糖尿病足患者血清脂联素水平变化及其生理意义

Serum adiponectin level in patients with diabetic foot

目的研究糖尿病足患者血清脂联素水平的变化及其生理意义。方法选取2008年1月至2010年12月于上海市第二人民医院内分泌科收治的糖尿病患者85例为研究对象，按照WHO糖尿病足诊断标准分为糖尿病足组（DF组）55例[其中男29例，女26例，平均年龄（68±11）岁]和糖尿病组（DM组）30例[其中男16例，女14例，平均年龄（65±11）岁]。以同期我院门诊的健康体检者30名（年龄、性别均匹配）为对照组（NC组）。测定身高、体重，计算体质指数（BMI），测定空腹血糖（FPG）、糖化血红蛋白（HbAlc）、高密度脂蛋白胆固醇（HDL—C）、超敏c反应蛋白（hsCRP）、24h尿白蛋白排泄率（UAER），测定肱动脉压和踝动脉压并计算踝肱指数（ABI），彩色多普勒超声检查颈动脉内中膜厚度（IMT）及下肢动脉病变。ELISA法测定血清脂联素水平。比较DM和DF组中他汀类调脂药的应用对脂联素水平的影响。方差齐性的正态分布资料采用单因素方差分析，方差不齐或非正态分布资料采用非参数检验（KruskM—WallisH检验），相关因素分析采用简单相关分析和逐步回归分析。结果DF组血清脂联素水平显著高于DM组，较NC组亦有升高趋势[（9．7±5．3）VS（5．4±2．8）VS（8．3±3．4）mg／L，F=8．65，P〈0．01]。在DF组中，随着UAER的增加，血清脂联素水平逐步升高[正常白蛋白尿组（6．0±1．7）mg／L，微量白蛋白尿组（9．0±3．4）mg／L，大量白蛋白尿组（11．7±4．4）mg／L；F=10．22，P〈0．01]。DF组中使用他汀类药物者血清脂联素水平较未使用者高，但差异无统计学意义[（10±6）VS（8±3）mg／L，t=-1．27，P〉0．05]。相关分析显示，糖尿病足患者血清脂联素水平与BMI、HbAlc呈显著负相关（r值分别为-0．314、-0．329，均P〈0．05），与UAER、IMT、HDL—C呈显著正相关（r值分别为0．401、0．360、0．441，均P〈0．05）。逐步回归分析显示，HDL—C、UAER为糖尿病足患者血清脂联素的独立影响因素。结论糖尿病足患者血清脂联素水平升高，HDL-C、UAER为血清脂联素水平的独立影响因素。

Objective To study the serum adiponectin level in diabetic foot patients and to analysis its biological mechanisms. Methods From January 2008 to December 2010, 85 patients with diabetes mellitus （DM） were enrolled, including 55 patients with diabetic foot （DF）（30 non-gangrenous cases and 25 gangrenous cases） and 30 without diabetic foot. Thirty age- and gender-matched healthy volunteers were served as controls. Clinical characteristics such as body mass index（ BMI）, fasting plasma glucose（ FPG）, glycosylated hemoglobin Alc （ HbAlc ）, high-density lipoprotein cholesterol （ HDL-C ）, high sensitive C-creaetive protein （hsCRP） , urinary albumin excretion rate （UAER） , ankle-brachial index （ ABI ） , and intima-media thickness （IMT）were recorded. Serum level of adiponectin was measured by ELISA. Influences of statins treatment on serum level of adiponectin were compared between DM and DF groups. Differences of means between groups were compared by One-way ANOVA. Correlations between serum adiponectin and other parameters were analyzed by Pearson＇ s correlation and multivariate stepwise regression. Results Serum adiponectin levels were higher in DF patients than DM patients and controls （（9.7±5.3）vs（5.4 ±2.8） and （8.3±3.4）mg/L,F =8.65, P 〈0.01）. In DF group, serum adiponeetin levels were increased in agreement with the exacerbation of albuminuria（ （6. 0 ± 1.7 ）vs （9. 0 ± 3.4） and （11.7 ±4.4 ）mg/L, F = 10. 22, P 〈 0. 01 ）. Serum adiponectin levels showed an increasing tendency bystatinsinDFgroup（（10±6） vs（8±3）mg/L, t= -1.27, P〉0.05）. In DF group, the correlation analysis indicated that adiponeetin level was negatively correlated with BMI （ r = - 0. 314 ） and HbA1 c （ r = - 0. 329 ）, while positively correlative with UAER （ r = 0. 401 ）, IMT （ r = 0. 360） and HDL-C （ r = 0. 441 ） （ all P 〈 0. 05 ） . In multivariate stepwise regression analysis, HDL-C and UAER were independent factors of serum adiponectin. Conclusion Serum adiponeetin level was significantly increased in DF patients. HDL-C and UAER may be independent factors of serum adiponeetin.