2型糖尿病患者非糖尿病一级亲属血清游离脂肪酸脂联素与胰岛素抵抗的关系

Relationship of levels of serum free fatty acids and adiponectin with insulin resistance in first-degree relatives of type 2 diabetes

目的测定2型糖尿病（T2DM）患者及其非糖尿病一级亲属（FDRs）血清游离脂肪酸（FFA）、脂联素水平，评估其胰岛素敏感性，分析FFA、脂联素与胰岛素抵抗（IR）之间的关系。方法测定健康对照组（46例）、FDRs组（43例）和T2DM组（30例）的血清FFA及脂联素，用IR指数（HOMA-IR）评估胰岛素敏感性，分析各指标在3组之间的差异及相关性。结果FFA在对照组（0．36±0．14）mmol／L、FDRs组（0．52±0．17）mmol／L和T2DM组（0．68±0．23）mmol／L，呈依次增高趋势，差异有统计学意义（P〈0．05）。脂联素在对照组和FDRs组分别为（10．25±2．34）mg／L和（6．03±1．91）mg／L，差异有统计学意义（P〈0．01）；而T2DM组为（4．75±1．27）mg／L，低于FDRs组，差异有统计学意义（P〈0．01）；HOMA-IR在对照组、FDRs组和T2DM组呈依次增高趋势，差异有统计学意义（P〈0．05）。FFA与HOMA-IR呈正相关，与脂联素呈负相关；脂联素与体质指数、HOMA-IR呈负相关。结论FDRs组已经存在IR，并且血清FFA水平升高，脂联素水平降低；FFA、脂联素与IR密切相关，可作为评估IR的较好指标。

Objective To investigate the changes of serum levels of free fatty acids（FFA）and adiponectin, and the relationship of FFA and adiponectin with insulin resistance （IR） in patients with type 2 diabetes mellitus （T2DM） and first-degree relatives of type 2 diabetes mellitus （FDRs）. Methods The subjects were divided into normal controls group （NC,n=46） ,FDRs group（n=43）and T2DM group（n=30）. Blood glucose, lipids, insulin, FFA and adiponectin concentrations were measured in all subjects. Insulin action was evaluated by HOMA-insulin resistance index （HOMA-IR）. Results Serum FFA levels in T2DM group [（0.68 ± 0. 23）mmol/L] and FDRs group [（0. 52±0. 17）mmol/L] were significantly higher than in NC group [（0. 36±0. 14）mmol/L] （all P〈0. 05）, and it was higher in T2DM group than in FDRs group （P〈0. 05）. Serum adiponectin levels were significantly lower in both T2DM group [（4.75±1.27） mg/l] and FDRs group [（6.03±1.91）mg/l] than in NC group [（10. 25±2.34） mg/1] （all P〈0. 01） ,and it was lower in T2DM group than in FDRs group （P〈0. 01）. HOMA-IR in T2DM group and FDRs group were significantly higher than in NC group （P〈0. 05）, and it was higher in T2DM group than in FDRs group （P〈0. 01）. Serum FFA concentration had significantly positively linear correlation with HOMe-IR（r=0. 49, P〈 0. 01）, while negatively correlated with serum adiponectin（r=-0.45, P〈0. 01）. Serum adiponectin was negatively correlated with BMI and HOMA-IR（r=-0. 54, P〈0. 001; r=-0. 55, P〈0. 01）. Further multivariate regression analysis revealed that fasting insulin, FFA, and adiponectin contributed to the degree of insulin resistance. Conclusions Insulin resistance exists in FDRs. Serum FFA level in FDRs group is much higher than in NC group, while serum adiponectin level is lower. Serum FFA and adiponectin levels are closely related to IR.