Lancet Diab & Endo：血循环25[OH]D浓度与患2型糖尿病风险的关系：孟德尔随机化研究

2014-10-24 MedSci译 MedSci原创

25[OH]D是维生素D的一种状态标志，研究已发现血循环中低的25[OH]D浓度与增加的2型糖尿病患病风险密切相关，但这种关系是否有因果关联目前还不是很清楚。为了研究25[OH]D浓度与2型糖尿病患病风险的因果关系，来自英国剑桥大学代谢科学研究所的科学家们根据多个欧洲裔人群数据源，包含患2型糖尿病与未患数据，利用单核苷酸多态性进行了一项大数据孟德尔随机化分析（研究共纳入28144病例数/76344

25[OH]D是维生素D的一种状态标志，研究已发现血循环中低的25[OH]D浓度与增加的2型糖尿病患病风险密切相关，但这种关系是否有因果关联目前还不是很清楚。

为了研究25[OH]D浓度与2型糖尿病患病风险的因果关系，来自英国剑桥大学代谢科学研究所的科学家们根据多个欧洲裔人群数据源，包含患2型糖尿病与未患数据，利用单核苷酸多态性进行了一项大数据孟德尔随机化分析（研究共纳入28144病例数/76344对照组），其中包括与25[OH]D合成与代谢有关的DHCR7，CYP2R1，DBP， CYP24A1 四个基因。

研究分析了每个单核苷酸基因多态性与血循环25[OH]D浓度、2型糖尿病患病风险和次要指标血糖情况的关系，并在孟德尔随机化分析的基础上进行整合及随机效应meta分析，以研究25[OH]D浓度与2型糖尿病和血糖情况的因果关系，并同先前的一项来自多个观察性研究的meta分析数据进行比较。

研究发现，所有四个单核苷酸多态性都与25[OH]D浓度有关(图A，p<10−6)，但与患2型糖尿病风险（图B）及血糖情况的关系并不显著(p>0·25)，且结论与先前的meta分析有所出入，但与其他两项临床试验一致。

由孟德尔随机化分析得到的2型糖尿病与每25·0 nmol/L (1 SD)低浓度25[OH]D的比值比OR为0·93 (95% CI 0·77-1·13;p=0·46)；整合更新后的meta分析与先前来自多个观察性研究的meta分析数据对应的相对危险度RR为1·22 (1·16-1·29;p=3·5 × 10−14) 。可见低浓度25[OH]D与增加的2型糖尿病患病风险之间的因果关联并不显著。

这项研究认为，目前通过增加25[OH]D浓度来减少2型糖尿病患病风险的干预措施并不合理，重点应该调查临床观察数据与因果关联证据缺失之间的不相符矛盾，这种矛盾可能是观察性研究中某些没有控制好的混杂因素影响的结果，比如肥胖、潜在的偏倚、反向因果关系等。因此基于先前的观察性研究结论而提高25[OH]D浓度并不能减少患2型糖尿病风险，还需要深入详细的调查研究来确定既能提高25[OH]D浓度也能减少2型糖尿病患病风险的因果关系要素。

专家评论（见下方文献）：

Brian Buijsse：德国人类营养Potsdam-Rehbruecke研究所的博士

2型糖尿病的维生素D补充疗法，前景乌云密闭

在解读这些结果时需要谨慎，毕竟孟德尔随机分析化方法本身是基于一些无法被完全检验的假设，目前维生素D补充疗法在2型糖尿病中的应用，这相关的随机试验也正在进行之中，其结果还是值得等待的。

本文是MedSci原创编译整理，欢迎转载！转载请注明来源并附原文链接。谢谢！

原始出处：

YeZ, Sharp SJ, Burgess S, Scott RA, Imamura F; InterAct Consortium, Langenberg C,
Wareham NJ, Forouhi NG.Association between circulating 25-hydroxyvitamin D and incident type 2 diabetes: a mendelian randomisation study.Lancet Diabetes Endocrinol.2014 Sep 30. pii: S2213-8587(14)70184-6. doi: 10.1016/S2213-8587(14)70184-6

Buijsse B.Vitamin D for prevention of type 2 diabetes: a clouded forecast for the sunshine vitamin.Lancet Diabetes Endocrinol. 2014 Sep 30. pii: S2213-8587(14)70202-5. doi: 10.1016/S2213-8587(14)70202-5. [Epub ahead of print]

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2015-11-29 三三五五

努力学习。。。

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2015-04-27 ms3994565386320060

#2型糖尿病风险#

77 0
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2015-06-08 ljjj1053

好好学习学习

215 0
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2015-09-10 howi

#Lancet#

71 0
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2015-04-11 x35042875

控制好糖尿病可能提高肝硬化患者的预后。

131 0
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2015-03-02 limedical1974

#风险的关系#

98 0
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2014-11-14 ms9608593228839890

#DIA#

89 0
[GetPortalCommentsPageByObjectIdResponse(id=44126, encodeId=a26444126ca, content=努力学习。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=197, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=df9e1651052, createdName=三三五五, createdTime=Sun Nov 29 19:12:00 CST 2015, time=2015-11-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1956270, encodeId=a93919562e07f, content=<a href='/topic/show?id=a74d1109c8' target=_blank style='color:#2F92EE;'>#2型糖尿病风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1109, encryptionId=a74d1109c8, topicName=2型糖尿病风险)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/101296147/4E6244DB7C1860858424437821E08291/100, createdBy=a6a52500039, createdName=ms3994565386320060, createdTime=Mon Apr 27 12:09:00 CST 2015, time=2015-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=26307, encodeId=23822630e53, content=好好学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=215, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=ac181616815, createdName=ljjj1053, createdTime=Mon Jun 08 14:04:00 CST 2015, time=2015-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1827904, encodeId=e681182e904c4, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Thu Sep 10 15:09:00 CST 2015, time=2015-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=20514, encodeId=4bf9205148a, content=控制好糖尿病可能提高肝硬化患者的预后。, beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150920/IMG55FDE671A89482379.jpg, createdBy=cef3108336, createdName=x35042875, createdTime=Sat Apr 11 23:04:00 CST 2015, time=2015-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1820357, encodeId=755b182035ecf, content=<a href='/topic/show?id=c87f10089032' target=_blank style='color:#2F92EE;'>#风险的关系#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100890, encryptionId=c87f10089032, topicName=风险的关系)], attachment=null, authenticateStatus=null, createdAvatar=http://login.medsci.cn/upload/avatar/cc81592b507031e3cfd8d4c57911d98b/62c22832a9474aea1ca90ca058aebc03.jpg, createdBy=bed5446, createdName=limedical1974, createdTime=Mon Mar 02 00:09:00 CST 2015, time=2015-03-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1636957, encodeId=c7c8163695e6a, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5916, encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=987022654425, createdName=ms9608593228839890, createdTime=Fri Nov 14 12:09:00 CST 2014, time=2014-11-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1544386, encodeId=2fec154438640, content=<a href='/topic/show?id=ac3d6549e75' target=_blank style='color:#2F92EE;'>#浓度#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65497, encryptionId=ac3d6549e75, topicName=浓度)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=16b213663040, createdName=12498974m55暂无昵称, createdTime=Sun Oct 26 01:09:00 CST 2014, time=2014-10-26, status=1, ipAttribution=)]
2014-10-26 12498974m55暂无昵称

#浓度#

81 0

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Lancet Diab & Endo：血循环25[OH]D浓度与患2型糖尿病风险的关系：孟德尔随机化研究

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