2型糖尿病家系一级亲属血清脂联素、肿瘤坏死因子-α与胰岛素抵抗的相关性研究

The Relationship of Serum Levels of Adiponectin and Tumor Necrosis Factor-α in the First-degree Family Relatives of Patients with Type 2 Diabetic

目的探讨2型糖尿病(DM)家系正常糖耐量一级亲属血清脂联素、肿瘤坏死因子-α(TNF-α)水平的变化,研究脂联素、TNF-α与胰岛素抵抗(IR)的关系。方法收集2型DM家系45个,在排除DM和糖耐量受损的前提下,选择一级亲属为观察组(83例),先证者的配偶或其同胞的配偶为正常对照组(76例),检测所有受试者的空腹血糖(FPG)、胰岛素(FINS)、胰岛素原(FPI)、血脂、脂联素、TNF-α水平。采用稳态模型法(HOMA)计算胰岛素抵抗指数(HOMAI-R)。结果一级亲属组的甘油三酯、FPI、FINS、HOMAI-R、TNF-α水平高于正常对照组(P<0.05或P<0.01),高密度脂蛋白、脂联素低于正常对照组(P<0.05)。相关分析显示,脂联素与TNF-α呈负相关。多元线性逐步回归分析显示,FPG、体质指数、脂联素、TNF-α是影响2型DM家系一级亲属IR的独立危险因素。结论2型DM家系一级亲属在未发生糖尿病时已存在IR,脂联素与TNF-α可能联合影响2型DM家系一级亲属IR的程度。

Objective To study the changes of serum levels of adiponectin and tumor necrosis factor-αin the first-degree family relatives of patients with type 2 diabetic mellitus and the relationship of adiponectin and TNF-αwith insulin resistance. Methods 45 families with type 2 diabetes were recruited. The observation group comprised 83 first-degree relatives who were with normal glucose tolerance （NGT）. The normal control group comprised 76 NGT spouses of the probands and his/her siblings. The levels of fasting blood glucose, insulin, proinsulin, lipid, adiponectin and TNF-α were measured among two groups. Insulin resistance was calculated using the homeostasis assessment（HOMA）. Results The levels of TG, fasting insulin（FINS）, fasting proinsulin（FPI）, TNF-α and HOMA-IR in first-degree relatives were significantly higher （P〈0.05 or P〈0.01）, and the HDL and adiponectin level was significantly lower （P〈0.05） than those in the normal control. The results by correlation analysis indicated that adiponectin was correlated negatively with TNF-α. Multivariate stepwise regression analysis showed that fasting blood glucose（FPG）, body mass index （BMI）, adiponectin and TNF-α were independent risk factors for insulin resistance in first-degree relatives. Conclusion insulin resistance had appeared before the onset of diabetes in first-degree relatives of probands with type 2 diabetes. Adiponectin and TNF-α may jointly affect the IR of first-degree relatives of probands with type 2 diabetes.