心脏自主神经病变是糖尿病常见且易被忽视的并发症，因早期无明显症状，发现时多为疾病的进展期，往往会造成不良心血管事件。维生素D除调节钙磷代谢，还具有调节糖脂代谢、改善胰岛素抵抗等骨骼外效应。近年的研究显示，维生素D缺乏与糖尿病患者心脏自主神经病变的发生发展相关。糖尿病患者维生素D缺乏时可出现心血管反射试验及心率变异性异常，尤以LF/HF及E/I比值异常多见，表现为心脏交感和副交感神经功能失衡，而补充维生素D可改善这种失衡。维生素D缺乏时，可能通过糖代谢紊乱促进内皮功能障碍，激活氧化应激/炎症反应，减低神经生长因子水平，导致神经元代谢紊乱等潜在机制致心脏自主神经受损，补充维生素D治疗可能对糖尿病患者心脏自主神经病变有一定程度的改善，但目前此类研究仍较少，其具体影响尚需要更多的基础和临床研究来证实。“,”Cardiac autonomic neuropathy (CAN) is a common and easily overlooked complication of diabetes. Due to lack of obvious symptoms in the early stage, diagnosis is often delayed until the progressive stage of the disease, leading to adverse cardiovascular events. Vitamin D can not only regulate calcium and phosphorus metabolism, but also regulate glucose and lipid metabolism and improve insulin resistance. Recent studies have shown that vitamin D deficiency is related to the occurrence and development of CAN in diabetic patients. Abnormal cardiovascular reflex test and heart rate variability can occur in diabetic patients with vitamin D deficiency. Abnormal LF/HF and E/I ratios are especially common, indicating imbalance of sympathetic and parasympathetic nerve function, and can be improved with vitamin D supplementation. Potential mechanism of vitamin D deficiency-mediated cardiac autonomic nerve damage includes disturbance of glucose metabolism, promotion of endothelial dysfunction, activation of oxidative stress and inflammatory reaction, reduction of nerve growth factor level, and disorder of neuronal metabolism. Vitamin D supplementation may improve CAN in diabetic patients to some extent, but such studies are still scanty, warranting more fundamental and clinical studies on the specific effects of vitamin D.