本文選題：2型糖尿病 + 維生素D　； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的綜合評(píng)價(jià)維生素D補(bǔ)充對(duì)2型糖尿病患者空腹血糖、糖化血紅蛋白、胰島素抵抗及胰島β細(xì)胞功能的影響,為臨床2型糖尿病患者補(bǔ)充維生素D輔助控制血糖提供依據(jù)。方法通過計(jì)算機(jī)檢索Cochrane圖書館(2015年第12期)、Pub Med、Web of Science、Science Direct Online、維普、中國知網(wǎng)、萬方數(shù)據(jù)庫、中國生物醫(yī)學(xué)文獻(xiàn)(CBM)數(shù)據(jù)庫,搜索從建庫到2015年12月,有關(guān)對(duì)2型糖尿病患者補(bǔ)充維生素D的隨機(jī)對(duì)照試驗(yàn)(RCT)。由2名研究者獨(dú)立篩選文獻(xiàn)、提取資料并對(duì)納入的研究進(jìn)行偏移風(fēng)險(xiǎn)評(píng)價(jià),然后使用Rev Man5.3及Stata12.0軟件進(jìn)行Meta分析。結(jié)果共納入19篇文獻(xiàn)(因3篇文獻(xiàn)中各含2個(gè)RCT,共包括22個(gè)RCT),1756例糖尿病患者,其中試驗(yàn)組889例,對(duì)照組867例。Meta分析結(jié)果顯示,維生素D補(bǔ)充組較對(duì)照組,胰島素抵抗(HOMA-IR)顯著改善(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)、糖化血紅蛋白(Hb A1c)(MD=-0.04,95%CI=-0.16~0.09,P=0.55)和胰島β細(xì)胞功能(HOMA-β)(SMD=-0.17,95%CI=-1.39~1.04,P=0.78)方面,兩組并無顯著差異。進(jìn)一步按照人種、性別、體質(zhì)指數(shù)等進(jìn)行亞組分析的結(jié)果顯示,維生素D補(bǔ)充組較對(duì)照組在中東人群、隨訪時(shí)間≤3個(gè)月的亞組中,FPG水平(中東人:MD=-8.83,95%CI=-15.12~-2.54,P=0.006;隨訪≤3月:MD=-7.94,95%CI=-13.39~-2.50,P=0.004)和HOMA-IR指標(biāo)(中東人:SMD=-0.94,95%CI=-1.80~-0.09,P=0.03;隨訪≤3月:SMD=-1.02,95%CI=-1.95~-0.10,P=0.03)方面作用效果更明顯。結(jié)論當(dāng)前研究表明,維生素D補(bǔ)充可改善2型糖尿病患者的胰島素抵抗,但對(duì)血糖控制和胰島β細(xì)胞功能的影響并不明顯。故維生素D補(bǔ)充對(duì)2型糖尿病患者血糖控制、改善胰島素抵抗和胰島β細(xì)胞功能的證據(jù)尚不充足,仍需大量高質(zhì)量的研究支持。目的通過計(jì)算每日維生素D的攝入量,探討其與2型糖尿病患者血糖控制的相關(guān)性,為2型糖尿病的防治提供依據(jù)。方法采用便利抽樣的方法選取青島市某三甲醫(yī)院住院的2型糖尿病患者200例作為試驗(yàn)組,選取同期在該院體檢中心查體的健康志愿者200例作為對(duì)照組。采用24小時(shí)膳食回顧法調(diào)查研究對(duì)象就診前1天的飲食及服用補(bǔ)充劑的情況,并采用富含維生素D食物頻率表對(duì)患者過去1個(gè)月內(nèi)富含維生素D的食物及補(bǔ)充劑的攝入頻率進(jìn)行調(diào)查,計(jì)算患者每日維生素D攝入量及過去1個(gè)月平均每周富含維生素D食物及補(bǔ)充劑的攝入頻次,并對(duì)患者年齡、體質(zhì)指數(shù)、血糖、血脂、血壓、戶外活動(dòng)時(shí)間、每日維生素D攝入量與糖化血紅蛋白進(jìn)行相關(guān)性分析,通過Logistic回歸分析血糖控制與各相關(guān)變量間的關(guān)系。結(jié)果2型糖尿病患者每日維生素D的攝入量為(202.86±85.87)IU,低于健康對(duì)照組(282.55±59.80)IU,差異有統(tǒng)計(jì)學(xué)意義(P0.05);且2型糖尿病患者每周富含維生素D的食物及補(bǔ)充劑的攝入頻次小于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。相關(guān)分析顯示,影響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、總膽固醇、高密度脂蛋白、低密度脂蛋白、每日膳食維生素D攝入量(r值分別為0.278,0.339,0.254,-0.457,0.219,-0.151;P值均0.05)。血糖達(dá)標(biāo)組患者和血糖不達(dá)標(biāo)組患者在甘油三酯、總膽固醇、高密度脂蛋白、每日維生素D攝入量方面差異有統(tǒng)計(jì)學(xué)意義(P0.05)。Logistic回歸顯示,2型糖尿病患者血糖控制的影響因素包括:總膽固醇、高密度脂蛋白、每日維生素D攝入量(B值分別為0.581,-1.921,-0.006;P值均0.05)。結(jié)論2型糖尿病患者富含維生素D食物及補(bǔ)充劑攝入不足。其每日維生素D的攝入量低于健康對(duì)照組。每日維生素D的攝入量與血糖控制有關(guān)。這提示維生素D攝入量過低可能是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.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R587.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 姜敏;曹娟;謝宇;鄭聞;張偉;王惠;王春;;不同劑量維生素D加鈣干預(yù)對(duì)中老年糖耐量減低患者血糖和胰島素敏感性的影響[J];中華糖尿病雜志;2016年12期

2 羅文超;徐飛;呂利佳;李巖;邢長泰;趙輝;;Ⅱ型糖尿病患者體成分、血糖和血脂的相關(guān)關(guān)系[J];解剖學(xué)雜志;2016年05期

3 張誠霖;王麗麗;張笑燕;蔣青;汪小華;;2型糖尿病患者糖尿病飲食知識(shí)掌握現(xiàn)狀及其對(duì)糖化血紅蛋白的影響[J];護(hù)士進(jìn)修雜志;2016年18期

4 尹秀梅;游娜;繆珩;林照;葛衛(wèi)星;徐家蓉;;補(bǔ)充維生素D對(duì)肥胖或糖代謝異常患者胰島素抵抗及血糖改善效果的meta分析[J];中華內(nèi)分泌代謝雜志;2016年08期

5 鮮彤章;潘琦;張麗娜;張潔;李銘;李淼;郭立新;;住院2型糖尿病患者血清25-羥維生素D水平與糖代謝指標(biāo)的相關(guān)性[J];中華臨床營養(yǎng)雜志;2016年03期

6 汪曉紅;李莉;;維生素D對(duì)老年2型糖尿病患者胰島素抵抗影響的研究[J];重慶醫(yī)學(xué);2016年09期

7 吳鋒;王海生;張建軍;;維生素D對(duì)2型糖尿病患者血糖控制及炎性反應(yīng)的影響[J];檢驗(yàn)醫(yī)學(xué)與臨床;2016年03期

8 林兵;馬小陶;王亞非;石勱;;糖尿病患者維生素D的膳食攝入狀況調(diào)查[J];中國食物與營養(yǎng);2016年01期

9 郝志華;呂超;李巖;陳春彥;王亞珍;劉玉靜;齊春萍;宋光耀;;甘油三酯、高密度脂蛋白變化與空腹血糖變化的5年隨訪研究[J];現(xiàn)代預(yù)防醫(yī)學(xué);2015年14期

10 劉冰;洪旭;尹潔;郝雅斌;;維生素D水平與2型糖尿病患者血糖控制關(guān)系的分析[J];中華臨床醫(yī)師雜志(電子版);2015年13期

相關(guān)碩士學(xué)位論文 前1條

1 張敬紅;成人維生素D補(bǔ)充對(duì)血糖，胰島素抵抗及胰島素分泌影響的meta分析[D];重慶醫(yī)科大學(xué);2014年

，

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