老年2型糖尿病合并非酒精性脂肪肝患者血清蛋白激酶Cε活性和胰岛素抵抗的关系研究

Relationship between serum protein kinase Cεactivity and insulin resistance in elderly patients with concurrent type 2 diabetes mellitus and non-alcoholic fatty liver disease

目的探讨老年2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)患者血清蛋白激酶Cε(PKCε)活性与胰岛素抵抗的相关性。方法回顾性分析2017年10月至2018年10月西安交通大学医学院第二附属医院住院的T2DM患者229例,根据病情分为T2DM组112例,T2DM+NAFLD组117例,另选同期健康对照组110例。比较3组入选者临床资料和实验室检查结果,计算稳态模型的胰岛素抵抗指数(HOMA-IR),采用酶联免疫吸附法测定血清PKCε活性,并分析其与胰岛素抵抗的相关性。结果T2DM+NAFLD组患者血清PKCε活性和HOMA-IR均高于单纯T2DM组和健康对照组[(195.5±62.1)μg/L比(188.7±61.2)μg/L和(89.1±20.2)μg/L、(12.5±7.9比14.1±5.7和5.8±4.1),F值分别为9.76、10.21,均P=0.010]。Pearson相关分析,T2DM+NAFLD组患者血清PKCε活性、HOMA-IR及三酰甘油呈正相关(r值分别为0.339、0.305、0.329,均P<0.015)。Logistic回归分析,血清PKCε活性、HOMA-IR和三酰甘油是T2DM+NAFLD组的危险因素(β值分别为0.849、0.022和0.710,均P<0.05)。血清PKCε活性升高是T2DM合并NAFLD的独立影响因素。结论老年T2DM合并NAFLD患者血清PKCε活性升高与胰岛素抵抗呈正相关,降低血清PKCε活性和改善胰岛素抵抗有助于延缓或改善T2DM及NAFLD。

Objective To investigate the association of serum protein kinase Cε(PKCε)activity with insulin resistance in elderly patients with concurrent type 2 diabetes mellitus(T2DM)and non-alcoholic fatty liver disease(NAFLD).Methods Clinical data of 229 patients with T2DM admitted to the Department of Geriatric Endocrinology of the Second Affiliated Hospital of Xi'an Jiaotong University from October 2017 to October 2018 were retrospectively analyzed.Patients were divided into the T2DM group(T2DM patients without NAFLD,n=112)and the T2DM+NAFLD group(T2DM patients with NAFLD,n=117).Healthy elderly subjects who underwent physical examination during the same period served as the control group(n=110).Clinical data and laboratory results were compared between the three groups.Serum PKCεactivity was measured by enzyme-linked immunosorbent assay,and the correlation between serum PKCεactivity and insulin resistance was analyzed statistically.Results Serum PKCεactivity and HOMA-IR were higher in the T2DM+NAFLD group than in the T2DM group and the control group[PKCε:(195.5±62.1)μg/L vs.(188.7±61.2)μg/L and(89.1±20.2)μg/L,F=9.76,P=0.010;HOMA-IR:12.5±7.9 vs.14.1±5.7 and 5.8±4.1,F=10.21,P=0.010].Pearson correlation analysis revealed that serum PKCεactivity,HOMA-IR and TG were positively correlated with T2DM+NAFLD(r=0.339,P=0.01;r=0.305,P=0.01;r=0.329,P=0.01)and that serum PKCεactivity was positively correlated with HOMA-IR and triglyceride(r=0.339,0.305 and 0.329,P=0.01).Logistic regression analysis showed that serum PKCεactivity,HOMA-IR and triglycerides were risk factors in the T2DM+NAFLD group,and the regression coefficients were 0.849,0.022 and 0.710,respectively.Increased serum PKCεactivity was an independent influencing factor for T2DM+NAFLD.Conclusions Elevated serum PKCεactivity is positively correlated with insulin resistance in elderly T2DM patients with NAFLD.Reducing serum PKCεactivity and improving insulin sensitivity will help to delay or reverse the development of T2DM and NAFLD.