2型糖尿病患者血清炎症因子和脂联素水平与动脉粥样硬化的关系

The Relationship Between Serum Levels of Inflammatory Factors,Adiponectin and Atherosclerosis in the Patients with Type 2 Diabetes Mellitus

目的探讨2型糖尿病患者血清炎症因子和脂联素水平与动脉粥样硬化的关系。方法将125例2型糖尿病患者根据颈动脉内膜中膜厚度分为非动脉粥样硬化组(n=65)和动脉粥样硬化组(n=60),并配对选取30例健康者为对照组。收集临床资料,检测空腹血糖、糖化血红蛋白、空腹胰岛素、餐后2 h血糖、血脂谱等生化指标,并测定血清脂联素、细胞间黏附分子1、肿瘤坏死因子α和高敏C反应蛋白水平。计算稳态模型评估的胰岛素抵抗指数。结果糖尿病患者血清总胆固醇、甘油三酯、低密度脂蛋白胆固醇、空腹血糖、餐后2 h血糖和糖化血红蛋白水平均高于对照组(P<0.05),糖尿病动脉粥样硬化组血甘油三酯和低密度脂蛋白胆固醇水平高于糖尿病非动脉粥样硬化组(P<0.05),糖尿病动脉粥样硬化组血清肿瘤坏死因子α和高敏C反应蛋白水平、胰岛素抵抗指数均高于非动脉粥样硬化组及对照组,而糖尿病动脉粥样硬化组血清脂联素水平低于非动脉粥样硬化组及对照组(P<0.05)。相关性分析显示,血清脂联素水平与内膜中膜厚度、细胞间黏附分子1、肿瘤坏死因子α、高敏C反应蛋白和胰岛素抵抗指数之间呈负相关(r值分别为-0.574、-0.635、-0.681、-0.768及-0.752,P<0.01),胰岛素抵抗指数与细胞间黏附分子1、肿瘤坏死因子α、高敏C反应蛋白之间呈正相关(r值分别为0.657、0.706及0.688,P<0.01)。多元回归分析显示甘油三酯、低密度脂蛋白胆固醇和胰岛素抵抗指数是2型糖尿病患者合并动脉粥样硬化的危险因素。结论炎症因子和脂联素参与了糖尿病血管并发症的发生,而脂联素可能通过拮抗炎症反应减轻胰岛素抵抗,延缓糖尿病动脉粥样硬化的发生。

Aim To investigate the relationship between serum levels of inflammatory factors,adiponectin and atherosclerosis in the patients with type 2 diabetic mellitus（T2DM）. Methods 125 cases of T2DM patients were divided into two groups according to the carotid intima-media thickness（IMT） as follows： 65 cases of non-atherosclerotic diabetic patients and 60 cases of atherosclerotic diabetic patients.30 non-diabetic subjects were recruited as normal control.The clinical characteristics were collected for each patient.Serum fasting plasma glucose（FPG）,glycation hemoglobin A1c（GHbA1c）,fasting insulin（FINS） 2 hours postprandic plasma glucose（2hPG）,lipid profiles levels were measured.Serum levels of adiponectin,intercellular adhesion molecule-1（ICAM-1）,tumor necrosis factor-α（TNF-α） and high sensitive C-reactive protein（hs-CRP） were also detected.Insulin resistance index（HOMA-IR） was calculated. Results The serum levels of total cholesterol,triglyceride（TG）,low density lipoprotein cholesterol（LDLC）,FPG,2hPG and GHbA1c were significantly higher in the T2DM group than that of normal control group（P0.05）.And the serum levels of TG and LDLC were higher in atherosclerotic T2DM patients than that of non-atherosclerotic T2DM patients（P0.05）.The serum levels of TNF-α and hs-CRP and HOMA-IR in atherosclerotic patients were significantly higher than that of in non-atherosclerotic and normal control group（P0.05）.However,serum adiponectin level in arteriosclerotic group was lower than that of other two groups（P0.05）.There were negative correlation between adiponecin and IMT,ICAM-1,TNF-α,hs-CRP and HOMA-IR（r=-0.574,-0.635,-0.681,-0.768 and-0.752,P0.01）.There were positive correlation between HOMA-IR and ICAM-1,TNF-α and hs-CRP（r=0.657,0.706 and 0.688,P0.01）.TG,LDLC and HOMA-IR were risk factors of T2DM complicated with arteriosclerosis according to multiple regression analysis. Conclusion Inflammatory factors and adiponectin are involved in the pathogenesis of diabetic vascular complications.The protective effects of adiponectin may be performed through its anti-inflammation to improve insulin resistance and delay the development of atherosclerosis.