2型糖尿病患者血清硒蛋白S水平与腹型肥胖的相关性

Correlation between serum selenoprotein S level and abdominal obesity in patients with type 2 diabetes mellitus

目的:探讨2型糖尿病(T2DM)患者血清硒蛋白S(SelS)与腹型肥胖的相关性。方法:收集2017年11月至2019年11月于大连医科大学附属第一医院国家标准化代谢性疾病管理中心进行管理的T2DM患者209例,于我院健康体检中心选取健康人55名作为健康对照组,进行回顾性横断面研究。记录患者的一般情况、生化指标及内脏脂肪面积(VFA)、皮下脂肪面积(SFA)、VFA与SFA比率(VSR)和内脏脂肪指数(VAI)等肥胖评价参数。根据亚洲人群腹型肥胖标准将T2DM患者分为非腹型肥胖组(VFA≤100 cm^(2))和腹型肥胖组(VFA>100 cm^(2))。按照血清SelS四分位数将T2DM患者分为4组,Q1组SelS≤95.10 ng/dl(53例)、Q2组SelS为95.12~111.62 ng/dl(52例)、Q3组SelS为112.46~130.97 ng/dl(52例)、Q4组SelS≥131.33 ng/dl(52例)。采用Pearson及Spearman相关分析评价血清SelS水平与肥胖评价指标及其他临床资料的相关性。采用多元逐步回归分析腹型肥胖评价指标的影响因素。结果:T2DM腹型肥胖(99例)、非腹型肥胖组(110例)与健康对照组(55名)间内脏脂肪指数(VAI)差异有统计学意义(H=36.679,P<0.01),血清SelS差异无统计学意义(P=0.335)。在SelS四分位数分组中,血清SelS水平最低四分位数组血清淀粉样蛋白A(SAA)水平最低,组间SAA水平差异有统计学意义(H=3.560,P<0.01),而VFA、SFA、VSR和VAI的差异无统计学意义(P均>0.05)。血清SelS与VFA(r=0.176,P=0.011)、VSR(r=0.188,P=0.006)、VAI(r=0.158,P=0.022)和SAA(r=0.448,P<0.01)呈正相关。血清SelS是VFA(β=0.172,P=0.003)、VSR(β=0.001,P=0.01)、VAI(β=0.009,P=0.038)的独立危险因素。结论:T2DM患者血清SelS水平与腹型肥胖评价指标VFA、VSR、VAI正相关,是其独立危险因素。

Objective To investigate the relationship between serum selenoprotein S(SelS)and obesity in patients with type 2 diabetes mellitus(T2DM).Methods Two hundred and nine T2DM patients who were managed by the National Metabolic Management Center(MMC)of the First Affiliated Hospital of Dalian Medical University from November 2017 to November 2019 and 55 healthy people as controls in the health examination center of our hospital were enrolled in the retrospective cross-sectional study.The general condition,biochemical indexes and obesity evaluation parameters were recorded.According to the serum SelS quartile,T2DM patients were divided into Q1 group:≤95.10 ng/dl(53 cases),Q2 group:95.12 to 111.62 ng/dl(52 cases),Q3 group:112.46 to 130.97 ng/dl(52 cases),Q4 group:≥131.33 ng/dl(52 cases).Analysis of variances,rank sum test and Chi-square test were used for comparison between groups.Multiple stepwise regression was used to analyze the influencing factors of obesity evaluation index.Results There was statistically significant difference in visceral fat index(VAI)among T2DM abdominal obesity group,non-abdominal obesity group and healthy control group(H=36.679,P<0.01),but there was no statistically significant difference in serum SelS.There was statistically significant difference in serum amyloid A(SAA)level among the SelS quartile groups(H=3.560,P<0.01),but there was no statistically significant difference in visceral fat area(VFA),subcutaneous fat area(SFA),visceral fat area to subcutaneous fat area ratio(VSR)and VAI.Serum SelS was positively correlated with VFA,VSR,VAI and SAA(r=0.158 to 0.448,all P<0.05).Serum SelS was an independent risk factor for VFA(β=0.172,P=0.003),VSR(β=0.001,P=0.01)and VAI(β=0.009,P=0.038).Conclusion Serum SelS level in T2DM patients is positively correlated with VFA,VSR and VAI,which is an independent risk factor for abdominal obesity.