2型糖尿病患者中脂联素和腹腔脂肪型丝氨酸蛋白酶抑制剂vaspin的水平及与胰岛素抵抗的关系

Adiponectin,vaspin and insulin resistance in patients with type 2 diabetes:a correlation study

目的观察2型糖尿病患者中脂联素、vaspin与胰岛素抵抗的关系。方法通过260例初诊2型糖尿病患者(126例男性、134例女性)和260名健康成年人研究脂联素、vaspin和肥胖、胰岛素抵抗的关系。非参数Spearman相关和多元回归分析观察脂联素、vaspin和胰岛素抵抗、肥胖、代谢变量的关系。结果 2型糖尿病人群与健康人群相比血清脂联素水平降低,血清vaspin增高(P<0.05)。血清vaspin在女性中蛋白表达水平增高。vaspin与体质量指数(BMI)、腰围、腰臀比、甘油三酯、稳态评估模型指数(HOMA-IR)、高密度脂蛋白胆固醇和空腹胰岛素有明显的相关性(P<0.01),脂联素除了和收缩压、舒张压、空腹血糖无明显相关外,与其他参数都有相关性(P<0.05)。脂联素、vaspin作为因变量,性别、是否肥胖、是否敏感、腰围、甘油三酯、高密度脂蛋白为自变量的多元回归分析中,当控制其他变量影响后,超重(肥胖)BMI≥25kg/m2较非肥胖BMI<25kg/m2的患者有较高的vaspin和较低的脂联素。胰岛素敏感(HOMA<2)相对于胰岛素抵抗(HOMA≥2)时,有较低的vaspin水平,较高的脂联素水平。结论脂联素、vaspin和肥胖、胰岛素抵抗密切相关,vaspin参与了胰岛素抵抗的发生,为今后2型糖尿病的诊治提供了新的思路。

Objective To investigate the correlation between adiponectin or vaspin and insulin resistance in patients with type 2 diabetes.Methods A total of 260 patients initially diagnosed with type 2 diabetes （126 males and 134 females） and a cohort of matching healthy controls were recruited to investigate the correlation between adiponectin,vaspin,obesity and insulin resistance.The nonparametric Spearman correlation and multiple regression analysis were used to test the correlation between adiponectin,vaspin and insulin resistance,obesity and metabolic variables.Results Type 2 diabetic patients had a lower adiponectin level but a higher serum vaspin level （P〈0.05） as compared with the normal controls.The serum level of vaspin protein was elevated in females.Vaspin was significantly associated with weight index （WI）,waist circumference,waste to hip ratio （WHR）,triglyceride （TG）,HOMA-IR,high-density lipoprotein cholesterol （HDL） and fasting insulin （FINS） （P〈0.01）,while adiponectin was associated with other indexes except systolic blood pressure （SBP）,diastolic blood pressure and fasting blood glucose （FBG） （P〈0.05）.In the multiple regression analysis with adiponectin and vaspin assigned as dependent variables,and gender,obesity,sensitivity,waist circumference,triglyceride （TG） and high-density lipoprotein cholesterol （HDL） as independent variables,over-weight patients （obesity） with BMI≥25 had relatively higher level of vaspin but lower level of adiponectin as compared with the non-obese patients with BMIM25 after controlling for other variables.Compared with subjects with insulin resistance （HOMAM2）,those with insulin sensitivity （HOMA≥2） had relatively lower vaspin but higher adiponectin level.Conclusion Adiponectin and vaspin are closely associated with obesity and insulin resistance.Vaspin appears to be involved in the development of insulin resistance,which may provide a new clue for diagnosis of type 2 diabetes in the future.