组织缺氧对2型糖尿病患者胰岛素抵抗的影响

Effect of hypoxia on insulin resistance in patients with type 2 diabetes mellitus

目的探讨组织缺氧对2型糖尿病(T2DM)患者胰岛素抵抗(IR)的影响。方法选取2015年1月-2016年10月该院门诊首次确诊的182例T2DM患者作为研究对象。检测所有患者空腹血糖(FPG)、空腹胰岛素(Fins)、血红蛋白(Hb)、2,3-二磷酸甘油酸(2,3-DPG)、缺氧诱导因子1α(HIF-1α)及乳酸等水平,据此计算其胰岛素抵抗指数(HOMA-IR)与胰岛素敏感指数(HOMA-IS);比较代谢综合征(MS)组(49例)和非MS组(133例)IR、组织缺氧相关指标,并根据患者Hb水平的三分位数分成3组;比较3组IR、组织缺氧相关指标。采用Pearson相关系数分析各指标相关性。结果 MS组FPG、Fins、HOMA-IR、Hb、HIF-1α及血乳酸水平高于非MS组,HOMA-IS低于非MS组(P<0.05)。随着Hb水平提高,Fins、HOMA-IR、HIF-1α、2,3-DPG及血乳酸水平逐渐升高(P <0.05),而HOMA-IS逐渐降低(P <0.05)。HOMA-IR与Hb、HIF-1α、2,3-DPG及血乳酸水平均呈正相关(r=0.197、0.303、0.136和0.153,P=0.017、0.000、0.067和0.039),HOMA-IS与Hb、HIF-1α、2,3-DPG及血乳酸水平均呈负相关(r=-0.197、-0.303、-0.136和-0.153,P=0.017、0.000、0.067和0.039)。结论 T2DM患者存在慢性组织缺氧和IR现象,两者有密切关系;慢性组织缺氧可能诱发机体代谢紊乱,加速IR。

Objective To study the effect of hypoxia on insulin resistance(IR)in patients with type 2 diabetes mellitus(T2DM).Methods A total of 182 patients with T2DM first diagnosed in our hospital from January 2015 to March 2016 were enrolled to the study.Fasting plsama glucose(FPG),fasting insulin(Fins),hemoglobin(Hb),2,3-diphosphoglyceric acid(2,3-DPG),hypoxia inducible factor-1α(HIF-1α)and lactic acid level were detected,then insulin resistance index(HOMA-IR)and insulin sensitivity index(HOMA-IS)were calculated.Hypoxia and IR indicators were compared between metabolic syndrome(MS)group(n=49)and non-MS group(n=133).All cases were divided into three groups according to the tri-sectional quantiles of Hb level,then hypoxia and IR indicators were compared among them.Pearson correlation coefficient was used to analyze the correlation of all indexes.Results The levels of FPG,FINS,HOMA-IR,Hb,HIF-1αand blood lactic acid in the MS group were significantly higher than those in the non-MS group,HOMA-IS was significantly lower than that in the non-MS group(P<0.05).With the increase of Hb level,the levels of Fins,HOMA-IR,HIF-1α,2,3-DPG and lactic acid gradually increased(P<0.05),while HOMA-IS gradually decreased(P<0.05).HOMA-IR was positive correlated with Hb,HIF-1α,2,3-DPG and blood lactic acid level(r=0.197,0.303,0.136 and 0.153,P=0.017,0.000,0.067 and 0.039),and HOMA-IS was negatively correlated with Hb,HIF-1α,2,3-DPG and blood lactic acid level(r=-0.197,-0.303,-0.136 and-0.153,P=0.017,0.000,0.067 and 0.039).Conclusions Chronic hypoxia and IR exist in T2DM,and there is a close relationship between them.Chronic hypoxia may induce metabolic disturbance and accelerate IR.