肥胖及2型糖尿病患者血清网膜素水平及其相关因素分析

Serum omentin level and related factors in obese and type 2 diabetic patients

目的测定肥胖及新诊断2型糖尿病患者血清网膜素水平，探讨网膜素与体脂参数、糖脂代谢、胰岛素抵抗的相关性。方法69例2型糖尿病（T2DM）和74例正常糖调节（NGR）者按BMI325ks／m^2分为正常体重与超重／肥胖亚组，采用ELISA法检测空腹血清网膜素水平，同时检测空腹血糖（FPG），口服葡萄糖耐量试验2h血糖（OGTY-2hPG），糖化血红蛋白（HbAlc）、血脂各项指标及空腹胰岛素（FINS）水平，计算体重指数（BMI）和腰臀比值（WHR），并以稳态模型（HOMA-model）计算胰岛素抵抗指数（HOMA-IR）。结果校正年龄及性别后，血清网膜素水平在T2DM组低于NGR组[（17．5±5．8）μg／Lvs（20．0±7．6）μg／L，P〈0．05]；T2DM组和NGT组中的超重／月巴胖者均低于非肥胖者[分别为（15．2±5．6）μg／Lvs（19．0±5．8）μg／L和（17．4±6．4）μg／Lvs（22．8±7．9）μg／L，均P〈0．05）]；且T2DM超重／肥胖组明显低于NGR超重／肥胖组。相关分析显示，血清网膜素水平与腰围、WHR、In（HOMA-IR）、甘油三酯、BMI、FINS、2hPG均呈负相关（r=-0．166～-0．313，P〈0．01或P〈0．05）；与HDL-C呈正相关（r=0．400，P〈0．01）。多元逐步回归分析发现，HDL-C、腰围和In（HOMA-IR）是血清网膜素独立相关因素（分别为r^2=0．155，r^2=0．181，r^2=0．201，均P〈0．01）。结论血清网膜素水平与腹型肥胖、胰岛素抵抗及脂代谢相关，可能参与构成胰岛素抵抗的病理生理基础。

ObJective To assay the serum omentin level in obese and newly diagnosed type 2 diabetes mellitus （T2DM） patients and investigate the relations hip between serum omentin level and body fat parameters, glucose and lipid metabolism and insulin resistance index （IR） etc. Methods 143 Shanghainese, 74 males and 69 females, aged 20 - 69, underwent evaluation of body mass index （ BMI）, waist circumference （W）, hip circumference （H）, and waist hip ratio （WHR）. 69 patients with T2DM were divided into 2 subgroups ： normal weight （T2DM-NW） subgroup （ n = 36, with BMI 〈 25 kg/m^2 ） and overweight/obese （T2DM-OW/OB） subgroup （ n = 8, with BMI ≥ 25 kg/m^2 ）. 74 patients with normal glucose regulation （NGR） were subdivided into 2 subgroups ： normal weight （NGR-NW） subgroup （ n = 36, with BMI 〈 25 kg/m^2） and overweight/obese （NGR-OW） subgroup （n = 38, with BMI≥25 kg/m^2 ）. The level of fasting serum omentin was measured by ELISA. Blood glucose, HbA1 c, lipids, and insulin levels were also measured. Insulin sensitivity was assessed by HOMA-IR. Results After age and sex adjusted, the serum omentin level of the T2DM group was （ 17.5 ± 5.8 ） μg/L , significantly lower than that of the NGR group [ （20.0 ± 7.6） μg/L, P 〈 0.05 ] ; the serum omentin level of the overweight/obese subjects was （ 16.8 ± 6.0）μg/L, significantly lower than that of the NW subjects [ （20.7 ± 7.2 ） μg/L, P 〈 0.01 ]. The serum omentin level of the T2DM -OW/OB subgroup was significantly lower than that of the NGR-OW/OB group （P 〈 0.05）. Partial correlation analysis showed that the serum omentin was negatively correlated to waist W, WHR, natural logarithm of HOMA-insulin resistance indexes [ In （HOMA-IR） ], triglycerides （TG）, BMI,fasting serum insulin （FINS）, and 2 hour OGTY glucose （2 hPG） （r = -0. 329, -0. 313, - 0. 301, - 0. 299, - 0.298, - 0.240, and - 0. 166 respectively,P 〈 0.01 or P 〈 0.05 ）, and positively correlated to high density lipoprotein- cholesterol （ HDL-C ） （ r = 0. 400, P 〈 0. 01 ）. Multiple linear regression showed that HDL-C, W and In （HOMA-IR） were independent variables of omentin. Conclusion The serum omentin level is low in the obese and type 2 diabetes mellitus subjects, and is correlated with obese indexes, insulin resistance and lipid metabolism. Serum omentin may directly contribute to the underlying pathophysiology of insulin resistance syndrome.