初诊2型糖尿病合并高血压患者血清脂联素和改良稳态模型评估法计算的胰岛素抵抗指数的变化及相关性

The changes and relationship of serum adiponectin and homeostasis model assessment-2 of insulin resistance in newly-diagnosed type 2diabetic patients accompanied with hypertension

目的探讨初诊的2型糖尿病合并高血压患者血清脂联素、改良稳态模型评估法计算的胰岛素抵抗指数(HOMA2-IR)的变化。方法收集正常对照组31人、初诊原发性高血压(HT组)41例、初诊2型糖尿病(DM组)46例、初诊2型糖尿病合并高血压(DMHT组)45例的资料,测定其血清脂联素、空腹血糖、空腹胰岛素(FINS)及其他各代谢指标,并计算HOMA2-IR。结果 DMHT组的HOMA2-IR高于DM组、HT组及正常对照组(3.49±2.01比2.10±1.33、1.53±0.65、0.66±0.19,均P<0.01)。DMHT组的血清脂联素低于DM组、HT组及正常对照组[(2.24±0.87)比(2.82±1.24)、(3.74±1.50)和(5.59±1.95)mg/L,均P<0.05]。Pearson相关分析表明,脂联素与HOMA2-IR、空腹血糖、体质量指数(BMI)、FINS、餐后血糖、糖化血红蛋白(HbA1c)、三酰甘油、收缩压、舒张压、脉压呈负相关(均P<0.01)。多元逐步线性回归分析表明,BMI、餐后2h血糖、收缩压、三酰甘油、FINS、HbA1c和HOMA2-IR为血清脂联素的独立影响因素(P<0.01)。结论 2型糖尿病合并高血压患者存在更严重的胰岛素抵抗和更低的脂联素水平。HOMA2-IR、血糖、血脂、血压、肥胖等因素与脂联素的变化密切相关。

Objective To investigate the changes of serum adiponectin and homeostasis model assessment-2 of insu- lin resistance （HOMA2-IR） and their relationship in newly-diagnosed type 2 diabetic patients accompanied with hy pertension. Methods Healthy controls （ control group, n= 31 ）, newly-diagnosed hypertensive patients without di abetes （ HT group, n = 41 ）, newly-diagnosed type 2 diabetic patients without hypertension （DM group, n = 46 ）, and newly-diagnosed type 2 diabetic patients accompanied with hypertension （DMHT group, n = 45） were recruited. Fasting plasma glucose I FPG）, fasting insulin （FINS）, serum adiponectin and other metabolic biomarkers were de- termined. HOMA2-IR was calculated as the index of insulin resistance. Results HOMA2-IR was significantly higher in DMHT group than inDM, HT and control group （3.49±2.01 vs 2. 10±1.33, 1.53±0.65 and 0.664. 0.19, respectively, all P〈0.01 ）. By contrast, serum adiponectin levels were significantly lower in DMHT group than inDM, HT and control groups [（2.24±0.87） vs （2.82±1.24）, （3.74±1.50） and （5.59±1.95） mg/l., respectively, all P〈0.05]. Pearson correlation analyses showed that serum adiponectin was negatively associated with HOMA2-IR, FPG, body mass index （BMI）, FINS, 2 hour postprandial plasma glucose （PPG）, hemoglobin Alc（HbAle）, triglycide （TG）, systolic blood pressure （SBP）, diastolic blood pressure （DBP） and pulse pressure （PP） Call P〈0.01）. Multiple regression analyses revealed that BMI, PPG, SBP, TG, FINS, HbAle and HOMA2-IR were independent risk factors for serum adiponectin （all P〈0.01）. Conclusion Type 2 diabetic pa tients with hypertension had more severe insulin resistance and lower serum adiponectin than those without. In ad- dition, HOMA2 IR, serum glucose, lipids, blood pressure and obesity are closely related with the changes of serum adiponectin.