2型糖尿病患者单核细胞/高密度脂蛋白胆固醇比值与胰岛素抵抗关系的研究

Relationship between monocyte/high-density lipoprotein cholesterol ratio and insulin resistance in patients with type 2 diabetes mellitus

目的探讨单核细胞/HDL-C比值(MHR)与T2DM患者IR的关系,分析IR发生的影响因素。方法选取2019年11月至2020年11月于徐州医科大学附属医院内分泌科住院治疗的T2DM患者536例(T2DM组),另选取同期于我院体检中心体检的健康人群163名为正常对照(NC)组,比较两组一般资料、生化指标,计算稳态模型胰岛素抵抗指数(HOMA-IR)。另根据HOMA-IR将T2DM组分为HOMA-IR<2.5、HOMA-IR≥2.5亚组,比较两亚组差异。再对T2DM组按MHR四分位数分为MHR≤0.26的Q1_(MHR)、0.26<MHR≤0.35的Q2_(MHR)、0.35<MHR≤0.46的Q3_(MHR)和MHR>0.46的Q4_(MHR)共4个亚组进行分析比较。结果与NC组比较,T2DM组BMI、FPG、TG、Hb A_(1c)、HOMA-IR、FC-P、血尿酸(SUA)、白细胞计数(WBC)、中性粒细胞计数(NE)、淋巴细胞计数(LY)、单核细胞计数(MO)、MHR升高,HDL-C降低(P<0.05)。HOMA-IR≥2.5亚组BMI、FPG、TG、Hb A_(1c)、FIns、FC-P、SUA、WBC、NE、LY、MO、MHR均高于HOMA-IR<2.5亚组,HDL-C水平低于HOMA-IR<2.5组(P<0.05)。Q4_(MHR)亚组HOMA-IR水平高于Q1_(MHR)、Q2_(MHR)、Q3_(MHR)亚组(P<0.05),Q3_(MHR)亚组HOMA-IR水平高于Q1_(MHR)、Q2_(MHR)亚组(P<0.05)。Spearman相关分析显示,T2DM患者IR与MHR呈正相关(r=0.368,P<0.001)。Logistic回归分析显示,BMI、FPG、SUA、MHR是IR的影响因素。ROC曲线结果显示,MHR预测T2DM患者发生IR的曲线下面积为0.759,灵敏度72.5%,特异度68.5%。结论 MHR与T2DM患者IR相关,MHR越大,T2DM患者IR程度越严重,MHR可预测T2DM患者IR。

Objective To investigate the relationship between the ratio of monocytes to high-density lipoprotein cholesterol (MHR) and insulin resistance (IR) in patients with type 2 diabetes mellitus(T2DM),and to explore the influnencing factors for IR.Methods A total of 536 patients with T2DM were selected as T2DM group from the Department of Endocrinology in Affiliated Hospital of Xuzhou Medical University from November 2019 to November 2020.In addition,163 healthy people from the physical examination center of our hospital were selected as normal control(NC)group.T2DM group was further divided into HOMA-IR<2.5 and HOMA-IR≥2.5 subgroups according to HOMA-IR,and divided into Q1_(MHR) subgroup with MHR≤0.26,Q2_(MHR)subgroup with MHR≤0.35,Q3_(MHR)subgroup with MHR≤0.46 and Q4_(MHR)subgroup with MHR>0.46 according to the quartile of MHR.General data,biochemical indexes,FIns and FC-P were analyzed in each group.HOMA-IR was calculated.Results Compared with NC group,BMI,FPG,TG,Hb A_(1c),HOMA-IR,FC-P,uric acid(SUA),white blood cell count(WBC),neutrophil count(NE),lymphocyte count(LY),monocyte count(MO),MHR increased and HDL-C decreased in T2DM group(P<0.05).BMI,FPG,TG,Hb A_(1c),FIns,FC-P,SUA,WBC,NE,LY,MO and MHR were higher,while HDL-C level was lower in HOMA-IR≥2.5 subgroup than in HOMA-IR<2.5 group(P<0.05).The level of HOMA-IR was higher in Q4_(MHR)subgroup than in Q1_(MHR),Q2_(MHR)and Q3_(MHR)subgroups(P<0.05).The level of HOMA-IR was higher in Q3_(MHR)subgroup than in Q1_(MHR)and Q2_(MHR)subgroup(P<0.05).Spearman correlation analysis showed that MHR was positively correlated with IR in T2DM patients(r=0.368,P<0.001).Multivariate Logistic regression analysis showed that BMI,FPG,SUA and MHR were the influencing factors for IR in T2DM patients.ROC curve analysis showed that the area under the curve of MHR for predicting IR was 0.759,with sensitivity of 72.5%and specificity of 68.5%in T2DM patients.Conclusion MHR is correlated to IR in patients with T2DM.The higher MHR is,the severer IR is in patients with T2DM.MHR can predict IR in T2DM patients.