口服补充维生素D对肥胖成年男性胰岛素敏感性的影响

卢富琼　谢凤珠　朱玉梅　莫俊銮　杨晓光　刘小立　周继昌

【摘要】 目的：分析肥胖成年男性在維生素D（VD）口服补充前后胰岛素敏感性和胰岛素抵抗的变化。方法：从深圳市某社区征集体质指数（BMI）>

28 kg/m2的肥胖成年男性志愿者，年龄35～69岁，测量其基本体格与25羟基VD[25（OH）D]、血糖、血脂、肝肾功等生化指标，并做口服糖耐量-胰岛素释放试验（OGTT-IRT）。对OGTT-IRT中血浆胰岛素浓度在两个时间点上超过参考范围上限的肥胖者，进一步纳入口服补充VD（每周一次性吞服

50 000 IU VD3）8周的试验。试验期间，受试者保持原有生活与作息方式。VD补充试验结束后再做一次体格生化指标检测和OGTT-IRT试验。结果：符

合条件的10名肥胖志愿者BMI平均值为（30.3±1.5）kg/m2。VD补充前后，血浆25（OH）D浓度从（49.6±9.6）nmol/L，显著上升到（114.6±25.9）nmol/L，

差异有统计学意义（P<0.05）;OGTT-IRT各时间点的血糖浓度并未显著变化（P>0.05），但胰岛素浓度显著降低（P<0.05），相应的口服葡萄糖胰岛素敏感性指标OGIS由（384.1±38.5）ml/（min·m2），提高到（422.7±41.1）ml/（min·m2），差异有统计学意义（P<0.05）;胰岛素抵抗指数HOMA-IR由3.0±1.2，降低到2.2±0.8，差异有统计学意义（P<0.05）。VD补充后，高密度脂蛋白胆固醇在正常范围内降低，谷草转氨酶在正常范围内升高，差异有统计学意义（P<0.05），而BMI、血钙、糖化血红蛋白、肾功等指标均未发生显著改变（P>0.05）。结论：本试验在一个小样本测试中发现口服补充维生素D可改善肥胖成年男性胰岛素敏感性，缓解胰岛素抵抗状态。

【关键词】 维生素D; 肥胖; 胰岛素

doi：10.14033/j.cnki.cfmr.2019.11.001 文献标识码 A 文章编号 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.