2型糖尿病患者血清瘦素水平与胆结石及胰岛素抵抗关系的研究

Study on the relationship between serum leptin level and gallstones as well as insulin resistance in type2diabetes patients

目的探讨2型糖尿病(T2DM)患者血清瘦素(Lep)水平与胆结石(GD) 及胰岛素抵抗(IR)相关指标的关系。方法153名2型糖尿病人根据胆囊B超显示的结石有无分成两组:糖尿病伴结石组和糖尿病不伴结石组,再按性别各分成2个亚组。所有对象均测量身高、体重、腰围、臀围及空腹胆囊B超,并留空腹静脉血浆测定血葡萄糖(FPG)、胰岛素(FIns)、C肽(FC-P)、空腹总胆固醇(TC)、甘油三酯(TG)及瘦素。结果女性血清瘦素水平是男性的3倍;女性糖尿病伴结石亚组的血清瘦素、BMI,TC,TG,FIns,FC-P 及HOMA胰岛素抵抗指数(HOMA-IR)均显著高于糖尿病不伴结石亚组,而腰臀比(WHR)及FPG两组间比较差异无显著性意义。男性亚组中除TG 差异无显著性外,其余指标变化同女性。以胆结石为应变量的Logistic回归分析表明,随血清瘦素水平增加,胆结石发生的危险性增加。简单相关分析:瘦素与BMI,FIns,FC-P,HOMA-IR等正相关(P<0.05),偏相关分析控制年龄和体重指数后,女性与TC,FINS,FC-P正相关;男性与FINS,FC-P正相关。以瘦素为应变量的多元逐步回归分析显示,男女性均见BMI及FINS是影响血清瘦素水平的独立因素,女性还受TC影响。结论瘦素可能与2型糖尿病人胆结石的形成有关。2型糖尿病人的血清瘦素水平也是胰岛素抵抗的一个预测指标。

Objective:To investigate the relationship of the serum leptin level and gallstones as well as other related factors of insulin resistance(IR)in type2diabetes mellitus(T2DM).Methods:153T2DM pa-tients underwent gallbladder ultrasonography firstly and then were divided into2groups according to the re-sults of gallbladder ultrasonography:T2DM with gallstones(DM with GD)and T2DM without gallstones(DM without GD),two groups were divided further into2subgroups according to gender.All subjects were mea-sured height,weight,waistline and the circumference of hip.TC,TG,leptin,plasma glucose,insulin and C-peptide were tested after over10hours fasting.Results:The serum leptin level in female was approximately3times higher than that in male.In female the blood leptin,BMI,TC,TG,HOMA-IR,FINS and FC-P in DM with GD were significantly higher than those of DM without GD,But there were no differences on WHR and FPG.The similar results were seen in two subgroups of male except for TG(no significant differences).The logistic regression analysis suggested that the risk of gallstones increased with the increasing of serum leptin level.Simple correlation analysis showed that:BMI,FINS,FC-P and HOMA-IR were positively corre-lated with serum leptin level;After controlling for BMI and age,partial correlation analysis showed that:in fe-male,TC,FINS and FC-P remained positivly correlated with leptin;in male,FINS and FC-P remained positivly correlated with leptin.The multiple factors stepwise regression indicated that BMI and FINS were independent effective factors of leptin in both gender,otherwise TC was another independen effective factors of leptin in female.Conclusion:Leptin may be involved in the formation of gallstones in T2DM.The serum leptin level is a predictive factor of IR in T2DM.