糖尿病脂肪肝患者visfatin与胰岛素抵抗关系的研究

The Study of Relationship between Visfatin and Insulin Resistance in Patients of Type 2 Diabetes Mellitus with Nonalcoholic Fatty Liver Disease

目的:探讨2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)患者血浆visfatin与胰岛素抵抗等相关代谢指标的关系。方法:采用酶联免疫吸附法(ELISA)检测T2DM合并NAFLD组(A组)、T2DM不合并NAFLD组(B组)以及正常对照组(NC组)的血浆visfatin水平,同时测定各组血糖、血脂、糖化血红蛋白、空腹胰岛素、肝功能,计算腰臀比(WHR)、体质量指数(BMI),稳态模型胰岛素抵抗指数(HOMA-IR),分析上述各指标与visfatin的关系。结果:(1)A组和B组的血浆visfatin水平均显著高于NC组(P<0.05或P<0.01)。(2)直线相关分析显示,A组血浆visfatin水平与HOMA-IR、FIns、P2hBG呈正相关(r分别为0.409、0.344、0.448,P<0.01),B组血浆visfatin水平与HOMA-IR、FIns、FBG、P2hBG、LDL-C呈正相关(r分别为0.704、0.520、0.453、0.362、0.314,P<0.05)。(3)多元逐步回归分析表明HOMA-IR、P2hBG、LDL-C分别是血浆visfatin水平的影响因素。结论:血浆visfatin水平与机体的胰岛素敏感性有关,并可能通过这一机制影响T2DM及NAFLD的发生发展。

Objective： To investigate the relationship between the plasma visfatin and the other indexes in patients of type 2 diabetes mellitus（T2DM） with nonalcoholic fatty liver disease （NAFLD）. Methods： The level of plasma visfatin was assayed by enzyme-linked immunosorbent assay （ELISA） in all subjects, patients of T2DM with NAFLD （group A）, T2DM without NAFLD （group B） and nomal group （group NC）. The relationship was analyzed between plasma visfatin and blood glucose, blood lipids, glycosylated hemoglobin（HbA1c）, fasting insulin（FIns）, liver function, waist-to-hip ratio（WHR）, body mass index（BMI） and homeostasis model assessment of insulin resistance （HOMA-IR）. Results： The levels of plasma visfatin were significantly increased in group A and B compared with that of group NC（P 0.05 or P 0.01）. The correlation analysis showed that the level of plasma visfatin was positively correlated with HOMA-IR, FIns and 2 h postprandial blood glucose （P2hBG） in group A （P 0.01）, meanwhile, it was positively correlated with HOMA-IR, FIns, FBG, P2hBG and low density lipoprotein-cholesterol （LDL-C） in group B （P 0.05）. Multiple regression analysis showed that HOMA-IR, P2hBG and LDL-C were the independent related factors in influencing plasma visfatin level. Conclusion： The level of plasma visfatin is associated with the sensitivity of insulin, which may contribute, in part, to the pathogenesis of type 2 diabetes mellitus and nonalcoholic fatty liver.