2型糖尿病患者血浆磷脂脂肪酸谱与胰岛素抵抗

Relationship between Plasma Phospholipid Fatty Acid Profile and Insulin Resistance in Type 2 Diabetics

目的研究2型糖尿病(T2DM)患者血浆磷脂脂肪酸谱与胰岛素抵抗(IR)之间的关系。方法选取浙江省沿海地区T2DM患者74例,采用气相色谱法测定血浆磷脂脂肪酸谱,胰岛素抵抗指数(HOMA-IR)评价IR,酶法测定血脂。结果(1)Spearman相关性分析显示空腹血糖(FPG)与C20:2n-6呈负相关;糖化血红蛋白(HbA1c)与C20:2n-6、C20:3n-6呈负相关;C肽与C14:0、C16:0、饱和脂肪酸(SFA)、腰臀比(WHR)、三酰甘油(TG)呈正相关,与C23:0、多不饱和脂肪酸(PUFA)、高密度脂蛋白胆固醇(HDL-C)呈负相关;空腹胰岛素(FINS)与C16:0、n-6/n-3、体质指数(BMI)、WHR、TG呈正相关,与C22:6n-3、n-3PUFA、HDL-C呈负相关;HOMA-IR与C16:0、总胆固醇(TC)、TG、低密度脂蛋白胆固醇(LDL-C)、BMI呈正相关;与HDL-C呈负相关。(2)以HOMA-IR为因变量,其相关因素为自变量进行多元逐步回归分析,去除变量间的交互影响,最终进入方程的变量分别是C16:0、TC、BMI,模型的总相关系数R为0.716。结论T2DM患者胰岛素敏感性受C16:0、TC、BMI的调节;升高血浆磷脂n-3PUFA、降低C16:0可能在一定程度上可改善胰岛素敏感性。

Objective To investigate the relationship between plasma phospholipid fatty acid profile and insulin resistance （IR） in patients with type 2 diabetes （T2DM）. Methods Totally 74 patients with T2DM from coastal areas of Zhejiang province were enrolled. Plasma phospholipid fatty acids were analyzed with capillary gas chromatography. Homeostasis model assessment （ HOMA - IR） was applied to assess the status of insulin resistance （IR）. Plasma lipids were measured by enzymatic assay. Results （1） Bivariate correlation analysis showed fasting plasma glucose （FPG） was negatively correlated with C20： 2n -6, HbAlc was negatively correlated with C20： 2n -6 and C20： 3n -6 ; C - peptide was positively correlated with C14 ： 0, C16： 0, saturated fatty acid （SFA）, waist hip ratio （WI-IR）, triglyceride （TG）, and negatively correlated with C23： 0, polyunsaturated fatty acid （ PUFA）, high - density lipoprotein cholesterol （ HDL - C ）. Fasting insulin （FINS） was positively correlated with C16 ： 0, n - 6/n - 3, Body mass index （ BMI）, WHR and TG, and negatively correlated with C22 ： 6n - 3, n - 3PUFA and HDL - C. I-IOMA - IR was positively correlated with C16 ： 0, BMI, total cholesterol （TC）, TG and Low - density lipoprotein cholesterol （ LDL - C）, and negatively correlated with HDL - C. （2） In the multiple regression analysis （ Stepwise regression）, the HOMA -IR was predicated significantly only by C16： 0, BMI and TC; and the general correlation coefficient was 0. 716. Conclusion In patients with T2DM the insulin sensitivity is modulated by C16： 0, BMI and TC; Increasing plasma phospholipid n -3 PUFA proportion and reducing C16：0 proportion may improve the insulin sensitivity.