摘要目的:探讨补充维生素D对肥胖患者减重效能和胰岛素抵抗（IR）的影响。方法:本研究为随机对照试验，连续选取2023年3—12月在天津市人民医院肥胖门诊就诊的190例肥胖伴维生素D缺乏患者，根据随机数表法分为对照组和维生素D组（各95例）。对照组给予限能量高蛋白饮食联合中等强度运动，维生素D组在对照组基础上添加维生素D补充剂，14 000 U/周，干预时间持续24周。中途两组由于各种原因出组25例，最终对照组79例、维生素D组86例纳入分析。采用独立样本 t检验和秩和检验比较两组基线和干预后血清25-羟维生素D［25（OH）D］浓度、体重、体重指数、脂肪量、内脏脂肪面积、空腹血糖、空腹胰岛素及糖化血红蛋白（HbA 1c）等指标差异，采用稳态模型胰岛素抵抗指数（HOMA-IR）来评估IR程度，分析补充维生素D对肥胖患者减重效能和IR的影响。 结果:干预前两组血清25（OH）D浓度差异无统计学意义（ P>0.05）；干预后维生素D组血清25（OH）D浓度显著高于对照组［（30.90±7.55）比（16.00±4.34）μg/L］（ t=-15.35； P<0.001）。干预后两组体重、体重指数、脂肪量、内脏脂肪面积、空腹血糖、空腹胰岛素、HbA 1c、HOMA-IR均显著低于干预前［对照组：（93.32±13.47）比（98.95±14.31）kg、（33.74±5.09）比（35.80±5.52）kg/m 2、（39.77±11.87）比（44.12±12.79）kg、（183.76±40.95）比（204.01±32.18）m 2、5.00（4.55，5.67）比5.24（4.68，6.42）mmol/L、16.78（13.94，24.30）比22.56（15.95，31.2）mU/L、5.55%±0.53%比6.05%±0.99%、4.11（3.14，5.57）比5.51（3.61，8.49）；维生素D组：（88.14±17.66）比（104.43±22.02）kg、（31.02±5.10）比（36.66±5.98）kg/m 2、（35.51±12.87）比（46.67±13.33）kg、（166.50±49.50）比（213.64±40.14）m 2、4.70（4.35，5.07）比5.17（4.77，6.30）mmol/L、13.18（9.87，18.84）比21.67（15.78，32.74）mU/L、5.43%±0.48%比6.21%±1.22%、2.88（1.99，4.21）比5.19（3.82，9.27）］，且维生素D组体重、体重指数、脂肪量、内脏脂肪面积、空腹血糖、空腹胰岛素、HOMA-IR均显著低于对照组［（88.14±17.66）比（93.32±13.47）kg、（31.02±5.10）比（33.74±5.09）kg/m 2、（35.51±12.87）比（39.77±11.87）kg、（166.50±49.50）比（183.76±40.95）m 2、4.70（4.35，5.07）比5.00（4.55，5.67）mmol/L、13.18（9.87，18.84）比16.78（13.94，24.30）mU/L、2.88（1.99，4.21）比4.11（3.14，5.57）］（均 P<0.05）。干预后维生素D组IR缓解率显著高于对照组（37.3%比15.3%）（ χ2=8.071； P=0.002）。 结论:在限能量高蛋白饮食联合中等强度运动基础上补充维生素D，可显著提升肥胖伴维生素D缺乏患者的减重效能，并明显改善IR。

abstractsObjective:To investigate the effect of vitamin D supplementation on weight loss efficacy and insulin resistance (IR) in obese patients.Methods:It was a randomized controlled trial. A total of 190 obese patients with vitamin D deficiency were selected from the obesity clinic of Tianjin Union Medical Center from March to December in 2023. The patients were divided into control group (95 cases) and vitamin D group (95 cases) according to random number table. The control group was given energy-limited high-protein diet combined with moderate intensity exercise, and the vitamin D group was supplemented with vitamin D on the basis of the control group, 14 000 U/week for 24 weeks. A total of 25 dropped out of the study from the two groups for various reasons. Finally, 79 cases in the control group and 86 cases in the vitamin D group were included in the analysis. Independent sample t test and rank sum test were used to compare serum 25 hydroxyvitamin D [25 (OH) D] level, body weight, body mass index, fat mass, visceral fat area, fasting blood glucose, fasting insulin and glycated hemoglobin (HbA 1c) between the two groups at baseline and after intervention. Homeostasis model insulin resistance index (HOMA-IR) was used to evaluate the degree of insulin resistance (IR), and the effects of vitamin D supplementation on weight loss efficiency and IR in those patients were analyzed. Results:There was no significant differences in serum 25(OH)D level between the two groups before intervention ( P>0.05); the serum 25(OH)D level in the vitamin D group was significantly higher than that in the control group after intervention [(30.90±7.55) vs (16.00±4.34) μg/L] ( t=-15.35, P<0.001). The body weight, body mass index, fat mass, visceral fat area, fasting blood glucose, fasting insulin, HbA 1c, and HOMA-IR were all significantly lower after the intervention than those before the intervention in both groups [control group: (93.32±13.47) vs (98.95±14.31) kg, (33.74±5.09) vs (35.80±5.52) kg/m 2, (39.77±11.87) vs (44.12±12.79) kg, (183.76±40.95) vs (204.01±32.18) m 2, 5.00 (4.55, 5.67) vs 5.24 (4.68, 6.42) mmol/L, 16.78 (13.94, 24.30) vs 22.56 (15.95, 31.2) mU/L, 5.55%±0.53% vs 6.05%±0.99%, 4.11 (3.14, 5.57) vs 5.51 (3.61, 8.49); vitamin D group: (88.14±17.66) vs (104.43±22.02) kg, (31.02±5.10) vs (36.66±5.98) kg/m 2, (35.51±12.87) vs (46.67±13.33) kg, (166.50±49.50) vs (213.64±40.14) m 2, 4.70 (4.35, 5.07) vs 5.17 (4.77, 6.30) mmol/L, 13.18 (9.87, 18.84) vs 21.67 (15.78. 32.74) mU/L, 5.43%±0.48% vs 6.21%±1.22%, 2.88 (1.99, 4.21) vs 5.19 (3.82, 9.27)], and the body weight, body mass index, adiposity, visceral fat area, fasting blood glucose, fasting insulin, and HOMA-IR were all significantly lower in vitamin D group than those in the control group [(88.14±17.66) vs (93.32±13.47) kg, (31.02±5.10) vs (33.74±5.09) kg/m 2, (35.51±12.87) vs (39.77±11.87) kg, (166.50±49.50) vs (183.76±40.95) m 2, 4.70 (4.35, 5.07) vs 5.00 (4.55, 5.67) mmol/L, 13.18 (9.87, 18.84) vs 16.78 (13.94, 24.30) mU/L, and 2.88 (1.99, 4.21) vs 4.11 (3.14, 5.57), respectivley] (all P<0.05). The IR remission rate was significantly higher in the vitamin D group than that in the control group after the intervention (37.3% vs 15.3%) ( χ2=8.071, P=0.002). Conclusion:Supplementation of vitamin D on the basis of energy-limited high-protein diet combined with moderate intensity exercise can significantly improve the efficacy of weight loss and IR in obese patients with vitamin D deficiency.