不同糖耐量人群血清nesfatin-1水平及相关因素分析

The correlation of serum nesfatin-1 level in individuals with different glucose tolerance

目的研究不同糖耐量人群血清nesfatin-1水平变化，及其与体重指数（BMI）、血糖、胰岛素敏感性等的关系。方法115例研究对象分为正常糖耐量组（NGT组，33例）、糖耐量减低组（IGT组，30例）和新诊2型糖尿病组（T2DM组，52例）3组。根据BMI将T2DM组分为糖尿病肥胖组（T2DM—OB组，22例）和糖尿病正常体重组（T2DM—NW组，30例）。采用ELISA法检测血清nesfatin-l水平。同时测定空腹血糖（FPG）、餐后2h血糖（2hPG）、白细胞介素-6（IL-6）、胰岛素、糖化血红蛋白A1C（HbAlC）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白一胆固醇（LDL—C）、高密度脂蛋白一胆固醇（HDL—C）。T2DM-OB组给予吡格列酮治疗，使仅BMI高于T2DM—NW组（P〈0．05）后再次检测血清nesfatin—l水平。计算稳态模型评估一胰岛素抵抗指数（HOMA—IR）、BMI、腰臀比（WHR）等。结果（1）T2DM组和IGT组血清nesfatin-1水平显著高于NGT组[（1780±660）ng／L，（1620±590）ng／Lw．（1390±610）ng／L，P〈0．05]。（2）T2DM—OB组血清nesfatin-1水平显著高于T2DM—NW组[（1897±670）ng／LUS．（1690±650）ng／L，P〈0．05]，经吡格列酮治疗后T2DM—OB组nesfatin-1水平仍高于T2DM．NW组[（1791±634）ng／LYS．（1690±650）ng／L，P〈0．05]。（3）Nesfatin-1水平与TG、FPG、2hPG、HbAlc、IL-6、HOMA—IR、BMI呈正相关（r=0．582，0．568，0．587，0．552，0．546，0．523，0．562）。多元逐步回归分析显示，HOMA—IR、FPG、BMI与血清nesfatin-1水平独立相关。结论随着糖耐量受损程度的加重及肥胖的发生，nesfatin-1水平逐渐升高，nesfatin-1可能在肥胖及糖耐量受损中发挥重要作用。

Objective To investigate changes of serum nesfatin level in individuals with different glucose tolerance, and its relationship with body mass index （BMI） , plasma glucose, insulin sensitivity, etc. Methods 115 subjects were divided into three groups：normal glucose tolerance group （NGT group, n = 33 ）, impaired glucose tolerance group（ IGT group, n = 30 ）and newly diagnosed type 2 diabetes group（ T2DM group,n = 52）. According to the BMI, T2DM group was divided into T2DM with obesity group （T2DM-OB group, n = 22） and T2DM with normal body weight group （T2DM-NW group, n = 30 ）. The serum nesfatin-1 level were measured by ELISA. Fasting plasma glucose （FPG） ,2 h postprandial blood glucose （2 h PG） , in- terleukin-6 （ IL-6 ）, insulin, hemoglobin A1 c （ HbA1 c ）, total cholesterol （ TC ）, triglyceride （ TG）, high density lipoprotein-eholesterol （ HDL-C ）, low density lipoprotein-eholesterol （ LDL-C ） were also measured. T2 DM-OB group were given pioglitazone. After only BMI was higher than that in T2DM-NW group （P 〈 0.05 ）, then nes- fatin-1 level was measured. The homeostasis model assessment-insulin resistance （ HOMA-IR ） , BMI were calculated as well. Results （ 1 ） The serum nesfatin-1 levels in T2DM group and IGT group were significant- ly higher than that in NGT group（ P 〈 0.05 ） [ （ 1 780 ± 660 ） ng/L, （ 1 620± 590 ） ng/L vs. （ 1 390 ± 610 ） ng/L,P 〈 0.05 ]. （2）The serum nesfatin-1 level in T2DM-OB group was significantly higher than that in T2DM-NW group [ （ 1897 ± 670） ng/L vs. （ 1 690 ± 650） ng/L, P 〈 0.051. After treated with pioglitazone, the serum nesfatin-1 level in T2DM-OB group was significantly higher than that in T2DM-NW group[ （ 1 791 ± 634） ng/L vs. （ 1 690 ± 650） ng/L,P 〈 0.05 ]. （ 3 ） Nesfatin-1 level was positively correlated with TG, FPG,2 h PG,HbAlc,IL-6, HOMA-IR,BMI（r =0. 582,0. 568,0. 587,0. 552,0. 546,0. 523,0. 562）. Multiple stepwise linear regression analysis showed that HOMA-IR, FPG and BMI were independently associated with serum nesfatin-1 level. Conclusion With the occurrence and aggravation of IGT and obesity,nesfatin-1 level increased, and nesfatin-1 may play a protective role in obesity and IGT.