血清microRNA-155、microRNA-21、趋化素、瘦素与糖尿病肥胖患者胰岛素抵抗的相关性

The associations of serum microRNA-155,microRNA-21,chemerin and leptin with insulin resistance in obese patients with diabetes mellitus

目的 探讨糖尿病肥胖患者血清microRNA-155(miR-155)、microRNA-21(miR-21)、趋化素、瘦素水平与胰岛素抵抗(IR)的相关性。方法 选取2022年1月—2023年4月山东中医药大学第二附属医院收治的138例2型糖尿病(T2DM)患者为研究对象,其中肥胖患者73例(肥胖组),非肥胖患者65例(非肥胖组)。肥胖组中有IR 45例(IR组),无IR 28例(非IR组)。收集患者一般资料,包括性别、体质量指数(BMI)、年龄、颈围(NC)、腰围(WC)、空腹血糖(FPG)、甘油三酯(TG)、空腹胰岛素(FINS)、高密度脂蛋白胆固醇(HDL-C)、miR-155、miR-21、趋化素、瘦素、胰岛素抵抗指数(HOMA-IR)水平;通过多因素逐步Logistic回归模型分析T2DM肥胖患者发生IR的危险因素;绘制受试者工作特征(ROC)曲线,分析miR-155、miR-21、趋化素、瘦素诊断T2DM肥胖患者IR的效能;Pearson法分析miR-155、miR-21、趋化素、瘦素与HOMA-IR的相关性。结果 肥胖组miR-155相对表达量低于非肥胖组(P <0.05),miR-21、趋化素、瘦素、HOMA-IR高于非肥胖组(P <0.05)。IR组miR-155相对表达量低于非IR组(P <0.05),NC、WC、miR-21、趋化素、瘦素水平高于非IR组(P<0.05)。多因素逐步Logistic回归分析结果显示:NC [O^R=1.416(95%CI:1.038,1.932)]、WC [O^R=1.227(95%CI:1.049,1.435)]、miR-155 [O^R=1.763(95%CI:1.205,2.579)]、miR-21[O^R=1.932(95%CI:1.356,2.753)]、趋化素[O^R=2.074(95%CI:1.492,2.883)]、瘦素[O^R=1.628(95%CI:1.246,2.127)]是T2DM肥胖患者发生IR的危险因素(P <0.05)。ROC曲线分析结果显示,miR-155、miR-21、趋化素、瘦素诊断T2DM肥胖患者IR的曲线下面积分别为0.865、0.909、0.874和0.871;敏感性为77.8%(95%CI:0.614,0.825)、86.7%(95%CI:0.792,0.917)、95.6%(95%CI:0.713,0.965)和80.0%(95%CI:0.692,0.917);特异性为85.7%(95%CI:0.647,0.903)、82.1%(95%CI:0.732,0.914)、75.0%(95%CI:0.675,0.928)和89.3%(95%CI:0.656,0.944)。miR-155与HOMA-IR呈负相关(r=-0.573,P=0.000),miR-21、趋化素、瘦素与HOMA-IR均呈正相关(r=0.531、0.558和0.568,均P=0.000)。结论 T2DM肥胖患者中IR较多,且miR-155、miR-21、趋化素、瘦素是T2DM肥胖患者发生IR的危险因素。

Objective To investigate the associations of serum levels of microRNA-155(miR-155),microRNA-21(miR-21),chemerin and leptin with insulin resistance(IR)in obese patients with diabetes mellitus.Methods A total of 138 patients with type 2 diabetes mellitus(T2DM)admitted to the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 2022 to April 2023 were selected,including 73 obese patients(obese group)and 65 non-obese patients(non-obese group).In the obese group,there were 45 cases with IR(IR group)and 28 cases without IR(non-IR group).The general data,including sex,body mass index(BMI),age,neck circumference(NC),waist circumference(WC),fasting plasma glucose(FPG),triglyceride(TG),fasting insulin(FINS),high-density lipoprotein cholesterol(HDL-C),miR-155,miR-21,chemerin,leptin,and insulin resistance index(HOMA-IR),were collected.Multivariable stepwise Logistic regression was performed to analyze the risk factors for IR in obese patients with T2DM.The receiver operating characteristic(ROC)curve was applied to determine the diagnostic values of miR-155,miR-21,chemerin and leptin for IR in obese patients with T2DM.Pearson correlation coefficients were used to analyze the correlations of miR-155,miR-21,chemerin and leptin with HOMA-IR.Results The level of miR-155 in the obese group was lower than that in the non-obese group(P<0.05),while the levels of miR-21,chemerin and leptin as well as HOMA-IR in the obese group were higher than those in the non-obese group(P<0.05).The level of miR-155 in the IR group was lower than that in the non-IR group(P<0.05),while NC,WC and the levels of miR-21,chemerin and Leptin in the IR group were higher than those in the non-IR group(P<0.05).Multivariable stepwise Logistic regression analysis showed that high NC[O^R=1.416(95%CI:1.038,1.932)],WC[O^R=1.227(95%CI:1.049,1.435)],and levels of miR-155[O^R=1.763(95%CI:1.205,2.579)],miR-21[O^R=1.932(95%CI:1.356,2.753)],chemerin[O^R=2.074(95%CI:1.492,2.883)]and leptin[O^R=1.628(95%CI:1.246,2.127)]were risk factors for IR in obese patients with T2DM(P<0.05).ROC curve analysis revealed that the areas under the curves of miR-155,miR-21,chemerin and leptin in diagnosing IR in obese patients with T2DM were 0.865,0.909,0.874 and 0.871,with the sensitivities being 0.778(95%CI:0.614,0.825),0.867(95%CI:0.792,0.917),0.956(95%CI:0.713,0.965)and 0.800(95%CI:0.692,0.917),and the specificities being 0.857(95%CI:0.647,0.903),0.821(95%CI:0.732,0.914),0.750(95%CI:0.675,0.928)and 0.893(95%CI:0.656,0.944).The level of miR-155 was negatively correlated with HOMA-IR(r=-0.573,P=0.000),while the levels of miR-21,chemerin and leptin were positively correlated with HOMA-IR(r=0.531,0.558 and 0.568,all P=0.000).Conclusion IR is prevalent in obese patients with T2DM,and high levels of miR-155,miR-21,chemerin and leptin are risk factors for IR among these patients.