制的因素包括:糖尿病病程、甘油三酯、总胆固醇、高密度脂蛋白、低密度脂蛋白、每日膳食维生素D摄入量(r值分别为0.278,0.339,0.254,-0.457,0.219,-0.151;P值均0.05)。血糖达标组患者和血糖不达标组患者在甘油三酯、总胆固醇、高密度脂蛋白、每日维生素D摄入量方面差异有统计学意义(P0.05)。Logistic回归显示,2型糖尿病患者血糖控制的影响因素包括:总胆固醇、高密度脂蛋白、每日维生素D摄入量(B值分别为0.581,-1.921,-0.006;P值均0.05)。结论2型糖尿病患者富含维生素D食物及补充剂摄入不足。其每日维生素D的摄入量低于健康对照组。每日维生素D的摄入量与血糖控制有关。这提示维生素D摄入量过低可能是2型糖尿病患者血糖升高的原因。
[Abstract]:Objective to evaluate the effects of vitamin D supplementation on fasting blood glucose, glycosylated hemoglobin, insulin resistance and islet beta cell function in type 2 diabetic patients, and to provide basis for supplementation of vitamin D supplementation in clinical type 2 diabetic patients by supplementation of Cochrane Library (period twelfth in 2015), Pub Med, Web of Science, Sci Ence Direct Online, VIP, China knowledge network, Wanfang database, Chinese Biomedical Literature (CBM) database, search for a randomized controlled trial of vitamin D supplementation to type 2 diabetic patients (RCT) from construction to December 2015. 2 researchers screened the literature independently, extracted data, and evaluated the included research on the risk of migration, and then made Meta analysis was carried out with Rev Man5.3 and Stata12.0 software. The results were included in 19 articles (2 RCT in 3 papers, 22 RCT in all), 1756 diabetic patients, 889 in the experimental group and 867 in the control group with.Meta analysis. The vitamin D supplementation group was significantly improved (SMD=-0.68,95%CI=-1.23~) (SMD=-0.68,95%CI=-1.23~, HOMA-IR) significantly improved (SMD=-0.68,95%CI=-1.23~). -0.12, P=0.02), but there was no significant difference between the two groups in the fasting blood glucose (FPG) (MD=-3.64,95%CI=-11.41~4.13, P=0.36), glycosylated hemoglobin (Hb A1c) (MD=-0.04,95%CI=-0.16~0.09, P=0.55) and beta cell function (HOMA- beta) (SMD=-0.17,95%CI=-1.39~1.04, P=0.78). Further subgroup analysis was carried out according to the ethnicity, sex, and body mass index. The results showed that the vitamin D supplement group was in the Middle East group compared with the control group, and the follow-up time was less than 3 months, and the FPG level (Middle East: MD=-8.83,95%CI=-15.12~-2.54, P=0.006; follow-up < March: MD=-7.94,95%CI=-13.39~-2.50, P=0.004) and HOMA-IR index (Middle East: SMD =-0.94,95%CI=-1.80~-0.09, P=0.03; follow up < March: SMD=-1.02,95%CI=-1.95~. The effect of -0.10, P=0.03) is more obvious. Conclusion the current study shows that vitamin D supplementation can improve insulin resistance in type 2 diabetic patients, but the effect on blood glucose control and islet beta cell function is not obvious. Therefore, vitamin D supplementation on blood glucose control in type 2 diabetic patients and evidence for improving insulin resistance and islet beta cell function Not enough, a large number of high quality research support is still needed. Objective by calculating the daily vitamin D intake, the correlation of blood glucose control in type 2 diabetes patients was discussed, and the basis for prevention and control of type 2 diabetes was provided. Methods 200 patients with type 2 diabetes hospitalized in a three a hospital in Qingdao were selected as a test by convenient sampling. 200 healthy volunteers in the physical examination center in the same period were selected as the control group. The diet and supplementation of the subjects were investigated by the 24 hour diet review method, and the vitamin D rich food frequency table was used to determine the intake of vitamin D rich food and supplement in the patients over the past 1 months. A survey was conducted to calculate the daily vitamin D intake and the frequency of vitamin D rich foods and supplements for the past 1 months. The patient's age, body mass index, blood sugar, blood lipid, blood pressure, outdoor activity time, daily vitamin D intake and glycosylated hemoglobin were analyzed by the Logistic regression analysis. Results the daily vitamin D intake of type 2 diabetic patients was (202.86 + 85.87) IU, lower than that of the healthy control group (282.55 + 59.80) IU, and the difference was statistically significant (P0.05), and the intake frequency of vitamin D rich food and supplement in type 2 diabetic patients was less than that of the control group, and the difference was statistically significant P0.05. Correlation analysis showed that factors affecting blood glucose control in type 2 diabetic patients include diabetes course, triglyceride, total cholesterol, high density lipoprotein, low density lipoprotein, and daily dietary vitamin D intake (r value of 0.278,0.339,0.254, -0.457,0.219, -0.151; P, respectively 0.05). The differences in triglyceride, total cholesterol, high density lipoprotein, and daily vitamin D intake were statistically significant (P0.05).Logistic regression showed that the factors affecting blood glucose control in type 2 diabetic patients included total cholesterol, high density lipoprotein, and vitamin D intake per day (B value of 0.581, -1.921, -0.006; P, respectively 0, respectively. .05) conclusion the intake of vitamin D is lower in type 2 diabetic patients. The daily vitamin D intake is lower than that in the healthy control group. Daily vitamin D intake is associated with blood glucose control. This suggests that low vitamin D intake may be the cause of higher blood glucose in type 2 diabetic patients.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1

【参考文献】