糖尿病一级康复干预研究:不同糖耐量时血清脂联素及氧化应激变化与胰岛素抵抗的关系

Primary rehabilitative intervention of diabetes mellitus:relationship between changes of serum adiponectin and oxidative stress and insulin resistance in patients with different glucose tolerance

目的:分析不同糖耐量时血清脂联素、氧化应激的变化及其与胰岛素抵抗(insulinresistance,IR)的关系。方法:纳入2003-05/12哈尔滨医科大学附属第二医院职工及门诊患者165例,分为正常对照组、肥胖组、糖耐量低减组、2型糖尿病组。测受试者体质量指数、腰臀比、空腹时血糖、血脂、胰岛素、脂联素、丙二醛及超氧化物歧化酶superoxidedismutase,SOD水平,计算()胰岛素敏感指数。结果:脂联素在正常组犤(12.95±2.36)mg/L犦最高,同其他组比差异有显著性意义(均P<0.05),肥胖组和糖耐量低减组犤(8.93±2.84、8.24±2.52)mg/L犦差异无显著性意义,但均显著高于2型糖尿病组犤(4.36±1.76)mg/L犦(均P<0.05)。脂联素与体质量指数、腰臀比、腰围、空腹血糖、三酰甘油、总胆固醇及丙二醛显著负相关,与胰岛素敏感指数及SOD显著正相关。多元回归分析发现脂联素与SOD及丙二醛2有高度相关性(R=0.605,P<0.01,F=34.70)。结论:氧化应激与IR有关。脂联素改善IR的机制可能与其抑制高血糖及脂肪细胞因子诱导的氧化应激有关。

AIM:To analyze the changes of serum adiponectin level and oxidative stress and their relationships with insulin resistance(IR) when glucose tolerance is different. METHODS:Totally 165 employees or outpatients in the Second Affiliated Hospital of Harbin Medical University during May and December 2003 were divided into normal control group,obesity group, impaired glucose tolerance(IGT) group and type 2 diabetes mellitus(T2DM) group.Body mass index(BMI),waist to hip ratio(WHR),fasting levels of blood glucose,blood lipid, insulin,adiponectin and malondiadehyde(MDA) and activity of superoxide dismutase(SOD) were measured in all the subjects,and insulin sensitivity index(ISI) was calculated. RESULTS:The level of serum adiponectin was significantly higher in the normal control group[(12.95± 2.36) mg/L] than in all the other groups(P< 0.05), and there was insignificant difference between the obesity group[(8.93± 2.84) mg/L] and IGT group[(8.24± 2.52) mg/L],and both were remarkably higher than that in the T2DM group[(4.36 ± 1.76) mg/L] (P< 0.05).Serum adiponectin level was significantly and positively correlated with BMI, WHR,waistline, fasting blood glucose,triglyceride(TG),total cholesterol(TC) and MDA,but had significant positive correlations with ISI and SOD.Multiple regression analysis showed that serum adiponectin level was highly correlated with SOD and MDA(R2 =0.605,P< 0.01,F=34.70). CONCLUSION:Oxidative stress is correlated with IR. The mechanism of adiponectin in ameliorating IR may be related to its inhibition to oxidative stress induced by hyperglycemia and fat cytokines.