口服補(bǔ)充維生素D對(duì)肥胖成年男性胰島素敏感性的影響

盧富瓊　謝鳳珠　朱玉梅　莫俊鑾　楊曉光　劉小立　周繼昌

【摘要】 目的：分析肥胖成年男性在維生素D（VD）口服補(bǔ)充前后胰島素敏感性和胰島素抵抗的變化。方法：從深圳市某社區(qū)征集體質(zhì)指數(shù)（BMI）>

28 kg/m2的肥胖成年男性志愿者，年齡35～69歲，測(cè)量其基本體格與25羥基VD[25（OH）D]、血糖、血脂、肝腎功等生化指標(biāo)，并做口服糖耐量-胰島素釋放試驗(yàn)（OGTT-IRT）。對(duì)OGTT-IRT中血漿胰島素濃度在兩個(gè)時(shí)間點(diǎn)上超過(guò)參考范圍上限的肥胖者，進(jìn)一步納入口服補(bǔ)充VD（每周一次性吞服

50 000 IU VD3）8周的試驗(yàn)。試驗(yàn)期間，受試者保持原有生活與作息方式。VD補(bǔ)充試驗(yàn)結(jié)束后再做一次體格生化指標(biāo)檢測(cè)和OGTT-IRT試驗(yàn)。結(jié)果：符

合條件的10名肥胖志愿者BMI平均值為（30.3±1.5）kg/m2。VD補(bǔ)充前后，血漿25（OH）D濃度從（49.6±9.6）nmol/L，顯著上升到（114.6±25.9）nmol/L，

差異有統(tǒng)計(jì)學(xué)意義（P<0.05）;OGTT-IRT各時(shí)間點(diǎn)的血糖濃度并未顯著變化（P>0.05），但胰島素濃度顯著降低（P<0.05），相應(yīng)的口服葡萄糖胰島素敏感性指標(biāo)OGIS由（384.1±38.5）ml/（min·m2），提高到（422.7±41.1）ml/（min·m2），差異有統(tǒng)計(jì)學(xué)意義（P<0.05）;胰島素抵抗指數(shù)HOMA-IR由3.0±1.2，降低到2.2±0.8，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。VD補(bǔ)充后，高密度脂蛋白膽固醇在正常范圍內(nèi)降低，谷草轉(zhuǎn)氨酶在正常范圍內(nèi)升高，差異有統(tǒng)計(jì)學(xué)意義（P<0.05），而BMI、血鈣、糖化血紅蛋白、腎功等指標(biāo)均未發(fā)生顯著改變（P>0.05）。結(jié)論：本試驗(yàn)在一個(gè)小樣本測(cè)試中發(fā)現(xiàn)口服補(bǔ)充維生素D可改善肥胖成年男性胰島素敏感性，緩解胰島素抵抗?fàn)顟B(tài)。

【關(guān)鍵詞】 維生素D; 肥胖; 胰島素

doi：10.14033/j.cnki.cfmr.2019.11.001 文獻(xiàn)標(biāo)識(shí)碼 A 文章編號(hào) 1674-6805（2019）11-000-03

The Effects on the Sensitivity of Insulin with Oral Vitamin D Supplementation in Obese Men/LU Fuqiong，XIE Fengzhu，ZHU Yumei，et al.//Chinese and Foreign Medical Research，2019，17（11）：-3

【Abstract】 Objective：To analyze the changes of insulin sensitivity and insulin resistance in obese adult males before and after oral vitamin D（VD） supplementation.Method：The obese adult（35-69 years old） male volunteers with body mass index（BMI）>28 kg/m2 were recruited from a community in Shenzhen city to measure their basic physical and biochemical indexes including 25-hydorxy vitamin D[25（OH）D]，glucose，lipids，hepatic and renal function parameters，etc，and to test their oral glucose tolerance and insulin release（OGTT-IRT）.Those obese volunteers，having their plasma insulin concentrations at any two time points of the OGTT-IRT beyond the upper limit of the reference range，were further included into the oral VD supplementation（50 000 IU VD3 per week） test for 8 weeks.They kept their normal living styles during the trial.Their physical and biochemical indicators and OGTT-IRT were tested again after the VD supplementation.Result：The mean BMI of the 10 eligible obese volunteers was （30.3±1.5）kg/m2.The plasma concentration of 25（OH）D was significantly increased from （49.6±9.6）nmol/L to （114.6±25.9）nmol/L by VD supplementation（P<0.05）.The plasma glucose level of the OGTT-IRT did not significantly change at any time point（P>0.05），but the plasma insulin concentration was significantly reduced（P<0.05），and the corresponding oral glucose insulin sensitivity（OGIS） index increased from （384.1±38.5）ml/（min·m2） to （422.7±41.1）ml/（min·m2），the difference was significant（P<0.05）.HOMA insulin resistance index was decreased from 3.0±1.2 to 2.2±0.8（P<0.05）.After VD supplementation，the high density lipoprotein cholesterol concentration decreased and the glutamic-oxalacetic transaminase activity increased in the normal range（P<0.05），while the BMI，blood calcium concentration，glycosylated hemoglobin percentage，and renal function parameters did not change（P>0.05）.Conclusion：This experiment in a small sample of volunteers found that oral VD supplementation can improve the insulin sensitivity and insulin resistance of obese adult men.