不同糖代谢水平血清脂联素与胰岛素抵抗及血管舒张功能相关性研究

Study of the correlation between vascular dilation function and insulin resistance as well as serum adiponectin in patients with different rates of glucose metabolism

目的研究不同糖代谢水平人群的血清脂联素与胰岛素抵抗、血管舒张功能的相关性。方法体检人群中经口服葡萄糖耐量试验（OGTT）筛选出糖耐量正常（NGT）17例，空腹血糖调节受损（1FG）22例，糖耐量受损（IGT）23例、2型糖尿病（T2DM）21例，检测血清脂联素（APN）水平；用HOMA—IR和I-IOMA—B指数分别评价胰岛素抵抗指数、B细胞功能指数；采用高分辨率血管外超声检测血流介导的内皮依赖性血管舒张功能（EDVD）和硝酸甘油介导的内皮非依赖性血管舒张功能（EIVD）。结果在NGT，IFG，IGT，DM组，APN和EDVD水平依次降低；HOMA-IR逐渐增高。校正了年龄、性别、体质量指数、腰臀比后，APN与HOMA—IR呈负相关（r=-0．353，P〈0．01），与EDVD和EIVD呈正相关（r分别为0．391，0．375，P〈0．01），APN与HOMA—B无关（P〉0．05）；EDVD与HOMA—IR无关（P〉0．05）。多元逐步回归分析以APN为应变量，HOMA—IR进入方程（P〈0．01）；以EDVD为应变量，APN进人方程（P〈0．05）HOMA—IR未进入方程。结论T2DM前期已经存在APN降低、胰岛素抵抗、血管内皮功能损害。APN与胰岛素抵抗负相关；与血管内皮功能正相关。APN与内皮依赖性血管舒张功能的关系独立于胰岛素抵抗。

Objective To study the correlation between serum adiponectin along with insulin resist- ance and vascular dilation function in patients with different rates of glucose metabolism. Method A total of 83 patients aged 50- 65 years, including 17 with normal glucose tolerance （NGT）, 22 with impaired fasting glucose （IFG）, 23 with impaired glucose tolerance （IGT） and 21 with diabetes （DM） were en- rolled. Serum adiponectin was measured, and homeostasis model assessment for insulin resistance index （HOMA-IR） and B cell function index were used to evaluate the function of insulin secretion before and during oral glucose tolerance test （OGTT）. The brachial artery responses to flow-mediated endothelium-dependent vascular dilation （EDVD） and nitroglycerin-mediated vascular dilation （EIVD） were evaluated by using the vascular ultrasound with high resolution. Results The serum adiponectin and EDVD decreased that the degrees of reduction from slightness to greatness were in turn from NGT, IFG, IGT to DM, whereas, the in- sulin resistance index （HOMA-IR） increased just in reverse order. Adiponectin was negatively associated with HOMA-IR （r=-0. 353, P 〈 0.01 ） but positively associated with EDVD and EIVD（r1 = 0. 391, r2 = 0. 375, P 〈0.01）, and was not associated with HOMA-B. On the other hand, EDVD was not associated with HOMA-IR （ P 〉 0.05 ）. In a multiple regression analysis with a stepwise manner to predict adiponectin concentration and EDVD, HOMA-IR was supposed to predict adiponectin concentration. Meanwhile APN but not HOMA-IR was used to predict EDVD （P 〈 0.05）. Conclusions The decrease in serum adiponec- tin, endothelial dysfunction and insulin resistance can be observed in the early stage of impaired glucose me- tabolism. Serum adiponectin concentration appears to be associated with vascular function and insulin resistance. The association between serum adiponectin concentration and vascular function seems to be independence from its link with insulin resistance index.