不同糖耐量人群及糖尿病患者血浆内脂素与血糖及胰岛功能的关系研究

Plasma visfatin levels in patients with newly diagnosed and untreated type 2 diabetes mellitus and impaired glucose tolerance

目的探讨不同糖耐量人群血浆内脂素的变化及其与体重指数(BMI)、腰围、血糖、胰岛素抵抗指数、胰岛B细胞功能、血脂等的关系。方法2006年4月至2006年10月在南京医科大学第一附属医院门诊常规健康体检及糖尿病初次就诊者95名,按WHO1999糖尿病诊断标准分为初诊2型糖尿病组(53例)、糖耐量减退组(7例)、正常糖耐量组(35名);以WHO1998肥胖诊断标准分为超重或肥胖组(50名)、正常体重组(45名)。检测受试者BMI、腰围、血压,测定空腹血浆内脂素、血糖、血脂、胰岛素等。结果初诊2型糖尿病患者空腹血浆内脂素明显高于正常糖耐量组(P<0.01)。超重或肥胖组与正常体重组间血浆内脂素差异无显著性意义。人群中血浆内脂素与空腹血糖(r=0.338,P<0.01)、餐后2h血糖(r=0.340,P<0.01)、胰岛素抵抗指数(r=0.227,P<0.05)呈正相关,与胰岛素分泌指数(HOMA-B)呈负相关(r=-0.296,P<0.05)。在2型糖尿病组,血浆内脂素与糖化血红蛋白(HbA1c)呈正相关(r=0.356,P<0.01)。多元线性逐步回归分析表明,餐后2h血糖是影响血浆内脂素的独立相关因素。结论初诊2型糖尿病患者血浆内脂素显著升高,可能是机体针对体内血糖增高、胰岛功能受损所发生的一种代偿效应。

Objective To investigate the plasma visfatin levels and explore the relationship between visfatin and anthropometric parameters, glucose,lipid profile,insulin sensitivity index and insulin secretion index in the subjects with different glucose tolerances, Methods Fifty-three patients with newly diagonosed type 2 diabetes（T2DM） ,7 subjects with impaired glucose tolerance（IGT） and 35 healthy controls were enrolled. Visfatin levels were measured along with the BMI, blood pressure, lipids,glucose,insulin and HOMA-IR indexes. Results Plasma visfatin levels were elevated in patients with newly diagnosed T2DM compared with IGT group or controls. There was no significant difference in the visfatin levels between IGT group and healthy controls. Plasma visfatin level was positively correlated with glucose levels and HOMA-IR, and negatively correlated with insulin secretion index （HOMA-B）. Multiple regression analysis showed that postprandial plasma glucose was independent related factor influencing plasma visfatin levels. In T2DM group,plasma visfatin concentration was positively correlated with HbA1 c level. Conclusion The increased plasma visfatin concentration in newly diagnosed and untreated type 2 diabetes mellitus represents a compensatory mechanism aimed at ameliorating the functional consequences of insulin deficiency.