本文關(guān)鍵詞： 25羥維生素D 糖尿病視網(wǎng)膜病變 糖化血紅蛋白 胰島素抵抗　出處：《濟南大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的 探究糖尿病患者中，25-羥維生素D（25-OHD）與糖尿病視網(wǎng)膜病變（DR）的關(guān)系。本研究通過檢測健康人及糖尿病患者體內(nèi)的25-OHD、糖基化血紅蛋白（HbA1C）、低密度脂蛋白（LDL）、總膽固醇（TCHO）、空腹胰島素水平（FINS）等指標(biāo)，察看所有參與者的眼底，探究血清25-OHD水平與DR發(fā)生發(fā)展的關(guān)系，分析DR與各指標(biāo)的關(guān)系，探究DR的影響因素，為臨床DR的預(yù)防及治療提供指導(dǎo)性建議。 方法 根據(jù)ADA1997年發(fā)布的糖尿病診斷標(biāo)準(zhǔn)，篩選我院住院2型糖尿�。═2DM）患者553人為糖尿病組（DM組）(男329人，女224人)，年齡（52.56±12.2歲,30-86歲），糖尿病病程(9.61±7.03年,0.4-45年)，并選入同時期我院健康體檢患者62人，作為對照組（NC組）。將患者根據(jù)DR分期進行分組：糖尿病組（NDR組）179人，年齡（51.06±12.15歲），，背景期視網(wǎng)膜病變組（NPDR組）269人，年齡（52.69±12.19歲）、增殖期視網(wǎng)膜病變組（PDR組）105人，年齡（54.81±12.06歲），健康對照組62人，年齡（52.58±13.20）。檢查并記錄所有參與者的眼底變化及血清25-OHD水平、糖化血紅蛋白（HbA1C）、低密度脂蛋白膽固醇（LDL）、總膽固醇（TCHO）、空腹胰島素水平（FINS）等指標(biāo)及患者一般情況，計算患者的胰島素抵抗指數(shù)（Homa-IR）及胰島素敏感指數(shù)（IS）。采用SPSS17.0統(tǒng)計學(xué)軟件分析數(shù)據(jù)，檢測結(jié)果均采用均值±標(biāo)準(zhǔn)差表示。相關(guān)性分析采用Pearson分析及偏相關(guān)分析。采用多元Logistic回歸以期分析DR的影響因素。以P＜0.05作為差異有統(tǒng)計學(xué)意義的標(biāo)準(zhǔn)。 結(jié)果 1一般情況 采用非參數(shù)檢驗得出吸煙（P＝0.475）、飲酒（P＝0.714）、性別（P＝0.1）等一般情況與DR無相關(guān)性，NC組較DM組、PDR組較NPDR組，維生素D缺乏發(fā)生率差異均無統(tǒng)計學(xué)意義（P=0.072，P＝0.611），DR組較NDR組，維生素D缺乏發(fā)生率差異有統(tǒng)計學(xué)意義（P＜0.01）。 2單因素分析 NC組與DM組進行比較，年齡差異無統(tǒng)計學(xué)意義（P=0.10）。NDR組、NPDR組、PDR組三組進行比較，年齡、病程、BP、HbA1C水平依次增加（P＜0.05），LDL、HDL、Homa-IR、IS的差異不明顯（P＞0.05）。上述四組進行比較血清25-OHD水平依次減少，且差異有統(tǒng)計學(xué)意義（P＜0.05）。 3相關(guān)性分析 采用Pearson相關(guān)分析及偏相關(guān)分析，校正年齡、性別后，25-OHD與Homa-IR、FPG、IS無相關(guān)性。 4Logistic回歸 將差異具有統(tǒng)計學(xué)意義的指標(biāo)納入多元Logistic回歸模型，結(jié)果示病程、BP、HbA1C是DR發(fā)生發(fā)展的危險因素，而高水平25-OHD可以預(yù)防及延緩DR的發(fā)生發(fā)展（P＜0.05）。 結(jié)論 1. NC、NDR、NPDR、PDR四組間，病程、收縮壓、糖化血紅蛋白差異具有統(tǒng)計學(xué)意義，且多元回歸分析示是DR發(fā)生發(fā)展的危險因素，而25-OHD是DR的保護性因素，預(yù)防延緩DR病變的發(fā)生發(fā)展。DR組25-OHD缺乏的發(fā)生率較NDR組有明顯增高，提示25-OHD缺乏的發(fā)生率可以預(yù)測DR的發(fā)生率。 2.吸煙、飲酒、性別的概率在各組間無統(tǒng)計學(xué)差異，提示吸煙、飲酒、性別與DR無相關(guān)性。 3.25-OHD與胰島素抵抗及胰島素敏感指數(shù)無相關(guān)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 鹵12.2 years old and 30-86 years old, the course of diabetes was 9.61 鹵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 鹵12.15 years old). Background retinopathy group (n = 269), NPDR group (n = 269), age 52.69 鹵12.19 years old, proliferative retinopathy group (n = 105), PDR group (n = 105). Age: 54.81 鹵12.06 years old, 62 healthy controls, age 52.58 鹵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 鹵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.
【學(xué)位授予單位】：濟南大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R587.2;R774.1

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