摘要
目的:观察2型糖尿病患者加之高血压、肥胖因素血清脂联素水平与单纯2型糖尿病患者及正常人群的差异,分析血清脂联素水平与胰岛素抵抗的关系。方法:选择2004-11/2005-12桂林医学院附属医院内分泌科、糖尿病防治中心住院及门诊2型糖尿病患者240例,以是否合并有高血压为标准分为两组,即高血压组120例,肥胖者(体质量指数≥25kg/m2)68例,非肥胖者(体质量指数<25kg/m2)52例;非高血压组120例,肥胖者62例,非肥胖者58例;另纳入健康者50例为对照组。分别检测以上3组患者的空腹脂联素、瘦素、肿瘤坏死因子、胰岛素、空腹和馒头餐后2h血糖、糖化血红蛋白、体质量指数、血压、总胆固醇、三酰甘油,计算胰岛素敏感指数,比较脂联素水平变化,并与其他因素进行相关分析及逐步回归分析,观察其与胰岛素抵抗的关系。结果:参与观察的2型糖尿病患者240例及健康者50例全部进入结果分析。①2型糖尿病合并高血压组空腹血糖、胰岛素、C肽及餐后2h血糖与其他两组比较,差异有非常显著性意义(P<0.01);体质量指数、瘦素、肿瘤坏死因子、收缩压、舒张压、总胆固醇、三酰甘油、糖化血红蛋白、胰岛素敏感指数与其他两组比较,差异有显著性意义(P<0.05)。②2型糖尿病合并高血压组和单纯2型糖尿病组血清脂联素水平低于正常对照组(P<0.01);2型糖尿病合并高血压组血清脂联素水平低于单纯2型糖尿病组(P<0.01);肥胖者均低于非肥胖者(P<0.05～0.01)。③多元线性相关分析显示,2型糖尿病合并高血压组中,脂联素与体质量指数、收缩压、空腹血糖、胰岛素、三酰甘油、瘦素、肿瘤坏死因子α之间存在显著负相关,与胰岛素敏感指数呈独立正相关,进入回归方程的因素为脂联素、瘦素、肿瘤坏死因子α、体质量指数、三酰甘油、收缩压;2型糖尿病非高血压组中,脂联素与空腹血糖、胰岛素、三酰甘油、瘦素、肿瘤坏死因子α之间存在显著负相关,与胰岛素敏感指数呈独立正相关,进入回归方程的因素为脂联素、瘦素、肿瘤坏死因子α、三酰甘油。结论:在2型糖尿病患者中,血清脂联素水平明显降低,合并高血压者血清脂联素水平更低,与胰岛素敏感指数呈独立正相关,脂联素水平与高血压之间存在一定的相关性。
AIM： To investigate the adiponeetin levels in patients of type 2 diabetes mellitus （DM） with hypertension and obesity, compare with the levels of simple DM patients and normal people, and analyze the correlation of adiponectin levels with insulin resistance. METHODS： A total of 240 patients with type 2 DM were selected from Diabetic Prevention and Treatment Center and Out-patient Clinics as well as Department of Endocrine in the Affiliated Hospital of Guilin Medical College during November 2004 and December 2005. They were divided into two groups： Group A： 120 cases of type 2 DM with hypertension, including 68 eases of obesity [body mass index （BMI） ≥ 25 kg/m^2] and 52 cases of non-obesity （BMI 〈 25 kg/m^2）; Group B： 120 cases of type 2 DM, including 62 cases of obesity and 58 cases of non-obesity; In addition, 50 normal controls were enrolled in this study. Fasting plasma adiponectin, leptin （LEP）, tumor necrosis factor （TNF-α）, insulin, fasting and 2 hours postprandial blood glucose, glucosylated hemoglobin （HbA1c）, BMI, blood pressure （BP）, total cholesterol （TC） and triglyceride （TG） were measured in three groups, and insulin sensitivity index （ISI） was calculated to compare the changes of adiponectin levels. The correlation of ISI and adiponectin levels was investigated with related analysis on other factors and a multiple linear stepwise regression analysis. RESULTS： Totally 240 DM patients and 50 normal controls were involved in the result analysis. ①Compared with Group B and control group, the difference was extremely significant in the levels of fasting insulin, C peptide along with fasting and 2 hours postprandial blood glucose （P 〈 0.01）, and significant in BMI, LEP, TNF-α, systolic pressure （SP）, diastolic pressure, TC, TG, HbAlc and ISI from Group A （P 〈 0.05）.②The plasma adiponectin level was lower in both Group A and Group B than in control group （P 〈 0.01）, also lower in Group A than in Group B （P 〈 0.01）, and still lower in obese cases than in non-obese cases （P 〈 0.05 -0.01）. ③ Multiple linear related analysis showed that, plasma adiponectin in Group A was significantly negatively related to BMI, SP, fasting blood glucose, fasting insulin, TG, LEP and TNF-α, while independently positively to ISI. There were adiponectin, LEP, TNF-α, BMI, TG and SP entering the regression equation. In Group B, plasma adiponectin had a significant negative relationship with fasting blood glucose, fasting insulin, TG, LEP, TNF-α whereas independent positive relationship with ISI. Adiponectin, LEP, TNF-α and TG were involved in the regression equation. CONCLUSION： The patients with type 2 DM have lower plasma adiponectin levels, while the patients with type 2 DM and hypertension have far lower levels, which are independently positively related with ISI. There is bound to be a correlation between adiponectin levels and hypertension.
出处
《中国临床康复》
CSCD
北大核心
2006年第36期18-20,共3页
Chinese Journal of Clinical Rehabilitation
基金
广西壮族自治区科技厅科学基金资助项目(0448082)~~
