RBP4、α2-MG、SAA在2型糖尿病及其微血管病变中的表达意义

Expression significance of RBP4,α2-MG and SAA in type 2 diabetes mellitus and its microangiopathy

目的探讨血清视黄醇结合蛋白4(RBP4)、α2巨球蛋白(α2-MG)、淀粉样蛋白A(SAA)和脂代谢指标等在2型糖尿病(T2DM)及其微血管病变发病中的作用与意义。方法选择2018年3-9月该院内分泌科收治的T2DM住院患者197例,分为单纯糖尿病无微血管并发症组(NMCD组,n=132)、糖尿病合并微血管病变组(MCD组,n=65),另选取同期在该院体检中心健康体检者80例作为健康对照组(NGT组),检测各组α2-MG、SAA、RBP4水平并进行比较,选择多个可能对微血管病变产生影响的因素,通过二分类logistic进行多因素分析。结果NMCD组较NGT组RBP4、SAA、α2-MG升高(P<0.05),较MCD组RBP4、SAA升高(P<0.05);MCD组较NMCD组LDL-C、TC、非HDL-C、载脂蛋白B100(ApoB100)显著升高(P<0.05)。logistic回归分析显示,RBP4升高(OR=1.128,95%CI:1.004~1.267,P<0.05)、空腹C肽降低(OR=0.139,95%CI:0.029~0.652,P<0.05)、SAA升高(OR=1.219,95%CI:1.075~1.382,P<0.01)、脂蛋白a[LP(a)]升高(OR=1.073,95%CI:1.017~1.132,P<0.05)是发生T2DM微血管病变的危险因素。结论RBP4、SAA升高与胰岛素抵抗及T2DM的发生相关;高RBP4、SAA、LP(a)及胰岛功能减退可能是发生T2DM微血管病变的危险因素;脂代谢紊乱在T2DM微血管病变的发生、发展中起着一定推动作用。

Objective To investigate the role and significance of serum retinol binding protein 4(RBP4),alpha2 macroglobulin(α2-MG),amyloid A(SAA)and lipid metabolism indexes in the pathogenesis of type 2 diabetes mellitus(T2DM)and its microangiopathy.Methods A total of 197 inpatients with T2DM in the endocrinology department of this hospital from March to September 2018 were selected,including the simple T2DM without microangiopath group(NMCD group,n=132)and T2DM complicating microangiopathy group(MCD group,n=65),and contemporaneous 80 subjects undergoing the healthy physical examination in the physical examination center were selected as the healthy control group(NGT group).The levels of serumα2-MG,SAA and RBP4 in each group were detected for conducting the comparison.The factors possibly producing the effect on the microvessels were selected to conduct the multivariate analysis by the binary logistic regression.Results The levels of RBP4,SAA andα2-MG in the NMCD group were higher than those in the NGT group(P<0.05);the levels RBP4 and SAA in the NMCD group were higher than those in the MCD group(P<0.05);the levels of LDL-C,TC,non-HDL-C,and apolipoprotein B100(ApoB100)in the MCD group were significantly increased compared with the NMCD group(P<0.05).The logistic regression analysis showed that the RBP4 level increase[odds ratios(OR)=1.128,95%confidence interval(CI):1.004-1.267,P<0.05],fasting C-peptide decrease[OR=0.139,95%CI:0.029-0.652,P<0.05],SAA increase[OR=1.219,95%CI:1.075-1.382,P<0.01]and LP(a)elevation[OR=1.073,95%CI:1.017-1.132,P<0.05]were the risk factors of diabetic microangiopathy occurrence in T2DM.Conclusion The elevation of RBP4 and SAA is correlated with insulin resistance and T2DM occurrence.Higher RBP4,SAA and LP(a)levels and islet hypofunction may be the risk factors for T2DM microvascular lesions occurrence.The lipid metabolic disorder plays a certain promotion role in the occurrence and development of T2DM microvascular lesions.