2型糖尿病患者血清瘦素变化与胰岛素抵抗的关系

Relationship Between Alteration of Serum Leptin and Insulin Resistance in Patients with Type 2 Diabetes

目的观察2型糖尿病患者血清瘦素及胰岛素的变化,探讨2型糖尿病血清瘦素和胰岛素抵抗的相互关系。方法39例2型糖尿病患者,检测身高、体重、空腹血糖(FPG)、血清空腹胰岛素(FINS)、血清瘦素(leptin)及肝肾功能和血脂变化,并计算胰岛素敏感指数(ISI)和胰岛素抵抗指数(HOMA-IR)。用多元逐步回归分析和偏相关分析对瘦素与上述指标和胰岛素敏感指数的相关性进行分析。结果糖尿病患者血清leptin,FINS,HOMA-IR均较正常对照组显著升高(P<0.01),ISI显著下降(P<0.01);在糖尿病患者中,瘦素水平与FINS,HOMA-IR明显正相关(r1=0.525,P<0.01,r2=0.391,P<0.05),与ISI明显负相关(r=-0.334,P<0.05);多元逐步回归分析显示,影响瘦素最主要的因素依次为性别,BMI,甘油三脂,胰岛素和ISI,(R2=0.358,P<0.01)。结论2型糖尿病患者血清瘦素水平显著升高,且与胰岛素抵抗有明显相关性。

Objective To study the correlation between insulin resistance (IR) and the change in serum leptin in patients with type 2 diabetes .Methods The body height and weight,fasting plasms glucose (FPG) ,fasting serum insulin (FINS) ,serum leptin, hepatic and renal function, and serum lipid were determined in 39 patients with type 2 diabetic meeting the 1997 ADA diagnostic criteria and 40 normal subjects as control. We used the HOMA model to calculate HOMA - IR as an index of insulin resistance. We also calculated the insulin sensitivity index (ISI). The correlation among the above mentioned parameters was analyzed by multiple regression analysis and partial correlation analysis, respectively.The body weight index (BWI) was calculated.Results The serum leptin level,FINS,HOMA- IR were significantly higher ( P < 0.01) but ISI was significantly lower (P< 0.01) in patients with diabetes than those in the normal control.The serum leptin was positively correlated with FINS and HOMA- IR (r1 =0.525, P <0.01,r2 = 0.391, P <0.05),but negatively correlated with ISI(r= -0.334, P <0.05) in the patients with diabetes. Multiple regressive analysis revealed that the important factors affecting the serum leptin level in the patients with type 2 diabetes were sex, BWI, TG, FTNS and ISI(R2= 0.358, P<0.01).Conclusions In patients with type 2 diabetes the serum leptin level is significantly higher than that in the normal subjects and related closely to IR .