摘要
背景目前2型糖尿病(type 2 diabetes mellitus,T2DM)患病人数不断增加,已经成为一个世界范围内的公共健康问题,对糖尿病前期患者尽早进行干预可以显著降低T2DM的发病风险,因此有必要对高危人群进行早期识别,并寻找评估可预警糖尿病前期的客观性指标。目的 分析血清硫氧还蛋白(thioredoxin,TRX)和白脂素(asprosin,Asp)在糖尿病前期和T2DM患者中水平的变化及相关影响因素。方法 选取2018年12月-2020年1月于保定市第一中心医院内分泌一科门诊就诊的155例患者为研究对象,其中空腹血糖受损者51例(IFG组),糖耐量减低者54例(IGT组),T2DM患者50例(DM组),同期42例正常糖耐量者作为对照组(NGT组),均行75 g口服葡萄糖耐量试验,比较各组之间相关指标差异;采用Elisa法测定血清TRX和Asp的水平;应用Spearman相关分析和多元线性回归分析探讨影响血清TRX和Asp的相关因素。结果 NGT组、IFG组、IGT组、DM组间血清TRX浓度依次降低[(5.01±0.71) ng/m L,(4.59±0.78) ng/m L,(4.24±0.71) ng/m L,(3.90±1.00) ng/m L],组间差异均有统计学意义(P均<0.05);血清Asp浓度依次升高[(4.05±0.75) ng/m L,(4.71±1.10) ng/m L,(5.37±1.63) ng/m L,(6.27±0.76) ng/m L],组间差异均有统计学意义(P均<0.05)。Spearman相关分析结果显示,血清TRX浓度与收缩压(systolic blood pressure,SBP)、总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、低密度脂蛋白胆固醇、空腹静脉血糖(fasting blood glucose,FBG)、葡萄糖耐量120 min血糖(postprandial blood glucose,PBG)、糖化血红蛋白(glycosylated hemoglobin,Hb A1c)、空腹胰岛素(fasting insulin, FINS)、胰岛素抵抗指数(homeostasis model assessment of insulin resistance,HOMA-IR)、Asp呈负相关,与高密度脂蛋白胆固醇呈正相关(P均<0.01);血清Asp与SBP、TC、TG、FBG、PBG、Hb A1c、FINS及HOMA-IR呈正相关,与血清TRX呈负相关(P均<0.01)。多元线性回归分析结果显示,FBG、FINS、HOMA-IR、Asp与血清TRX独立关联(P均<0.05);FBG、TC、FINS、HOMA-IR与血清Asp独立关联(P均<0.05)。结论 糖尿病和糖尿病前期患者血清TRX水平较正常糖耐量人群降低,血清Asp水平升高,提示血清TRX和Asp参与糖尿病前期患者病程的发展,对糖尿病前期和糖尿病的及时诊治有重要的参考价值。
Background At present, the number of patients with type 2 diabetes mellitus(T2 DM) is constantly increasing, and T2 DM has become a public health problem worldwide. Early intervention for patients with prediabetes can significantly reduce the risk of T2 DM, therefore, it is necessary to identify the high-risk population as early as possible and search for objective indicators for the evaluation and early warning of prediabetes. Objective To investigate the changes in serum thioredoxin(TRX) and asprosin(Asp) in patients with prediabetes or T2 DM and related influencing factors. Methods A total of 155 patients who attended the outpatient service of Department of Endocrinology in Baoding First Central Hospital from December 2018 to January 2020 were enrolled as subjects, among whom there were 51 patients with impaired fasting glucose(IFG group), 54 patients with impaired glucose tolerance(IGT group), 50 patients with T2 DM(DM group), and another 42 subjects with normal glucose tolerance during the same period of time were enrolled as control group(NGT group). The 75 g oral glucose tolerance test was performed for all subjects, and related indice were compared between groups. ELISA was used to measure the serum levels of TRX and Asp, and Spearman correlation analysis and multiple linear regression analysis were used to investigate the influencing factors for serum TRX and Asp.Results The NGT group had the highest serum TRX concentration of 5.01±0.71 ng/m L, followed by the IFG group(4.59±0.78 ng/m L), the IGT group(4.24±0.71 ng/m L), and the DM group(3.90±1.00 ng/m L), and there were significant differences between groups(all P <0.05);the DM group had the highest serum Asp concentration of 6.27±0.76 ng/m L, followed by the IGT group(5.37±1.63 ng/m L), the IFG group(4.71±1.10 ng/m L), and the NGT group(4.05±0.75 ng/m L), with significant differences between groups(P<0.05). The Spearman correlation analysis showed that serum TRX concentration was negatively correlated with systolic blood pressure(SBP), total cholesterol(TC), triglyceride(TG), low-density lipoprotein, fasting blood glucose(FBG), 120-minute postprandial blood glucose(PBG) in glucose tolerance test, glycosylated hemoglobin(Hb A1 c), fasting insulin(FINS),Homeostasis Model Assessment of Insulin Resistance(HOMA-IR), and Asp(all P<0.01) and was positively correlated with highdensity lipoprotein(P<0.01). The serum Asp concentration was positively correlated with SBP, TC, TG, FBG, PBG, Hb A1 c, FINS,and HOMA-IR(all P<0.01) and was negatively correlated with serum TRX(P<0.01). The multiple linear regression analysis showed that FBG, FINS, HOMA-IR, and Asp were independently associated with serum TRX(all P<0.05), and FBG, TC, FINS,and HOMA-IR were independently associated with serum Asp(all P <0.05). Conclusion Patients with diabetes or prediabetes have a lower serum level of TRX and a higher serum level of Asp than the population with normal glucose tolerance, suggesting that serum TRX and Asp may be involved in disease progression in patients with prediabetes, which is of important reference value for the timely diagnosis and treatment of prediabetes and diabetes.
作者
胡雅楠
李苗
李宝新
方新梅
常文龙
赵聪聪
王翯
张云良
HU Ya'nan;LI Miao;LI Baoxin;FANG Xinmei;CHANG Wenlong;ZHAO Congcong;WANG He;ZHANG Yunliang(Department of Endocrinology,Baoding First Central Hospital,Baoding 071000,Hebei Province,China;Hebei Provincial Center for Optical Sensing Innovations,Baoding 071000,Hebei Province,China)
出处
《解放军医学院学报》
CAS
北大核心
2022年第2期139-144,共6页
Academic Journal of Chinese PLA Medical School
基金
国家自然科学基金青年基金项目(81500644)
保定市慢性糖尿病并发症机理研究重点实验室建设项目(2074P015)。