伴微量白蛋白尿的初诊2型糖尿病患者血清脂联素水平及影响因素

The level and influential factors of serum adiponectin in newly diagnosed type 2 diabetic patients with microalbuminuria

目的探讨伴有微量白蛋白尿的初诊2型糖尿病患者血清脂联素水平的变化及相关影响因素。方法病例组选择符合1999年WHO糖尿病诊断标准的初诊2型糖尿病患者60例,按尿白蛋白排泄率(UAER)分为单纯糖尿病组(DM组)和糖尿病伴微量白蛋白尿组(DM+UAER组),采用ELISA法检测血清脂联素水平,并分别观察体重指数(BMI)、腰臀比(WHR)、血糖、血脂、胰岛素抵抗指数(HOMA-IR)等因素与血清脂联素之间的关系。正常对照组(NC组)选择30例健康体检者。根据体重指数(BMI)再将三组分别分为非肥胖亚组(Ⅰ)和肥胖亚组(Ⅱ),进一步观察肥胖对血清脂联素的影响。结果①糖尿病两组中血清脂联素水平均低于正常对照组(P<0.01),DM+UAER组脂联素显著低于DM组(P<0.05)。②糖尿病两组中肥胖亚组血清脂联素水平均低于同组非肥胖亚组(P<0.01);三组间相同BMI水平脂联素比较;肥胖亚组脂联素水平依次降低,差异有统计学意义(P<0.01),非肥胖亚组脂联素水平也依次降低,但差异无统计学意义(P>0.05)。③Pearson相关分析显示,脂联素与BMI、WHR、HOMA-IR、UAER、空腹血糖(FPG)、餐后2h血糖(2hPG)、甘油三酯(TG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、空腹C肽(FCPS)呈负相关,与高密度脂蛋白(HDL)呈正相关;多元逐步回归分析结果显示,脂联素与BMI、HbA1c、TG独立相关。结论①初诊2型糖尿病患者血清脂联素明显低于正常人,在伴有微量白蛋白尿时血清脂联素水平更低。②血清脂联素水平受肥胖程度和类型(中心型肥胖)影响,与血糖代谢、甘油三脂水平、胰岛素抵抗程度及尿蛋白的排泄呈负相关关系,与高密度脂蛋白呈现正相关关系。

Objective To explore the difference and influential factors of serum adiponectin in newly diagnosed type 2 diabetic patients with microalbuminuria.Methods Sixty newly diagnosed type 2 diabetic patients were included in the present study,and divided into simple diabetic group（DM group） and diabetic group with microalbuminuria（DM＋UAER group） according to urinary albumin excretion rate（UAER）,thirty normal healthy people for control（NC group）.Serum adiponectin was measured by ELISA,and the relationship among the body mass index（BMI）,waist hip ratio（WHR）,plasma glucose,blood lipid and homeostasis model assessment-insulin resistance index（HOMA-IR） and serum adiponectin were observed.According to BMI,the patients were divided into three groups of non-obese subgroups（Ⅰ） obesity subgroups（Ⅱ）,and further observed obesity on serum adiponectin impact.Results Compared with normal control group,the level of serum adiponectin was significantly lower in type 2 diabetes mellitus group（P0.01）.Besides,the level of serum adiponectin was significantly lower in DM＋UAER group than that in DM group（P0.05）;the level of serum adiponectin was significantly lower in diabetic patients with obesity subgroup than those in non-obese subgroup（P0.01）.Among the normal control group,DM group and DM＋UAER group,the decline of serum adiponectin levels was more clearly in obesity subgroup than non-obese subgroup（P0.01）;Pearson correlation analysis indicated that serum adiponectin was negatively with BMI,WHR,HOMA-IR,UAER,fast plasma glucose（FPG）,2-hour plasma glucose（2hPG）,glycated haemoglobin（HbA1c）,triglycerides（TG）,fasting plasma insulin（FINS）,fasting plasma C-peptide（FCPS）,and positively with high density lipoprotein（HDL）.The results of multi-factors stepwise regression analysis show there were an independent correlation between serum adiponectin and BMI,HbA1c,TG.Conclusion Serum adiponectin concentrations are decreased in newly diagnosed type 2 diabetic patients,when accompanied microalbuminuria,the level of serum adiponectin even lower;The degree and type（central obesity） of obesity influenced serum adiponectin levels,and serum adiponectin was negatively with glycometabolism,triglycerides levels,the degree of insulin resistance and urinary albumin excretion,positively with high density lipoprotein levels.