【摘要】 目的 探讨在不同血糖控制水平2型糖尿病（T2DM）老年营养状况差异及与糖尿病周围神经病变（DPN）的关系。方法 选择选取2021年1月至2024年6月浙江省人民医院收治的140例T2DM老年患者作为研究对象，根据糖化血红蛋白（HbA1c）水平将其分为血糖控制良好组（n=73）和血糖控制不良组（n=67），采用单因素分析两组的一般资料，通过多因素logistic回归分析T2DM老年患者的营养状况差异与DPN，采用限制性样条模型（RCS）分析营养指标及HbA1c水平与T2DM老年患者DPN发生风险的剂量反应关系，采用Hayes Process程序分析营养指标在HbA1c与DPN之间的中介效应。结果 血糖控制不良组患者的25-羟基维生素D[25（OH）D]、叶酸（FA）、维生素B₁₂、Ca明显低于血糖控制良好组，同型半胱氨酸（Hcy）水平明显高于血糖控制良好组，差异有统计学意义（P<0.05）。logistic回归模型显示，校正混杂因素前后，营养指标与血糖控制不良之间始终存在独立相关性（P<0.05）,25（OH）D、病程、FA、维生素B₁₂、Hcy、Ca、HbA1c水平均为T2DM老年患者DPN发生的风险因素（P<0.05）。与未合并DPN组相比，合并DPN组的25（OH）D、FA、维生素B₁₂、Ca水平明显降低，病程、Hcy、HbA1c水平明显升高，差异有统计学意义（P<0.001）。当T2DM老年患者的25（OH）D<22.01μg/L、FA<9.26μg/L、维生素B₁₂<512.19 ng/L、Ca<2.31 mmol/L时，T2DM老年患者DPN发生风险随其下降而升高（P<0.05）；当Hcy≥12.48μmol/L、HbA1c≥8.49%时，T2DM老年患者DPN发生风险随其增加而升高（P<0.05）。中介效应分析结果显示，25（OH）D、FA、维生素B₁₂、Hcy、Ca相关因子在HbA1c与DPN之间具有明显的中介调控作用（P<0.05）。结论 不同血糖控制水平下，T2DM老年患者的营养状况差异与DPN的发生密切相关。通过优化营养管理和血糖控制策略，可能有助于预防和治疗DPN，提高患者的生活质量。更多还原

【Abstract】 Objective To understand the differences in nutritional status among elderly patients with type 2diabetes mellitus （T2DM） at different blood glucose control levels and its relationship with diabetic peripheral neuropathy（DPN）.Methods 140 elderly patients with Type 2 diabetes mellitus（T2DM）,admitted to our hospital from January 2021 to June 2024,were chosen as the research subjects.Based on their HbA1c levels,they were divided into a good blood glucose control group（n=73） and a poor blood glucose control group（n=67）.The general data of the two groups were analyzed by using univariate analysis.Multivariate logistic regression analysis was employed to examine differences in nutritional status and the incidence of diabetic peripheral neuropathy（DPN） in elderly patients with T2DM.The dose-response relationship between nutritional indicators,HbA1c levels,and the risk of DPN in elderly patients with T2DM was analyzed by using the restricted cubic spline（RCS） model.Hayes Process procedure was used to analyze the mediating effect of nutritional indicators between HbA1c and DPN.Results The levels of 25 hydroxyvitamin D[25（OH）D],folate（FA）,vitamin B₁₂,and Ca in patients with poor blood glucose control were significantly lower than those in the group with good blood glucose control（P<0.05）,while the levels of homocysteine（Hcy） were significantly higher than those in the group with good blood glucose control（P<0.05）.logistic regression model showed that there was an independent correlation between nutritional indicators and poor blood glucose control before and after adjusting for confounding factors（P<0.05）.The levels of 25（OH）D,course of disease,FA,vitamin B₁₂,Hcy,Ca and HbA1c were all risk factors for the risk of DPN in elderly T2DM patients（P<0.05）.Compared with the non-DPN group,the DPN group had significantly lower levels of 25（OH）D,FA,vitamin B₁₂,and Ca（P<0.001）,and significantly higher course of disease,Hcy,and HbA1c（P<0.001）.When25（OH）D<22.01μg/L,FA<9.26μg/L,vitamin B₁₂<512.19 ng/L,and Ca<2.31 mmol/L in elderly patients with T2DM,the risk of DPN increased with the decrease of 25（OH）D,FA,vitamin B₁₂,and Ca（P<0.05）.When Hcy≥12.48μmol/L and HbA1c≥8.49%,the risk of DPN in elderly T2DM patients increased with the increase of Hcy and HbA1c（P<0.05）.When 25（OH）D<22.01μg/L,FA<9.26μg/L,vitamin B₁₂<512.19 ng/L,and Ca<2.31 mmol/L in elderly patients with T2DM,the risk of DPN increased with the decrease of 25（OH）D,FA,vitamin B₁₂,and Ca（P<0.05）.When Hcy≥12.48μmol/L and HbA1c≥8.49%,the risk of DPN in elderly T2DM patients increased with the increase of Hcy and HbA1c （P<0.05）.The results of mediating effect analysis showed that 25（OH）D,FA,vitamin B₁₂,Hcy,and Ca had significant mediating effects between HbA1c and DPN（P<0.05）.Conclusion The differences of nutritional status in elderly patients with T2DM under different levels of glycemic control are closely related to the occurrence of diabetic peripheral neuropathy.Optimizing nutritional management and glucose control strategies may help prevent and treat DPN and improve the quality of life of patients.更多还原