2型糖尿病胰岛素抵抗与RBP4、游离脂肪酸临床相关研究

摘要

目的：探讨2型糖尿病(T2DM)患者胰岛素抵抗与视黄醇结合蛋白4(RBP4)、游离脂肪酸的变化特点及临床意义。方法2型糖尿病患者39例分为：胰岛素抵抗指数( HOMA-IR)<2．69者19例,HOMA-IR≥2．69者20例,健康者对照(NC)组20例。测量身高、体重、血压/腰围、甘油三酯(Triglyceride,TG)、高密度脂蛋白(High density lipoprotein, HDL)、总胆固醇(Total cholesterol,CHO)、低密度脂蛋白(Low density lipoprotein,LDL),体质指数(BMI)计算BMI=体质(kg)/身高(m)2；放免法和酶联免疫吸附法(ELISA)测空腹血糖(FPG)、胰岛素(FINS)、RBP4、游离脂肪酸；采用胰岛素抵抗指数HOMA-IR=Fins(μU/mL)× FPG( mmol/L)/22．5。结果随着胰岛素抵抗指数的增加,腰围、BMI 2型糖尿病组高于健康组,差异有统计学意义(P<0．05)；游离脂肪酸(FFA)、RBP4在2型糖尿病组高于健康组,差异有统计学意义(P<0．05)；总胆固醇及甘油三酯2型糖尿病组高于健康组,差异有统计学意义(P<0．05)。结论随着胰岛素抵抗加重,血清RBP4、游离脂肪酸及胆固醇、甘油三酯水平增加,胰岛素抵抗状态下血清RBP4、游离脂肪酸水平改变可能是联系胰岛素抵抗和2型糖尿病的纽带。%Objective To study the insulin resistance and retinol binding protein 4(RBP4),free fatty acid changes and its clinical significance in patients with type 2 diabetes mellitus(T2DM). Methods 39 patients with type 2 diabetes mellitus were divided into:a group that homeostasis model assessment-insulin resistance index( HOMA-IR) of patients was less than 2. 69 had 19 cases,a group that HOMA-IR of patients was more than or equal to 2. 69 had 20 cases and normal control(NC)group had 20cases. Measure the height,weight,blood pressure/waist circumference,triglyceride( TG) ,high density lipoprotein( HDL) ,total cholesterol ( CHO) ,low density lipoprotein( LDL) and body mass index( BMI) . Calculated BMI=weight( kg)/height( m) 2 . We used radioim-munoassay and enzyme-linked immune adsorption assay( ELISA) to measure fasting plasma glucose( FPG) ,fasting insulin( FINS) , RBP4 and free fatty acid. The homeostasis model assessment-insulin resistance index we used was HOMA-IR=Fins( U/mL) × FPG(mmol/L)/22. 5. Results With the increase of homeostasis model assessment-insulin resistance index,the waist circumfer-ence and BMI of patients in T2DM group were higher than that in healthy group,and the difference was statistically significant(P<0. 05);Free fatty acid(FFA)and RBP4 of patients in T2DM group were higher than that in healthy group,and the difference is sta-tistically significant(P<0. 05);Total cholesterol and triglyceride of patients in T2DM group were higher than that in healthy group,and the difference is statistically significant(P<0. 05). Conclusion With the worsening of insulin resistance,the level of serum RBP4,free fatty acid,cholesterol and triglyceride increased,the changes of serum RBP4 and free fatty acid may be the link between insulin resistance and type 2 diabetes in insulin resistance state.