第一型及第二型糖尿病患者其血清維他命D濃度之研究

The Studies of Serum Vitamin D Levels in Type 1 and Type 2 Diabetes Mellitus Patients

曾幸徵(Hsing-Cheng Tseng)

指導教授 ： 陳百薰

高雄醫學大學/醫學院/醫學研究所/碩士(2011年)

摘要

除了小孩軟骨病及成人骨軟化外，在人類維他命D缺乏也可能跟一些癌症、心臟血管疾病、糖尿病、多發性硬化症等有關。以往研究顯示第一型及第二型糖尿病與其血液中25(OH)D濃度之關係均仍有不同之結果，過去也未曾有研究以高效液相層析串聯質譜儀偵測糖尿病患者血液中25(OH)D2、25(OH)D3濃度以區分出維他命D缺乏的可能來源。本研究主要目的是分別使用高效能液相層析串聯質譜分析儀以及火焰式原子吸收光譜儀來偵測中國人第一型及第二型糖尿病患者其血清中25(OH)D2及25(OH)D3濃度與鈣濃度。吾人從高雄醫學大學附設醫院小兒科、內科部內分泌新陳代謝科門診採集第一型糖尿病56位及第二型糖尿病41位病患與門診非糖尿病者、保健科體檢志願者年齡對稱對照組的血清檢體，共收集169位中國人為測試對象。所有參與本研究者均有本人或其法定代理人之知情同意書。吾人研究結果顯示第一型糖尿病患者其血清25(OH)D及25(OH)D3濃度都高於對照組者(p=0.002，0.002)。第二型糖尿病患者血清25(OH)D及25(OH)D3濃度亦比對照組者高(p=0.013，0.012)。第一型或第二型糖尿病患者血清25(OH)D2濃度與對照組者比較都呈無意義之差異。本研究中第一型糖尿病患者其血清25(OH)D濃度不足(<30 ng/mL)者19.6%，缺乏(<20 ng/mL)者7.1%。第二型糖尿病患者血清中25(OH)D濃度不足者僅2.4%，且無25(OH)D濃度缺乏者。第一型及第二型糖尿病者血清鈣濃度與25(OH)D濃度之間均無相關。第一型及第二型糖尿病者25(OH)D濃度與HbA1C值之間亦均無相關。總之吾人研究顯示第一型及第二型糖尿病與其血清中25(OH)D濃度之關係仍有待進一步釐清。

關鍵字

糖尿病 ； 維他命D ； 鈣 ； 高效液相層析串聯質譜儀 ； 火焰式原子吸收光譜儀

並列摘要

Except rickets in children and osteomalasia in adults, vitamin D deficiency may also related cancer, cardiovascular disease, diabetes and multiple sclerosis in human. There were controversial results of serum vitamin D levels in type 1 and type 2 diabetes patients and there were still no previous literatures concerning serum vitamin D levels in diabetes patients by using liquid chromatography tandem mass spectrometry to differentiate the possible source of vitamin d deficiency. We investigated Chinese serum specimens from 56 type 1 diabetes and 41 type 2 diabetes patients from Department of Pediatrics and Division of Endocrinology, Department of Internal Medicine, Kaohsiung Medical University Hospital outpatient clinics. Forty-four and twenty-eight non-diabetes age matched Chinese outpatients and volunteer in Department of Physical Examination of the same hospital were enrolled as type 1 and type 2 diabetes control groups, respectively. All participants in this study gave their informed consent which was approved by The Ethic Committee of our hospital. Serum 25(OH)D2 and 25(OH)D3 levels were measured with liquid chromatography tandem mass spectrometry. We found that our type 1 diabetes patients had significantly higher serum 25(OH)D and 25(OH) D3 levels than that of control groups. (p=0.002, 0.002, respectively). Type 2 diabetes patients also had significantly higher serum 25(OH) D3 levels than that of control groups (p=0.013, 0.012, respectively). There were no significant difference of serum 25(OH) D2 levels between type 1, type 2 diabetes and control groups. Our study revealed that 19.6% of type 1 diabetes patients were 25(OH)D insufficient (< 30 ng/mL) and 7.1% were 25(OH)D deficient. In type 2 diabetes patients, only 2.4% were 25(OH)D insufficient and none was 25(OH)D deficient. There were no correlation between serum calcium levels and 25(OH)D levels in type 1 and type 2 diabetes patients. There were also no correlation between serum 25(OH)D levels and HbA1C levels in type 1 and type 2 diabetes patients. In conclusion, the relationship between type 1, type 2 diabetes and serum 25(OH)D levels still needs further clarification.

並列關鍵字

Diabetes Mellitus ； 25-hydroxyvitamin D ； Calcium ； LC-MS/MS ； Atomic Absorption Spectrometer (AA)

參考文獻

[1]Chen SY, Lin JR, Chen TH, Guo SG, Kao MD, Pan WH. Dietary supplements usage among elderly Taiwanese during 2005-2008. Asia Pac J Clin Nutr 2011; 20:327-336.

[2]Adams JS, Hewison M. Update in vitamin D. J Clin Endocrinol Metab 2010; 95:471-478.

[3]Poduje S, Sjerobabski-Masnec I, Ozanic-Bulic S. Vitamin D--the true and the false about vitamin D. Coll Antropol 2008; 32 Suppl 2:159-162.

[4]Marques CD, Dantas AT, Fragoso TS, Duarte AL. The importance of vitamin D levels in autoimmune diseases. Rev Bras Reumatol 2010; 50:67-80.

[5]Lips P. Vitamin D physiology. Prog Biophys Mol Biol 2006; 92:4-8.