維生素D與糖尿病視網膜病變

10.6666/ClinMed.202202_89(2).0014

陳佑霖；邱哲琳；楊妹鳳；楊雀戀

維生素D ； 糖尿病視網膜病變 ； 血糖控制

臨床醫學月刊

89卷2期（2022 / 02 / 25）

80 - 83

繁體中文

糖尿病視網膜病變是造成全球人口失明主要原因之一，也引起壯年人口視力障礙，進而影響生產力。維生素D與血糖的控制有關，缺乏會降低胰島素分泌與釋放、增加胰島素阻抗，提升血糖控制的難度。近期動物實驗亦發現，維生素D有抑制血管增生的功能，可能減少糖尿病視網膜病變的發生。針對第二型糖尿病人的統合分析研究指出，缺乏維生素D罹患視網膜病變風險較高，且視網膜病變者血液維生素D濃度顯著較低，然目前尚無相關研究探討高劑量維生素D補充對於糖尿病視網膜病變的進展及嚴重程度有幫助。由於國民營養調查指出維生素D缺乏現象相當普遍，發生率達65%，「國人膳食營養素參考攝取量」（Dietary Reference Intakes, DRIs）建議每日攝取400-600 IU維生素D。同時維持理想的血糖控制，以及避免血清低密度脂蛋白數值過高，才能降低糖尿病人發展視網膜病變的風險。

1. 國民健康署衛生福利部健康九九。.
2. 國民健康署。.
3. Aksoy, H,Akçay, F,Kurtul, N(2000).Serum 1,25 dihydroxy vitamin D(1,25(OH)2D3), 25 hydroxy vitamin D(25(OH)D) and parathormone levels in diabetic retinopathy.Clin Biochem,33,47-51.
4. Albert, DM,Scheef, EA,Wang, S(2007).Calcitriol is a potent inhibitor of retinal neovascularization.Invest Ophthalmol Vis Sci,48,2327-2334.
5. Ben-Shoshan, M,Amir, S,Dang, DT(2007).1alpha,25-dihydroxyvitamin D3(Calcitriol) inhibits hypoxiainducible factor-1/vascular endothelial growth factor pathway in human cancer cells.Mol Cancer Ther,6,1433-1439.
6. Bouillon, R,Carmeliet, G,Verlinden, L(2008).Vitamin D and human health: lessons from vitamin D receptor null mice.Endocr Rev,29,726-776.
7. Chiu, TT,Tsai, TL,Su, MY(2021).The Related Risk Factors of Diabetic Retinopathy in Elderly Patients with Type 2 Diabetes Mellitus: A Hospital-Based Cohort Study in Taiwan.Int J Environ Res Public Health,18,307.
8. Fullerton, B,Jeitler, K,Seitz, M(2014).Intensive glucose control versus conventional glucose control for type 1 diabetes mellitus.Cochrane Database Syst,2014,Cd009122.
9. Gungor, A,Ates, O,Bilen, H(2015).Retinal Nerve Fiber Layer Thickness in Early-Stage Diabetic Retinopathy With Vitamin D Deficiency.Invest Ophthalmol Vis Sci,56,6433-6437.
10. Jamali, N,Wang, S,Darjatmoko, SR(2017).Vitamin D receptor expression is essential during retinal vascular development and attenuation of neovascularization by 1, 25(OH)2D3.PLoS One,12,e0190131.
11. Jee, D,Han, K,Kim, EC(2014).Inverse association between high blood 25-hydroxyvitamin D levels and diabetic retinopathy in a representative Korean population.PLoS One,9,e115199.
12. Kim, HU,Park, SP,Kim, YK(2021).Long-term HbA1c variability and the development and progression of diabetic retinopathy in subjects with type 2 diabetes.Sci Rep,11,4731.
13. Lee, JH,O'Keefe, JH,Bell, D(2008).Vitamin D deficiency an important, common, and easily treatable cardiovascular risk factor?.J Am Coll Cardiol,52,1949-1956.
14. Lin, KD,Hsu, CC,Ou, HY(2019).Diabetes-related kidney, eye, and foot disease in Taiwan: An analysis of nationwide data from 2005 to 2014.J Formos Med Assoc,118,S103-S110.
15. Luo, BA,Gao, F,Qin, LL(2017).The Association between Vitamin D Deficiency and Diabetic Retinopathy in Type 2 Diabetes: A Meta-Analysis of Observational Studies.Nutrients,9,307.
16. Mathieu, C,Gysemans, C,Giulietti, A(2005).Vitamin D and diabetes.Diabetologia,48,1247-1257.
17. Mohamed, Q,Gillies, MC,Wong, TY(2007).Management of diabetic retinopathy: a systematic review.JAMA,298,902-916.
18. Ross, AC,Manson, JE,Abrams, SA(2011).The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know.J Clin Endocrinol Metab,96,53-58.
19. Saeedi, P,Petersohn, I,Salpea, P(2019).Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9(th) edition.Diabetes Res Clin Pract,157,107843.
20. Saxena, S(2021).Vitamin D supplementation in diabetic retinopathy in the era of COVID-19.Indian J Ophthalmol,69,483-484.
21. Shiferaw, WS,Akalu, TY,Desta, M(2020).Glycated hemoglobin A1C level and the risk of diabetic retinopathy in Africa: A systematic review and metaanalysis.Diabetes Metab Syndr,14,1941-1949.
22. Tilahun, M,Gobena, T,Dereje, D(2020).Prevalence of diabetic retinopathy and its associated factors among diabetic patients at debre Markos Referral Hospital, Northwest Ethiopia, 2019: hospital-based cross-sectional study.Diabetes Metab Syndr Obes,13,2179-2187.
23. Vieth, R.(2006).What is the optimal vitamin D status for health?.Prog Biophys Mol Biol,92,26-32.
24. Zhang, J,Upala, S,Sanguankeo, A(2017).Relationship between vitamin D deficiency and diabetic retinopathy: a meta-analysis.Can J Ophthalmol,52,219-224.
25. Zoungas, S,Arima, H,Gerstein, HC(2017).Effects of intensive glucose control on microvascular outcomes in patients with type 2 diabetes: a meta-analysis of individual participant data from randomised controlled trials.Lancet Diabetes Endocrinol,5,431-437.
26. 李美璇、林以勤、黃怡真。國人維生素D營養狀況初步分析結果：由NAHSIT1993-1996到2005-2008．2018．
27. 施得恩,楊倫欣(2014)。維生素D與人體健康。內科學誌，25，250-260。