糖尿病肥胖及非肥胖患者影响糖化血红蛋白的因素不同

Different Risk Factors for Hemoglobin Alc in Obesity and Nonobesity Diabetic Patients

目的研究糖尿病肥胖及非肥胖患者糖化血红蛋白(HbAlc)与糖脂代谢指标的相关性。方法收集121例2型糖尿病研究对象,以体质量指数(BMI)≥25 kg/m^2为肥胖症标准,分为糖尿病合并肥胖症组(DM-OB)57例,糖尿病非肥胖症组(DM-NOB)64例,比较 DM-OB 组及 DM-NOB 组年龄、BMI、HbAlc、收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、餐后2 h 血糖(PPG)、餐后血糖波动(PPGE)、胰岛素抵抗指数(HOMA-IR)、三酰甘油(TG)、胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、1/高密度脂蛋白胆固醇(1/HDL-C)、血清高敏 C 反应蛋白(hsCRP)差别;相关分析及多因素逐步回归分析 HbAlc 与以上指标的相关性。结果 DM-OB 组 HOMA-IR、BMI、DBP、TC、hsCRP、HbAlc、LDL-C 较 DM-NOB 组增高。在 DM-OB 组,Pearson 相关分析显示,HbAlc 与 BMI、FBG、FPG、HOMA2IR、hs-CRP 正相关(P 均<0.05);偏相关分析显示,控制 FBG、PPG、BMI 后,HbAlc 仍与 HO-MA2IR、hs-CRP 正相关(P 均<0.05);多因素逐步回归分析 HbAlc 与 FPG、HOMA2IR、hs-CRP 密切相关(P 均<0.01)。在 DM-NOB 组,Pearson 相关分析显示,HbAlc 与 PPG、PPGE 呈正相关(P 均<0.05);偏相关分析显示,在控制 PPEG 后,HbAlc 仍与 PPG 正相关(P<0.05);多因素逐步回归分析 HbAlc 与 PPG 密切相关(P<0.01)。结论2型糖尿病,胰岛素抵抗、亚临床炎症、高空腹血糖是影响肥胖患者 HbAlc 水平的主要因素;餐后血糖是影响非肥胖患者 HbAlc 水平的主要因素,提示应当研究不同的治疗措施治疗糖尿病合并肥胖与不合并肥胖的病人。

Objective To explore the underlying relationship between hyperglycemic factors in type 2 diabetes. Methods Fifty seven type 2 diabetes with obesity （DM-OB）and 64 without obesity（DM-NOB）were recruited. Age, body mass index（BMI）, hemoglobin Alc （ HhAlc）, homeostasis model assessment-2 insulin resistance （ HO- MA-IR）, high-sensitivity C-reactive protein（hsCRP）, fasting plasma glucose, postprandial plasma glucose（PPG）, postprandial glucose excursion（PPGE）, lipid profile, blood pressure were determined. Results DM-OB subjects had significantly higher HOMA-IR, BMI, DBP, TC, hsCRP, HhAlc, LDL-C when compared with DM-NOB subjects. Pearson correlation analysis, in DM-OB subjects, BMI, FBG, FPG, HOMA-IR, hs-CRP were all the positive relative factors（P all〈0.05）; adjustment for BMI, FBG, FPG in partial correlation, HOMA-IR, hs-CRP were still the positive relative factors（P all〈0.05）; in stepwise regression analysis, FPG, HOMA-IR, hs-CRP were the most important predictive factor for HhAlc（P all〈0.01 ）. On the other hand, in DM-NOB subjects, PPG, PPGE were both the positive relative factors（P all〈0.05）, adjustment for PPEG in partial correlation, PPG was still the positive relative factor（P〈0.05）, in stepwise regression analysis, PPG was the more important predictive factor for HhAlc（P〈0.01 ）. Conclusion In the DM-OB subjects, FPG, insulin resistent, subclinical inflammation factor were the most important risk factors for HhAlc, however, in DM-NOB subjects, it was PPG, suggesting research for different approaches in T2DM with or without obesity is warranted.