2型糖尿病患者血清Irisin和Vaspin水平与代谢综合征临床表型的关系

Associaiton of irisin and vaspin with clinical presentations of metabolic syndrome in patients with type 2diabetes mellitus

目的 在2型糖尿病（T2DM）患者中，观察合并代谢综合征（MS）患者血清Irisin、内脏脂肪特异性丝氨酸蛋白酶抑制剂（Vaspin）及活性氧（ROS）水平的变化，并分析Irisin和Vaspin与MS临床表型的相关性。方法 收集T2DM患者260例，测定其一般人体测量指标、生化指标、血清Irisin、Vaspin及ROS水平，计算稳态模型胰岛素抵抗指数（HOMA-IR）。分别采用Wilcoxon秩和检验、相关性分析、Logistic回归、多元线性回归、受试者工作特征（ROC）曲线进行统计学分析。结果 T2DM患者中，伴有MS的患者血清Irisin水平较不伴MS的患者降低［男性：112.81（86.96-191.84）μg/L比156.23（110.61-225.97）μg/L， 女性：141.09（77.52-175.55）μg/L比172.15（95.69-240.37）μg/L，P＜0.01］，Vaspin和ROS水平升高［男性：1.13（0.95-1.38）μg/L比0.36（0.21-0.82）μg/L，1 540（1 250-1 860）kU/L比1 020（920-1 350）kU/L；女性：1.52（1.13-1.80）μg/L比0.51（0.47-1.08）μg/L，1 650（1 320-1 940）kU/L比1 120（980-1 420）kU/L，P＜0.01］。在T2DM患者中，血清Irisin水平与Vaspin水平呈负相关（r=－0.382，P＜0.01），与ROS呈负相关（r=－0.410，P＜0.01）；Vaspin水平与ROS水平呈正相关（r=0.400，P＜0.01）。多元线性回归分析表明，Irisin与体质量指数（BMI）、腰围和三酰甘油显著相关，Vaspin与性别、BMI和腰围之间具有相关性（P＜0.05）。Logistic回归分析显示Irisin、Vaspin、ROS均与MS具有相关性（Irisin：OR=0.77，95% CI 0.608～0.978；Vaspin：OR=1.39，95% CI 1.252～1.539；ROS：OR=1.38，95% CI 1.112～1.718，P均＜0.05）。ROC分析结果显示，Irisin和Vaspin可以作为MS的预测指标（曲线下面积分别为0.931和 0.777，P＜0.01）。结论 伴有MS的T2DM患者血清Irisin水平显著下降，Vaspin和ROS水平升高，Irisin、Vaspin与MS的临床表型相关，并可作为MS的预测指标。

Objective To explore the changes in serum concentrations of irisin, vaspin and reactive oxygen species （ROS） in patients with type 2 diabetes mellitus （T2DM） and metabolic syndrome （MS）, and to investigated the correlation of irisin and vaspin with clinical parameters of MS. Methods A total of 260 T2DM patients were enrolled. Age and gender were recorded, anthropometrics, biochemical parameters, and levels of irisin, vaspin and ROS in fasting serum were measured, and homeostatic model assessment of insulin resistance （HOMA-IR） calculated. Wilcoxon rank sum test, correlation analysis, Logistic regression analysis, multiple linear regression analysis and receiver operating characteristic （ROC） curve analysis were performed. Results Compared to T2DM patients without MS, T2DM patients with MS had lower serum level of irisin [male： 112.81（86.96-191.84）μg/L vs. 156.23（110.61-225.97）μg/L, female： 141.09（77.52-175.55）μg/L vs. 172.15（95.69-240.37）μg/L, P〈0.01], higher levels of vaspin and ROS [male： 1.13（0.95-1.38）μg/L vs. 0.36（0.21-0.82）μg/L, 1 540（1 250-1 860）kU/L vs. 1 020（920-1 350）kU/L; female： 1.52（1.13-1.80）μg/L vs. 0.51（0.47-1.08）μg/L, 1 650（1 320-1 940）kU/Lvs. 1 120（980-1 420）kU/L, P〈0.01]. In the T2DM patients, serum irisin level was negatively correlated with vaspin （r=-0.382, P〈0.01） and ROS （r=-0.410, P〈0.01）, while vaspin was positively correlated with ROS （r=0.400, P〈0.01）. Multiple linear regression analyses showed that irisin was significantly correlated with body mass index （BMI）, waist circumference and triglyceride, while vaspin was correlated with gender, BMI, and waist circumference （all P〈0.05）. Logistic regression analysis revealed that irisin, vaspin and ROS were all associated with MS （OR=0.77, 95% CI 0.608-0.978; OR=1.39, 95% CI 1.252-1.539; OR=1.38, 95% CI 1.112-1.718, all P〈0.05）. ROC analysis demonstrated that irisin and vaspin had significant area under the curve （AUC=0.931, P〈0.01; AUC=0.777, P〈0.01） for the prediction of MS.Conclusions Serum irisin level was significantly decreased, while vaspin and ROS were significantly increased in T2DM patients with MS. Irisin and vaspin were associated with clinical presentations of MS, suggesting that irisin and vaspin might be valuable predictors of MS.