糖耐量减低患者血清瘦素水平及相关因素分析

Level of serum leptin and related factors in patients with impaired glucose tolerance

目的:探讨初诊的糖耐量减低(impairedglucosetolerance,IGT)患者血清瘦素水平与年龄、性别、体质量指数、糖代谢、脂代谢等指标的关系。方法:2002-04/09青岛大学医学院附属医院内分泌门诊IGT患者106例。纳入标准:符合1998年世界卫生组织IGT诊断标准;均为初诊且未经干预治疗。排除标准:排除有高血压、冠心病等疾病及其他代谢性疾病患者。符合上述标准IGT患者57例(IGT组),男29例,女28例;肥胖者犤体质量指数(bodymassindex,BMI)≥25kg/m2犦27例,非肥胖者(BMI<25kg/m2)30例。收集同期本院体检自愿参加研究的健康人。纳入标准:无糖尿病家族史,空腹、餐后血糖均在正常范围。排除标准:排除有高血压、心脏疾病等患者。符合上述标准健康人52例为对照组,男26例,女26例;肥胖者(BMI≥25kg/m2)25例,非肥胖者(BMI<25kg/m2)27例。采用放射免疫分析法(RIA)和酶联免疫吸附法(ELISA)检测IGT组及对照组的空腹血清瘦素、睾酮、雌二醇和真胰岛素;同时测定血糖、血清胆固醇、三酰甘油和尿酸。结果:IGT组血清瘦素水平犤(10.87±6.28)μg/L犦稍低于对照组犤(11.26±7.31)μg/L犦,但差异无显著性意义(P>0.05);IGT组女性瘦素水平犤(12.78±5.62)μg/L犦明显低于对照组女性犤(16.13±7.42)μg/L犦(F=12.476,P<0.01);

AIM: To investigate the relationships of serum leptin level with age, gender, body mass index (BMI), glycometabolism, lipometabolism and other factors in patients with preliminary diagnosis of impaired glucose tolerance (IGT). METHODS: Totally 106 IGT patients in the Department of Endocrinology, Affiliated Hospital of Medical College, Qingdao University during April and September 2004 were selected. All the subjects were in accordance with the diagnostic criteria of WHOIGT in 1998, preliminary diagnosis but did not received any intervention. Those who had hypertension, coronary heart disease and other metabolic diseases were excluded. There were IGT 57 patients (IGT group, 29 males and 28 females) who met the above-mentioned criteria, including 27 cases with obesity (BMI≥25 kg/m2) and 30 cases with non-obesity (BMI< 25 kg/m2). Another 52 health volunteers (26 males and 26 females) were taken as the normal controls, including 25 cases with obesity (BMI)≥25 kg/m2) and 27 cases with non-obesity (BMI< 25 kg/m2). All the healthy controls had no family history of diabetes mellitus, and their fasting and postprandial glucose were in a normal range, while those with hypertension and heart diseases were excluded. The radioimmunoassay (RIA) and enzyme linked immunosorbent assay(ELISA) were used to determine the fasting serum levels of leptin, testosterone (TT), estradiol (E2) and true insulin were measured in the IGT group and control group, the fasting blood glucose(FBG), cholesterol, triacylglycerol(TG) and uric acid were assayed simultaneously. RESULTS: The serum leptin level in the IGT group [(10.87±6.28) μg/L]was slightly lower than that in the control group [(11.26±7.31) μg/L] with insignificant difference ( P >0.05). The serum leptin level of females in the IGT group [(12.78±5.62) μg/L] was obviously lower than that in the control group [(16.13±7.42) μg/L] (F=12.476, P< 0.01). In the IGT group, the serum leptin levels were significantly higher in the patients with obesity than those without obesity (F=39.864, P< 0.01); and significantly higher in females than in males (F=28.354, P< 0.01).In the IGT group, the serum leptin levels were positively correlated with BMI, insulin concentration, waist circumference, total cholesterol and uric acid (t=2.665 to 5.389, P< 0.05),but negatively correlated with TT, FBG and ISI(t=-4.517 to -2.832,P< 0.05). CONCLUSION: The synthesis of leptin by adipose tissue is more susceptible to be regulated by insulin and glucose in female IGT patients than in male ones. The serum leptin levels are correlated with gender, BMI, waist circumference, insulin concentration, insulin resistance, TT, blood glucose and other factors in IGT patients. Leptin plays a part in the occurrence of IGT by participating in the regulation of glycometabolism; Leptin plays a role in lipometabolism and uric acid metabolism.