维生素D与1型糖尿病及其并发症相关性的研究进展

doi:10.12114/j.issn.1007-9572.2024.0224

摘要/Abstract

摘要： 1型糖尿病（T1DM）目前被认为是由胰腺β细胞破坏所引起的慢性自身免疫性疾病，主要是由遗传因素及环境因素共同发挥作用导致胰岛β细胞被破坏，使体内胰岛素分泌绝对不足，需终身依赖体外胰岛素治疗。随着T1DM发病率在全球范围内不断增加，使得人们更加重视T1DM的预防及治疗。诸多研究已证实维生素D除对体内骨代谢及钙磷平衡具有重大价值外，在慢性炎症及免疫相关疾病的发生及进展中亦有重要作用。因此本文在介绍T1DM流行病学及维生素D作用的基础上，进一步阐述维生素D与T1DM及其并发症间的相关性，以期为临床医生综合诊治T1DM提供理论依据。

关键词: 糖尿病，1型, 维生素D, 糖尿病并发症

Abstract:

Type 1 diabetes mellitus (T1DM) is currently considered to be a chronic autoimmune disease caused by destruction of pancreatic β-cells. It is mainly caused by a combination of genetic and environmental factors that lead to destruction of pancreatic β-cells, which results in an absolute lack of insulin secretion in the body and a lifelong dependence on extracorporeal insulin therapy. As the incidence of T1DM continues to increase globally, more attention has been paid to the prevention and treatment of T1DM. Numerous studies have demonstrated that vitamin D, in addition to its value in bone metabolism and calcium-phosphorus homeostasis, also plays an important role in the development and progression of chronic inflammatory and immune-related diseases. Therefore, on the basis of introducing the epidemiology of T1DM and the role of vitamin D, this article further elaborates the correlation between vitamin D and T1DM and its complications, with a view to providing a theoretical basis for clinicians to comprehensively diagnose and treat T1DM.

Key words: Diabetes mellitus, type 1, Vitamin D, Diabetes complications

中图分类号:

R 587.1

吕程,蒋升. 维生素D与1型糖尿病及其并发症相关性的研究进展[J]. 中国全科医学, 2025, 28(12): 1538-1542. DOI: 10.12114/j.issn.1007-9572.2024.0224.
LYU Cheng,JIANG Sheng. Research Progress on the Relationship between Vitamin D and Type 1 Diabetes Mellitus and Its Complications[J]. Chinese General Practice, 2025, 28(12): 1538-1542. DOI: 10.12114/j.issn.1007-9572.2024.0224.

参考文献 41

[1]	EIZIRIK D L，PASQUALI L，CNOP M. Pancreatic β-cells in type 1 and type 2 diabetes mellitus：different pathways to failure[J]. Nat Rev Endocrinol，2020，16（7）：349-362. DOI：10.1038/s41574-020-0355-7.
[2]	BLAGOV A V，SUMMERHILL V I，SUKHORUKOV V N，et al. Type 1 diabetes mellitus：inflammation，mitophagy，and mitochondrial function[J]. Mitochondrion，2023，72：11-21. DOI：10.1016/j.mito.2023.07.002.
[3]	GREEN A，HEDE S M，PATTERSON C C，et al. Type 1 diabetes in 2017：global estimates of incident and prevalent cases in children and adults[J]. Diabetologia，2021，64（12）：2741-2750. DOI：10.1007/s00125-021-05571-8.
[4]	GREGORY G A，ROBINSON T I G，LINKLATER S E，et al. Global incidence，prevalence，and mortality of type 1 diabetes in 2021 with projection to 2040：a modelling study[J]. Lancet Diabetes Endocrinol，2022，10（10）：741-760. DOI：10.1016/S2213-8587(22)00218-2.
[5]	WENG J P，ZHOU Z G，GUO L X，et al. Incidence of type 1 diabetes in China，2010-13：population based study[J]. BMJ，2018，360：j5295. DOI：10.1136/bmj.j5295.
[6]	CARSTENSEN B，RØNN P F，JØRGENSEN M E. Prevalence，incidence and mortality of type 1 and type 2 diabetes in Denmark 1996-2016[J]. BMJ Open Diabetes Res Care，2020，8（1）：e001071. DOI：10.1136/bmjdrc-2019-001071.
[7]	ABELA A G，FAVA S. Why is the incidence of type 1 diabetes increasing?[J]. Curr Diabetes Rev，2021，17（8）：e030521193110. DOI：10.2174/1573399817666210503133747.
[8]	DELRUE C，SPEECKAERT M M. Vitamin D and vitamin D-binding protein in health and disease[J]. Int J Mol Sci，2023，24（5）：4642. DOI：10.3390/ijms24054642.
[9]	JIANG Z W，PU R，LI N，et al. High prevalence of vitamin D deficiency in Asia：a systematic review and meta-analysis[J]. Crit Rev Food Sci Nutr，2023，63（19）：3602-3611. DOI：10.1080/10408398.2021.1990850.
[10]	ZHANG S，MILLER D D，LI W. Non-musculoskeletal benefits of vitamin D beyond the musculoskeletal system[J]. Int J Mol Sci，2021，22（4）：2128. DOI：10.3390/ijms22042128.
[11]	MIAO Z G，WANG S，WANG Y M，et al. A potential linking between vitamin D and adipose metabolic disorders[J]. Can J Gastroenterol Hepatol，2020，2020：2656321. DOI：10.1155/2020/2656321.
[12]	杨洪艳. 维生素D与糖尿病发生及发展的相关性研究进展[J]. 现代医药卫生，2020，36（13）：2028-2031. DOI：10.3969/j.issn.1009-5519.2020.13.022.
[13]	INFANTE M，RICORDI C，SANCHEZ J，et al. Influence of vitamin D on islet autoimmunity and beta-cell function in type 1 diabetes[J]. Nutrients，2019，11（9）：2185. DOI：10.3390/nu11092185.
[14]	CZARNYWOJTEK A，FLOREK E，PIETROŃCZYK K，et al. The role of vitamin D in autoimmune thyroid diseases：a narrative review[J]. J Clin Med，2023，12（4）：1452. DOI：10.3390/jcm12041452.
[15]	陈丹妮，王世令，路红，等. 维生素D与代谢相关脂肪性肝病的关系及机制[J]. 协和医学杂志，2023，14（6）：1258-1265.
[16]	LEI M，LIU Z S，GUO J. The emerging role of vitamin D and vitamin D receptor in diabetic nephropathy[J]. Biomed Res Int，2020，2020：4137268. DOI：10.1155/2020/4137268.
[17]	LAI X Y，LIU X Y，CAI X，et al. Vitamin D supplementation induces CatG-mediated CD₄⁺ T cell inactivation and restores pancreatic β-cell function in mice with type 1 diabetes[J]. Am J Physiol Endocrinol Metab，2022，322（1）：E74-84. DOI：10.1152/ajpendo.00066.2021.
[18]	MORRÓ M，VILÀ L，FRANCKHAUSER S，et al. Vitamin D receptor overexpression in β-cells ameliorates diabetes in mice[J]. Diabetes，2020，69（5）：927-939. DOI：10.2337/db19-0757.
[19]	YU J，SHARMA P，GIRGIS C M，et al. Vitamin D and beta cells in type 1 diabetes：a systematic review[J]. Int J Mol Sci，2022，23（22）：14434. DOI：10.3390/ijms232214434.
[20]	SEGOVIA-ORTÍ R，BENNASSAR A B，DE SOTTO-ESTEBAN D，et al. Vitamin D status is related to severity at onset of diabetes and worse glycemic control[J]. J Pediatr Endocrinol Metab，2020，33（10）：1265-1271. DOI：10.1515/jpem-2020-0149.
[21]	BOUICHRAT N，BENYAKHEF S，ASSARRAR I，et al. Vitamin D status in diabetic moroccan children and adolescents：a case-control study[J]. Rev Diabet Stud，2023，19（1）：1-7. DOI：10.1900/RDS.2023.19.1.
[22]	KAMIŃSKI M，URUSKA A，ROGOWICZ-FRONTCZAK A，et al. Insulin resistance in adults with type 1 diabetes is associated with lower vitamin D serum concentration[J]. Exp Clin Endocrinol Diabetes，2021，129（5）：396-402. DOI：10.1055/a-0895-5166.
[23]	KANG X Y，CUI J W，ZHANG M J，et al. Maternal level of 25-hydroxyvitamin D during pregnancy associated with risk of type 1 diabetes in the offspring，a meta-analysis[J]. J Nutr Sci Vitaminol，2020，66（5）：402-408. DOI：10.3177/jnsv.66.402.
[24]	MIETTINEN M E，NIINISTÖ S，ERLUND I，et al. Serum 25-hydroxyvitamin D concentration in childhood and risk of islet autoimmunity and type 1 diabetes：the TRIGR nested case-control ancillary study[J]. Diabetologia，2020，63（4）：780-787. DOI：10.1007/s00125-019-05077-4.
[25]	CALMARZA P，PÉREZ AJAMI R I，PRIETO LÓPEZ C，et al. Vitamin D concentration in type 1 diabetic children. Association with glycemic control，lipidic and bone metabolism[J]. Nutr Hosp，2022，39（5）：997-1003. DOI：10.20960/nh.04040.
[26]	POVALIAEVA A，PIGAROVA E，ZHUKOV A，et al. Evaluation of vitamin D metabolism in patients with type 1 diabetes mellitus in the setting of cholecalciferol treatment[J]. Nutrients，2020，12（12）：3873. DOI：10.3390/nu12123873.
[27]	PAPADIMITRIOU D T，DERMITZAKI E，CHRISTOPOULOS P，et al. Secondary prevention of diabetes type 1 with oral calcitriol and analogs，the PRECAL study[J]. Children，2023，10（5）：862. DOI：10.3390/children10050862.
[28]	蓝峥.维生素D滴剂联合胰岛素治疗1型糖尿病患儿的效果观察[J].中国现代医生生，2022，60（26）：87-91，96.
[29]	SAVASTIO S，CADARIO F，D'ALFONSO S，et al. Vitamin D supplementation modulates ICOS+ and ICOS- regulatory T cell in siblings of children with type 1 diabetes[J]. J Clin Endocrinol Metab，2020，105（12）：dgaa588. DOI：10.1210/clinem/dgaa588.
[30]	NWOSU B U，PARAJULI S，JASMIN G，et al. Ergocalciferol in new-onset type 1 diabetes：a randomized controlled trial[J]. J Endocr Soc，2021，6（1）：bvab179. DOI：10.1210/jendso/bvab179.
[31]	张晓红，袁高品，李艳红. 1型糖尿病患儿25羟维生素D水平及其对残存胰岛β细胞功能和血糖控制的影响[J]. 福建医科大学学报，2020，54（6）：403-405，410. DOI：10.3969/j.issn.1672-4194.2020.06.008.
[32]	CHOE Y，LEE Y J，KIM J H，et al. Free，bioavailable 25-hydroxyvitamin D levels and their association with diabetic ketoacidosis in children with type 1 diabetes at diagnosis[J]. Front Endocrinol，2022，13：997631. DOI：10.3389/fendo.2022.997631.
[33]	AL-ZUBEIDI H，LEON-CHI L，NEWFIELD R S. Low vitamin D level in pediatric patients with new onset type 1 diabetes is common，especially if in ketoacidosis[J]. Pediatr Diabetes，2016，17（8）：592-598. DOI：10.1111/pedi.12342.
[34]	HUANG B，WEN W，YE S. Correlation between serum 25-hydroxyvitamin D levels in albuminuria progression of diabetic kidney disease and underlying mechanisms by bioinformatics analysis[J]. Front Endocrinol（Lausanne），2022，13：880930. DOI：10.3389/fendo.2022.880930.
[35]	BURLAKA I，MITYURYAYEVA I O. To the question of vitamin D network in type 1 diabetes and diabetic nephropathy in children nursed in Ukrainian endocrinology unit[J]. SAGE Open Nurs，2022，8：23779608221145122. DOI：10.1177/23779608221145122.
[36]	LOPES M，LAIGINHAS R，MADEIRA C，et al. Association between serum vitamin D and diabetic retinopathy in Portuguese patients with type 1 diabetes[J]. Acta Med Port，2020，33（7/8）：459-465. DOI：10.20344/amp.12890.
[37]	SHIMO N，YASUDA T，KANETO H，et al. Vitamin D deficiency is significantly associated with retinopathy in young Japanese type 1 diabetic patients[J]. Diabetes Res Clin Pract，2014，106（2）：e41-43. DOI：10.1016/j.diabres.2014.08.005.
[38]	KAUR H，DONAGHUE K C，CHAN A K，et al. Vitamin D deficiency is associated with retinopathy in children and adolescents with type 1 diabetes[J]. Diabetes Care，2011，34（6）：1400-1402. DOI：10.2337/dc11-0103.
[39]	FERNANDEZ-ROBREDO P，GONZÁLEZ-ZAMORA J，RECALDE S，et al. Vitamin D protects against oxidative stress and inflammation in human retinal cells[J]. Antioxidants，2020，9（9）：838. DOI：10.3390/antiox9090838.
[40]	POLAT İ，YıLMAZ G C，DEDEOĞLU Ö. Vitamin D and nerve conduction in pediatric type-1 diabetes mellitus[J]. Brain Dev，2022，44（5）：336-342. DOI：10.1016/j.braindev.2022.01.001.
[41]	余鑫华，王江，张杰涛. 1型糖尿病性亚临床周围神经病变相关危险因素分析[J].中国当代医药，2024，31（7）：87-91.