2型糖尿病合并肥胖患者血清Irisin和SFRP5水平变化的研究

The changes of serum Irisin and SFRP5 levels in obese patients with type 2 diabetes mellitus

目的 探讨2型糖尿病合并肥胖患者血清鸢尾素（Irisin）和分泌型卷曲相关蛋白5（SFRP5）水平的变化.方法 选取2015年10月至2016年12月在保定市第一中心医院内分泌住院的195例2型糖尿病患者,根据体重指数分为糖尿病正常体重组（n=71）、糖尿病超重组（n=70）、糖尿病肥胖组（n=54）,同期体检体重指数正常的健康受试者为对照组（n=50）,分别比较4组一般资料、血清Irisin及SFRP5水平的差异,采用Spearman相关性分析法分析血清Irisin和SFRP5与体重指数、腰臀比、血脂、血糖的相关性,多元逐步回归分析血清Irisin和SFRP5与相关代谢指标的关系.结果 与糖尿病正常体重组和糖尿病超重组相比,糖尿病肥胖组空腹胰岛素（FINS）、稳态模型评估-胰岛素抵抗指数（HOMA-IR）明显增加（x2=17.85、19.63,P均＜0.05）,血清Irisin、SFRP5水平明显下降（F=51.70、15.13,P均＜0.05）.Spearman相关性分析显示,血清Irisin水平与体重指数、腰臀比、总胆固醇、甘油三酯、FINS、HOMA-IR呈负相关（r=-0.77～-0.23,P均＜0.05）,与高密度脂蛋白-胆固醇（HDL-C）、SFRP5呈正相关（r=0.20、0.22,P均＜0.01）;血清SFRP5水平与体重指数、腰臀比、糖尿病病程、甘油三酯、低密度脂蛋白-胆固醇、HbA1c、FINS、HOMA-IR呈负相关（r=-0.38～-0.13,P均＜0.05）,与HDL-C、Irisin呈正相关（r=0.17、0.22,P均＜0.05）.多元逐步回归分析显示体重指数、腰臀比、FINS与血清Irisin呈显著负相关（β=-0.04、-2.75、-2.27,P均＜0.05）,体重指数与血清SFRP5呈显著负相关（β=-1.14,P＜0.05）.结论 2型糖尿病合并肥胖时血清Irisin和SFRP5水平均显著降低,二者可能在糖尿病合并肥胖的发病中发挥一定作用.

Objective To study the changes of serum Irisin and secreted frizzled-related protein 5 （SFRP5） levels in obese patients with type 2 diabetes mellitus.Methods A total of 195 patients with type 2 diabetes hospitalized in the Department of Endocrinology of the First Central Hospital of Baoding City from October 2015 to December 2016 were divided into diabetic normal weight group （n =71）,diabetic overweight group （n =70） and diabetic obesity group （n =54） according to body mass index （BMI）.Another 50 healthy subjects with normal BMI in the same period were included as control group （n =50）.The general information and serum Irisin and SFRP5 levels were compared among 4 groups.Spearman correlation analysis was used to analyze the correlation between serum Irisin,SFRP5 and BMI,waist to hip ratio （WHR）,blood lipid and blood glucose.Multiple stepwise regression analysis was used to analyze the relationship between serum Irisin,SFRP5 and related metabolic indexes.Results Compared with diabetic normal weight group and diabetic overweight group,fasting insulin （FINS） and homeostasis model assessmentinsulin resistance index（HOMA-IR） were increased （x2 =17.85,19.63,all P ＜ 0.05）,whereas the levels of serum Irisin and SFRP5 were declined （F =51.70,15.13,all P ＜ 0.05） in diabetic obesity group.Spearman correlation analysis showed that serum Irisin was negatively correlated with BMI,WHR,total cholesterol （TC）,triglyceride （TG）,FINS,and HOMA-IR （r =-0.77--0.23,all P ＜ 0.05）,but positively correlated with high density lipoprotein-cholesterol （HDL-C） and SFRP5 （r =0.20,0.22,all P ＜ 0.01）;SFRP5 was negatively correlated with BMI,WHR,the course of diabetes,TG,low density lipoprotein cholesterol （LDL-C）,HbA1c,FINS,HOMA-IR （r =-0.38--0.13,all P ＜0.05）,and positively correlated HDL-C and Irisin （r =0.17,0.22,all P ＜ 0.05）.Multiple stepwise regression analysis showed that BMI,WHR and FINS were significantly negatively associated with serum Irisin （β =-0.04,-2.75,-2.27,all P ＜0.05）,and BMI was significantly negatively associated with serum SFRP5 （β =-1.14,P ＜ 0.05）.Conclusion Serum Irisin and SFRP5 levels are decreased in diabetic patients with obesity,and may play important roles in the occurrence and development of diabetes accompanied with obesity.