血清脂联素、同型半胱氨酸、超敏C反应蛋白、胰岛素抵抗与2型糖尿病大血管病变关系的研究

Study on Correlation of Serum Adiponectin, Homocysteine, High Sensitive C Reactive Proteinand Insulin Resistance with Macroangiopathy in Type 2 Diabetes Mellitus

【目的】探讨血清脂联素（APN）、同型半胱氨^（tHcy）、超敏C反应蛋白（hsCRP）、稳态模型评估的胰岛素抵抗指数（Homa-IR）与2型糖尿病（T2DM）大血管病变的关系。【方法】将受试者分为对照组、T2DM无血管病变组（DMl组，”=45）和大血管病变组（DM2，n一65）。测定血清APN、t-Hcy、hsCRP及相关指标，计算Homa-IR。【结果】①单因素方差分析显示，DM2组病程、腰围（wc）、空腹血糖（FPG）、餐后2h血糖（2hPG）、糖化血红蛋白（HbAIC）、Homa-IR、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、tHcy、hs—CRP等指标均显著高于DMl和对照组，而APN却显著低于其他两组（Pd0．05）。②多元逐步回归分析表明WC（R。一～0．37）、HOMA_IR（R。一一0．49）、hs—CRP（R。一一0．37）、tHey（R。一一0．21）是影响APN的重要因素（P〈O．05）。③Logistic回归分析显示血清APN、tHcy、hsCRP和HOMA．IR水平增高是糖尿病大血管病变的独立的危险因素。【结论】APN、tHcy、hsCRP、HOMA-IR参与了糖尿病大血管并发症的发生。APN可能通过减少炎症因子表达，减轻胰岛素抵抗，从而防治糖尿病大血管并发症的发生。

[Objective]To explore the correlation of serum adiponectin（APN）, homocysteine（tHcy）, high sensitive C reactive protein（hs-CRP）, homeostasis model assessment of insulin resistance index（HOMA-IR） with macroangiopathy in type 2 diabetes mellitus（T2DM）. [Methods] All subjects were divided into control group, T2DM without macroangiopathy group（DM1 group） and T2DM with macroangiopathy group（DM2 group）. Serum APN, tHcy, hs-CRP and other factors were measured. HOMA-IR was calculated. [Results] Univariate ANOVA showed that disease course, waist circumference（WC）, FPG, 2hPG, HbA1C, HOMA- IR, TG, LDL-C, Hcy and hs-CRP in DM2 group were significantly higher than those in DM1 group and con- trol group, while APN in DM2 group was significantly lower than that in other two groups（ P d0.05） . Mul- tiple stepwise regression analysis showed that WC（R2 = --0.37）, HOMA-IR（R2 =--0.49）, hs-CRP（Rz = -- 0.37） and tHcy（R2 = --0.21） were the important factors affecting the level of APN（ P d0.05）. Logistic re- gression analysis showed that the increasing of serum APN, tHcy, hs-CRP and HOMA-IR were the independ- ent risk factors of macroangiopathy in T2DM. [Conclusion] APN, t-Hcy, hs-CRP and HOMA-IR participate in the pathogenesis of diabetic macrovascular complications. APN may prevent the incidence of macrovascular complications in T2DM through reducing the inflammatory factors and decreasing IR.