肥胖与非肥胖2型糖尿病患者血清YKL-40水平差异及与胰岛素抵抗的相关性研究

Study on the correlation between serum YKL-40 level and insulin resistance in obese and non-obese patients with type 2 diabetes mellitus

目的观察肥胖与非肥胖2型糖尿病患者血清几丁质酶-3样蛋白-1(YKL-40)水平差异及与胰岛素抵抗的相关性。方法回顾性分析扬州大学附属医院2016年10月~2018年11月就诊的286例2型糖尿病患者的临床资料。按体质量指数(BMI)的不同分为2组,肥胖组患者144例(BMI≥28kg/m2);非肥胖组患者142例(BMI18.5~23.0kg/m2),其中非肥胖组患者为经本院互联网慢病管理后减重为标准体质量的2型糖尿病患者。比较各组患者的血清YKL-40水平的差异,观察其与胰岛素抵抗指数(HOMA-IR)及其他相关指标的相关性。结果肥胖组的YKL-40、糖化血红蛋白、HOMA-IR指数及脂肪细胞脂肪酸结合蛋白(A-FABP)明显高于非肥胖组(P<0.05)。Pearson直线相关分析显示,BMI、腰围、HOMA-IR及A-FABP和血清YKL-40水平呈正相关关系(r=0.504,0.589,0.320,0.389,P<0.05)。多重线性回归分析结果显示,在调整了相关变量因素后,BMI、腰围、HOMA-IR、A-FABP是影响血清YKL-40水平的独立相关因素(P<0.05)。结论与非肥胖2型糖尿病患者相比,肥胖糖尿病患者具有较高的血清YKL-40水平,而YKL-40水平也与胰岛素抵抗密切相关。

Objective To investigate the correlation between serum chitinase 3 like protein-1(YKL-40) and insulin resistance in obese and non-obese type 2 diabetes mellitus patients. Methods From October 2016 to November 2018,the clinical data of 286 patients with type 2 diabetes mellitus in affiliated Hospital of Yangzhou University were retrospectively analyzed. All patients were divided into two groups according to the body mass index(BMI). The obese group includes 144 obese type 2 diabetic patients(BMI ≥ 28 kg/m2). The non-obese group includs 142 cases of non-obese type 2 diabetes mellitus patients(BMI:18.5-23.0 kg/m2). The patients of non-obese group were type 2 diabetic patients with standard body mass after reduced weight by internet chronic disease management. They were compared with the difference of serum YKL-40 level in two groups and the correlations were observed with YKL-40 level,HOMA insulin resistance(HOMA-IR) index and other related indexes.Results The YKL-40 level,glycosylated hemoglobin(HbA1c) level,HOMA-IR index and adipocyte fatty acid binding protein(A-FABP) level in obese group were significantly higher than non-obese group(P < 0.05). The YKL-40 level was positively correlated with BMI,waist circumference,HOMA-IR index,A-FABP(r =0.504,0.589,0.320,0.389,P < 0.05) using Pearson linear correlation analysis. Multiple linear regression analysis showed that BMI,waist circumference,HOMA-IR and A-FABP level were independent correlation factors of serum YKL-40 level after adjusted the related variable factors(P < 0.05). Conclusion Compared with non-obese type 2 diabetes patients,obese diabetic patients have higher serum YKL-40 level,and YKL-40 level is closely related to insulin resistance.