2型糖尿病患者硒蛋白P和胰岛素抵抗的相关性

Selenoprotein P in type 2 diabetes mellitus and its association with insulin resistance

目的：研究健康人和2型糖尿病患者中硒蛋白P （ SEPP ）和胰岛素抵抗的相关性。方法入组门诊初发2型糖尿病患者156例和64名健康人作为对照，测定空腹血糖（ FPG）、空腹胰岛素（ FIN）、血脂谱、SEPP 水平，记录身高、体重和血压，采用稳态模型评估胰岛素抵抗指数（HOMA-IR）和计算胰岛素敏感性指数（ISI）。结果（1）肥胖和非肥胖糖尿病组的SEPP水平均显著高于对照组[（4.43±1.95）、（3.01±1.20）比（2.34±2.30）mmol/L，均P＜0.01]，肥胖糖尿病组的SEPP水平高于非肥胖糖尿病组（均P＜0.05）。（2）在总队列人群中SEPP水平和FIN、FPG、体质指数（BMI）、甘油三酯（TG）和HOMA-IR呈正相关（r＝0.401、0.202、0.420、0.239、0.445，均P＜0.05）和ISI呈负相关（r＝-0.414，P＜0.01）。（3）多元逐步回归分析显示，影响胰岛素抵抗的主要因素为SEPP水平（β＝0.293，P＜0.01）。影响ISI的主要因素为收缩压、HbA1c和SEPP水平（β＝-0.195、-0.185、-0.246，均P＜0.05）。结论血清SEPP水平不受年龄、血压、血脂等影响，是胰岛素抵抗的独立影响因素。

Objective To explore the relationship between selenoprotein P （ SEPP ） and insulin resistance in subjects with normal glucose tolerance and type 2 diabetes mellitus .Methods A total of 156 subjects with newly onset diabetes and 64 subjects with normal glucose tolerance were enrolled .Fasting plasma glucose （ FPG ） , fasting insulin （ FIN ） , lipid profile and SEPP level were measured and height , weight and blood pressure were recorded.Insulin resistance index was calculated by homeostatic model assessment （ HOMA-IR）.Results The SEPP level was significantly higher in obese and non-obese diabetic groups than control group （（4.43 ±1.95）, （3.01 ±1.20） vs （2.34 ±2.30）mmol/L, both P〈0.01）.The SEPP level was significantly higher in obese subgroup of diabetic group than non -obese subgroup （ P〈0.05）.The SEPP level was positively correlated with FIN , FPG, body mass index （BMI）, triglycerides （TG） and HOMA-IR （r=0.401, 0.202, 0.420, 0.239, 0.445, P〈0.05） and negatively with ISI （r=-0.414, P 〈0.01 ）.Multivariate regression analysis demonstrated that SEPP level was independently correlated with insulin resistance （β=0.293, P〈0.01）.And the independent factors for ISI were systolic pressure, HbA1c and SEPP level （β=-0.195, -0.185 and -0.246, P〈0.05）.Conclusion Serum SEPP level may be an independent risk factor for insulin resistance regardless of age , blood pressure or lipid profile.