25-羟维生素D与糖尿病视网膜病变的关系

发布时间：2018-02-03 02:48

本文关键词： 25羟维生素D 糖尿病视网膜病变糖化血红蛋白胰岛素抵抗　出处：《济南大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的探究糖尿病患者中，25-羟维生素D（25-OHD）与糖尿病视网膜病变（DR）的关系。本研究通过检测健康人及糖尿病患者体内的25-OHD、糖基化血红蛋白（HbA1C）、低密度脂蛋白（LDL）、总胆固醇（TCHO）、空腹胰岛素水平（FINS）等指标，察看所有参与者的眼底，探究血清25-OHD水平与DR发生发展的关系，分析DR与各指标的关系，探究DR的影响因素，为临床DR的预防及治疗提供指导性建议。方法根据ADA1997年发布的糖尿病诊断标准，筛选我院住院2型糖尿病（T2DM）患者553人为糖尿病组（DM组）(男329人，女224人)，年龄（52.56±12.2岁,30-86岁），糖尿病病程(9.61±7.03年,0.4-45年)，并选入同时期我院健康体检患者62人，作为对照组（NC组）。将患者根据DR分期进行分组：糖尿病组（NDR组）179人，年龄（51.06±12.15岁），，背景期视网膜病变组（NPDR组）269人，年龄（52.69±12.19岁）、增殖期视网膜病变组（PDR组）105人，年龄（54.81±12.06岁），健康对照组62人，年龄（52.58±13.20）。检查并记录所有参与者的眼底变化及血清25-OHD水平、糖化血红蛋白（HbA1C）、低密度脂蛋白胆固醇（LDL）、总胆固醇（TCHO）、空腹胰岛素水平（FINS）等指标及患者一般情况，计算患者的胰岛素抵抗指数（Homa-IR）及胰岛素敏感指数（IS）。采用SPSS17.0统计学软件分析数据，检测结果均采用均值±标准差表示。相关性分析采用Pearson分析及偏相关分析。采用多元Logistic回归以期分析DR的影响因素。以P＜0.05作为差异有统计学意义的标准。结果 1一般情况采用非参数检验得出吸烟（P＝0.475）、饮酒（P＝0.714）、性别（P＝0.1）等一般情况与DR无相关性，NC组较DM组、PDR组较NPDR组，维生素D缺乏发生率差异均无统计学意义（P=0.072，P＝0.611），DR组较NDR组，维生素D缺乏发生率差异有统计学意义（P＜0.01）。 2单因素分析 NC组与DM组进行比较，年龄差异无统计学意义（P=0.10）。NDR组、NPDR组、PDR组三组进行比较，年龄、病程、BP、HbA1C水平依次增加（P＜0.05），LDL、HDL、Homa-IR、IS的差异不明显（P＞0.05）。上述四组进行比较血清25-OHD水平依次减少，且差异有统计学意义（P＜0.05）。 3相关性分析采用Pearson相关分析及偏相关分析，校正年龄、性别后，25-OHD与Homa-IR、FPG、IS无相关性。 4Logistic回归将差异具有统计学意义的指标纳入多元Logistic回归模型，结果示病程、BP、HbA1C是DR发生发展的危险因素，而高水平25-OHD可以预防及延缓DR的发生发展（P＜0.05）。结论 1. NC、NDR、NPDR、PDR四组间，病程、收缩压、糖化血红蛋白差异具有统计学意义，且多元回归分析示是DR发生发展的危险因素，而25-OHD是DR的保护性因素，预防延缓DR病变的发生发展。DR组25-OHD缺乏的发生率较NDR组有明显增高，提示25-OHD缺乏的发生率可以预测DR的发生率。 2.吸烟、饮酒、性别的概率在各组间无统计学差异，提示吸烟、饮酒、性别与DR无相关性。 3.25-OHD与胰岛素抵抗及胰岛素敏感指数无相关性。
[Abstract]:Purpose To investigate the relationship between 25-hydroxyvitamin D (25-OHD) and diabetic retinopathy (DRN) in diabetic patients, the 25-OHD was detected in healthy subjects and diabetic patients. Glycosylated hemoglobin (HbA1C), low density lipoprotein (LDLN), total cholesterol (TCHO), fasting insulin level (FINS), and so on, were examined in the fundus of all participants. To explore the relationship between serum 25-OHD level and the occurrence and development of Dr, to analyze the relationship between Dr and various indexes, to explore the influencing factors of Dr, and to provide guiding suggestions for the prevention and treatment of clinical Dr. Method According to the diagnostic criteria of diabetes mellitus published by ADA1997, 553 patients with type 2 diabetes mellitus (T2DM) in our hospital were selected as DM group (329 males and 224 females). The age was 52.56 卤12.2 years old and 30-86 years old, the course of diabetes was 9.61 卤7.03 years and 0.4-45 years, and 62 healthy people were selected in the same period. The patients were divided into two groups according to Dr stage: 179 patients in the diabetic group with NDR (51.06 卤12.15 years old). Background retinopathy group (n = 269), NPDR group (n = 269), age 52.69 卤12.19 years old, proliferative retinopathy group (n = 105), PDR group (n = 105). Age: 54.81 卤12.06 years old, 62 healthy controls, age 52.58 卤13.20. The fundus changes and serum 25-OHD level of all participants were examined and recorded. HbA1C, LDLX, TCHO, fasting insulin level and general status of patients. The insulin resistance index (SPSS17.0) and insulin sensitivity index (ISI) were calculated. The data were analyzed by SPSS17.0 software. The results were expressed as mean 卤standard deviation, Pearson and partial correlation were used in correlation analysis, and multivariate Logistic regression was used to analyze the influencing factors of Dr (P < 0. 0). 05 as the standard of statistical significance. Results 1 General situation The results of nonparametric test showed that there was no correlation between smoking and Dr in NC group compared with DM group. There was no significant difference in the incidence of vitamin D deficiency between the PDR group and the NPDR group. The incidence of vitamin D deficiency in the PDR group was significantly higher than that in the NDR group. The incidence of vitamin D deficiency was significantly different (P < 0.01). 2 single factor analysis There was no significant difference in age between NC group and DM group. There was no significant difference in age between NPDR group and PDR group. The HbA1C level increased in turn (P < 0.05). The serum 25-OHD level in the above four groups decreased in turn, and the difference was statistically significant (P < 0.05). 3 correlation analysis Using Pearson correlation analysis and partial correlation analysis, there was no correlation between age, sex and Homa-IRN FPGIS. 4Logistic regression The results showed that the course of disease was a risk factor for the development of Dr, and HbA1C was a risk factor for the development of Dr. High level 25-OHD could prevent and delay the development of Dr (P < 0. 05). Conclusion 1. There were significant differences in course of disease, systolic blood pressure and glycosylated hemoglobin among the four groups, and the multiple regression analysis showed that the risk factors of Dr development were multiple regression analysis. 25-OHD is the protective factor of Dr. The incidence of 25-OHD deficiency in Dr group is significantly higher than that in NDR group. It is suggested that the incidence of 25-OHD deficiency can predict the incidence of Dr. 2. The probability of smoking, drinking and sex had no statistical difference among the groups, suggesting that smoking, drinking, sex and Dr had no correlation. 3.25-OHD had no correlation with insulin resistance and insulin sensitivity index.
【学位授予单位】：济南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R587.2;R774.1

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