新诊断2型糖尿病患者血清高分子量脂联素水平及其影响因素分析

摘要

目的：观察新诊断 T2DM 患者血清高分子量脂联素（HMW‐APN）水平，探讨其与糖脂代谢、IR及胰岛β细胞功能的关系。方法176例研究对象，根据75gOGTT结果分为新诊断T2DM组88例和NGT组88名，两组再以BMI 25 kg／m2为切点分为正常体重（NW）亚组和肥胖（OB）亚组。检测各组HbA1 c、血糖、胰岛素、血脂及 HMW‐APN 水平。结果 T2DM 组血清 HMW‐APN 水平低于NGT组[0.99（0.52～1.56） vs 2.53（1.69～5.44）ng／L]（P＜0.01）。 T2DM 组和 NGT 组的 OB亚组HMW‐APN水平均低于同组内NW亚组[0.74（0.35～1.39） vs 1.21（0.74～2.08） ng／L ；2.11（1.47～4.01） vs 4.49（2.40～6.11）ng／L]（P＜0.05）。相关性分析提示，HMW‐APN与BMI、WC、WHR、SBP、TG、FPG、2 hPG、HbA1c、FIns、2 hIns、胰岛素抵抗指数（HOMA‐IR）、高敏C反应蛋白（hsC‐RP）呈负相关（P＜0.05或 P＜0.01），与HDL‐C、胰岛β细胞功能指数（HOMA‐β）呈正相关（P＜0.01）。多元逐步回归分析提示，2 hPG、hsC‐RP及 WHR是血清 HMW‐APN 水平的独立影响因素。结论血清 HMW‐APN水平在新诊断T2DM患者中降低，其与肥胖、糖脂代谢、IR、胰岛β细胞功能及hsC‐RP密切相关，提示血清HMW‐APN下降可能参与了肥胖和T2DM的发生发展。%Objective To investigate the change of serum high‐molecular‐weight adiponectin(HMW‐APN)level in newly diagnosed type 2 diabetes mellitus (T2DM )patientsand investigate the relationships between serum HMW‐APN level and glycolipid metabolism ,insulin resistance and pancreas βcell function. Methods A total of 176 Chinese subjects were enrolled in the study ,including eighty‐eight patients with newly‐diagnosed T2DM and eighty‐eight subjects with normal glucose tolerance (NGT ). NGT and T2DM groups were further divided into normal weight(NW) and obese(OB) subgroups separately. Obesity was defined as BMI≥25 kg/m2according to the WHO‐Western Pacific Region diagnostic set forth in 2000. 75 g oral glucose tolerance test (OGTT) was performed in all subjects. HbA1c ,blood glucose ,blood insulin , blood lipids and HMW‐APN level were also determined. Results The serum HMW‐APN level was significantly lower in T2DM group than in NGT group[0.99(0.52~1.56)vs 2.53(1.69~5.44) ng/L ,P<0.01].Within subgroups of T2DM and NGT ,serum HMW‐APN level was lower in OB subgroups than in NW subgroups[0.74(0.35~1.39) vs 1.21(0.74~2.08) ng/L ;2.11(1.47~4.01)vs 4.49(2.40~6.11)ng/L ,P<0.05]. Pearson correlation analysis showed that serum HMW‐APN level was negatively correlated with BMI ,WC ,WHR ,SBP ,TG ,FPG ,2 hPG ,HbA1 c ,FIns ,2 hIns ,HOMA‐IR and hsC‐RP(P<0.05 or P< 0.01 ) ,and was positively correlated with HDL‐C and HOMA‐β( P < 0.01 ). Multiple linear regression analysis showed that 2 hPG ,hsC‐RP and WHR were independently related to serum HMWAPN level ( P < 0.01 ). Conclusion Serum HMW‐APN level is decreased in subjects with newly diagnosed T2DM. Serum HMW‐APN level is closely correlated with obesity ,glycolipid metabolism ,insulin resistance ,pancreas β cell function and hsC‐RP. It suggests that the HMW‐APN decline may be play an importantrole in the pathogenesis of obesity and T2DM.