2型糖尿病一级亲属血清视黄醇结合蛋白4水平及其与代谢综合征的相关性

Serum levels of retinol-binding protein-4 and its association with metabolic syndrome in first-degree relatives of type 2 diabetes mellitus

目的测定不同糖代谢状态的2型糖尿病（T2DM）一级亲属血清视黄醇结合蛋白4（RBP-4）水平，探讨RBP-4在T2DM和代谢综合征（MS）发病中的作用及检测的意义。方法收集既往无糖尿病史的T2DM一级亲属糖耐量正常（NGT）组174例、空腹血糖受损（IFG）或糖耐量低减（IGT）组55例，以及新发T2DM71例，无糖尿病家族史的NGT114名作为正常对照组（NC）。放射免疫法测定血清RBP-4。用稳态模型指数（HOMA—IR）评价胰岛素抵抗状态。根据2005年国际糖尿病联盟共识诊断MS。结果（1）NC、NGT、IFG／IGT和T2DM组，血清RBP-4水平分别为（18±7）μg／ml、（22±8）μg／ml、（24±9）μg／ml和（26±9）μg／ml，与无家族史的NC相比，一级亲属NGT组血清RBP-4明显增加[（18±7）μg/ml比（22±8）μg/ml，P〈0．05]，并随糖调节异常程度的加重RBP-4水平进一步增加，但T2DM组与IGT／IFG组相比[（26±9）μg/ml比（24±9）μg/ml]差异无统计学意义。（2）以RBP-4水平四分位值分组（Q1-Q4）比较：高浓度血清RBP-4水平不仅与糖调节异常密切相关（Q4／Q1OR值为5．26），而且与高血压（OR：1．96）、血脂异常（OR：4．14）和肥胖（OR：2．18）以及MS（OR：4．30）相关。结论（1）T2DM一级亲属在糖耐量异常发生前，RBP-4水平明显升高，并随糖调节异常程度加重而进一步升高，提示RBP-4与T2DM的早期发病进程密切相关；（2）RBP-4与代谢综合征关系密切。

Objective To evaluate serum levels of retinol-binding protein-4 （RBP-4） in firstdegree relatives （FDR） of type 2 diabetes mellitus （T2DM） with different glucose tolerance status and to observe its correlation to metabolic syndrome （MS）. Methods Subjects from FDR of T2DM, including 174 with NGT, 55 with IGT/IFG, and 71 patients with newly diagnosed of T2DM and 114 subjects without diabetic family history as control group [ （ 18 ± 7 ） μg/ml vs （ 22 ± 8 ） μg/ml, （ NC ） [ （ 18 ± 7 ）μg/ml vs （ 22 ± 8 ） μg/ml, were recruited. Serum RBP-4 level was measured by radioimmunoassay. Insulin resistance was evaluated by the homeostasis model assessment （HOMA-IR）. MS was diagnosed according to 2005 IDF consensus. Results （1） Serum RBP-4 levels in NC, NGT, IFG/IGT and T2DM groups were （18 ±7）, （22±8）, （24 ± 9） and （26 ± 9 ）trg/ml respectively. Serum RBP-4 was significantly elevated in NGT group of diabetic FDR as compared with NC group [ （26 ±9）μg/ml vs（24 ±9）μg/ml] , and increased with the severity of glucose intolerance. However, no difference was found between serum RBP-4 in the IFG/IGT and T2DM groups. （2） When the distribution of RBP-4 was stratified into quartiles （Q1-Q4）, subjects in the top quartile （Q4） was not only associated with greater risk for impaired glucose regulation as compared with Q1 OR =5.26）, but also significantly with risk for hypertension （ OR = 1.96）, dyslipidemia （ OR =4. 14）, obesity （ OR = 2.18） and MS （ OR = 4.30）. Conclusion （ 1 ） Serum RBP-4 levels in FDR of T2DM were elevated significantly even before the development of impaired glucose regulation and were further increased with severity of glucose tolerance, suggesting a possible role of RBP-4 in the early pathogenesis of T2DM. （2）Serum RBP-4 level was closely related to MS.