肥胖2型糖尿病患者胰岛素抵抗与瘦素、血浆抵抗素、血脂、骨代谢临床分析

Clinical analysis of insulin resistance,leptin,serum resistin,lipid and bone metabolism in type 2 diabetic patients with obesity

目的探讨肥胖2型糖尿病患者胰岛素抵抗与瘦素、血浆抵抗素、血脂、骨代谢的变化及相关性.方法 55例糖尿病患者根据体质量指数(BMI)=体质量(kg)/身高(m2),当BMI≥25为肥胖2型糖尿病患者(26例),当BMI<25为非肥胖2型糖尿病患者(29例),检测两组患者定血清瘦素(LEP)、血浆抵抗素(R)、血脂、胰岛素抵抗指数(Homa-IR)、股骨颈(Femmeck)、华氏三角(Ward's triangie)和腰椎前后位(第2～4)骨密度,进行组间比较和多因素的分析.结果临床和实验室检查结果显示肥胖2型糖尿病患者R、骨钙素(BGP)、雌二醇(E2)、睾酮(T) 、腰椎(L2～4)的骨密度、LEP、空腹胰岛素(INS)、Homa-IR,均高于非肥胖2型糖尿病患者,而降钙素(CT)、高密度脂蛋白胆固醇(HDL-C),均低于非肥胖2型糖尿病患者.结论提示2型肥胖糖尿病患者均存在一定的胰岛素抵抗,血浆抵抗素、瘦素、高胰岛素血症、血脂异常与其有正相关关系.

Objective To investigate the relationship and changes between insulin resistance and serum resistin, leptin,lipid,and bone metabolism in type 2 diabetic patients with obesity. Methods Fifty type 2 diabetics patients were divided into two group according to body mass mass index（BMI） ：one group without obesity（BMI（25kg/m^2 , n=29） and the other with obesity（BMI≥25 kg/m^2 , n=26）. The levels of serum leptin（LEP）, resistin（R）, lipid, insulin resistence index（Homa-IR）, the bone mineral density（BMD） of upper part of femur（Femneck and Ward＇s triangle） and lumbar 2-4 were determined, compared and analysed by multiply factors between two groups. Results The serum resistin,bone gla protein（BGP）, estradiol（E2 ）, testosterone（T）, bone mineral desity of lumbar 2- 4, LEP, fasting insulins （FINS）, and fasting C-peptide, Homa-IR were significantly higher in type 2 diabetic patients with obesity than those without obesity, but the serum calcitionin（CT）, high density lipoprotein-C（HDL-C） were decreased significantly. Conclusion The study shows that type 2 diabetes patients with obesity all have insulin resistence in certain degree, which is positively correlated to serum resistin, LEP, hyperinsulin and dyslipidemia.