Diabetes Care：T1DM患者维生素D代谢受损与动脉粥样硬化没有相关性

 1型糖尿病(T1DM)患者早发动脉粥样硬化的风险较高。已有的证据表明维生素D代谢受损可能会促进动脉粥样硬化的发生。来自美国华盛顿大学的Sachs博士等人进行了一项研究，测定T1DM患者血循环中维生素D代谢产物浓度与亚临床动脉粥样硬化间的联系。研究发现，维生素D代谢受损与动脉粥样硬化没有相关性。研究结果在线发表于2013年3月25日的美国《糖尿病护理》(Diabetes Care)杂志上。
研究对象为糖尿病控制与并发症/糖尿病干预和流行病学(DCCT/EDIC)研究中的1,193名T1DM患者。DCCT研究结束，采用质谱法测定血浆中25-羟维生素D[25(OH)D]，1,25-二羟维生素D和24,25-二羟维生素D的浓度。在交错横断面设计中，测定维生素D代谢产物与冠状动脉钙化(CAC)及颈总动脉和颈内动脉内膜中层厚度(IMT)的相关性。CAC采用计算机x线断层扫描测定，检测中位时间为10年后；颈动脉IMT采用B型超声检查，检查中位时间为分别为4年后和10年后。作者假设每个低浓度维生素D代谢产物与CAC风险增高及颈动脉IMT增加相关。
测定代谢产物浓度时，患者平均年龄32.4岁，糖尿病病程7.5年。结果显示，随着每个维生素D代谢产物的浓度降低，CAC发病率和严重程度呈降低趋势(而不是升高)。例如，在完全校正的多项式logistic模型中，25-羟维生素D浓度降低25nmol/L，CAC评分较高的可能性降低0.8倍(95% CI 0.68-0.96，P=0.01)。维生素D代谢产物与颈总动脉或颈内动脉平均IMT都不相关。
研究表明，维生素D代谢受损与T1DM患者亚临床动脉粥样硬化没有联系。
与粥样硬化相关的拓展阅读：

• Diabetes Care：甘精胰岛素轻度降低动脉粥样硬化风险
• EMBO：揭示单核细胞迁移至血管壁导致动脉粥样硬化机制
• J BIOL CHEM:发现抑制动脉粥样硬化新分子信号途径
• JAMA：减少动脉粥样硬化性血栓形成实现持续健康
• Diabetes Care:胰岛移植或改善糖尿病相关动脉粥样硬化
• AHA年会：妊娠失败增加多种动脉粥样硬化风险
更多信息请点击：有关粥样硬化更多资讯

Circulating Vitamin D Metabolites and Subclinical Atherosclerosis in Type 1 Diabetes.
Abstract
OBJECTIVEPeople with type 1 diabetes are at high risk of premature atherosclerosis. Existing evidence suggests that impaired vitamin D metabolism may contribute to the development of atherosclerosis. We tested associations of circulating vitamin D metabolite concentrations with subclinical atherosclerosis among 1,193 participants with type 1 diabetes in the DCCT/EDIC study.RESEARCH DESIGN AND METHODSWe measured plasma concentrations of 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D, and 24,25-dihydroxyvitamin D by mass spectrometry at the end of the DCCT. In a staggered cross-sectional design, we tested associations with coronary artery calcium (CAC), measured by computed tomography a median of 10 years later, and with common and internal carotid intima-media thickness (IMT), measured by B-mode ultrasonography on two occasions a median of 4 years later and a median of 10 years later. We hypothesized that lower concentrations of each vitamin D metabolite would be associated with increased risk of CAC and greater carotid IMT.RESULTSAt the time metabolites were measured, mean age was 32.4 years and mean duration of diabetes was 7.5 years. The prevalence and severity of CAC tended to be lower-not higher-with lower concentrations of each vitamin D metabolite. For instance, in a fully adjusted multinomial logistic model, a 25 nmol/L lower 25-hydroxyvitamin D was associated with a 0.8-fold decrease in the odds of having higher CAC (95% CI 0.68-0.96, P = 0.01). No vitamin D metabolite was associated with either common or internal mean IMT.CONCLUSIONSWe did not find evidence linking impaired vitamin D metabolism with increased subclinical atherosclerosis in type 1 diabetes.