不同尿碘水平的初诊2型糖尿病患者血清代谢组分及肠道菌群生态的差异分析

Differential analysis of serum metabolic components and intestinal flora ecology in newly diagnosed type 2 diabetes patients with different urinary iodine levels

目的:探讨不同尿碘水平的初诊2型糖尿病(T2DM)患者的血清代谢组分及肠道菌群生态的差异与临床意义。方法:选取149例初诊T2DM患者为研究对象,按照尿碘水平分为碘营养不足组(A组,n=49)、碘营养充足组(B组,n=54)及碘营养过量组(C组,n=46)。对患者血清中脂质、空腹及餐后2 h血糖、C肽及胰岛素水平(FIns)等指标进行检测,同时随机抽取各组部分患者对其肠道菌群及代谢物短链脂肪酸(SCFA)进行检测,并比较其组间差异。分析两组患者肠道SCFA与UIC、HbA1c、FPG及HOMA-IR的相关性。结果:A组患者血糖、血脂与B组患者比较,差异有统计学意义(P<0.05)。A组及C组患者空腹Fins水平及HOMA-IR高于B组,HOMA-β低于B组,差异均有统计学意义(P<0.05)。B组患者肠道产丁酸菌及肠道来源SCFA中的丁酸水平高于A组或C组患者,差异有统计学意义(P<0.05)。A组中丁酸浓度与UIC正相关,与HbA1c、FPG、HOMA-IR负相关(P<0.05)。C组中丁酸浓度与UIC负相关,与HbA1c、FPG、HOMA-IR正相关(P<0.05)。结论:碘营养不良与初诊T2DM患者的IR、糖脂代谢等水平相关;T2DM患者肠道来源碘营养可能通过影响肠道产丁酸菌及丁酸丰度参与其中。

Objective:To explore the difference and clinical significance of serum metabolic components and intestinal flora ecology in newly diagnosed type 2 diabetes(T2DM)patients with different urine iodine levels.Methods:A total of 149 patients with newly diagnosed T2DM were selected as the research subjects and divided into iodine deficiency group(group A,n=49),iodine adequate nutrition group(group B,n=54),and excessive iodine nutrition group(group C,n=46)based on urinary iodine levels.Serum lipids,fasting and 2-hour postprandial blood glucose,C-peptide and insulin levels(FIns)were detected,and some patients in each group were randomly selected for their intestinal flora and short-chain fatty acids(SCFA)were detected,and the differences between the groups were compared.The correlation between intestinal SCFA and UIC,HbA1c,FPG,and HOMA-IR in two groups of patients were analyzed.Results:There was a significant difference in blood glucose and blood lipid between group A and B(P<0.05).The fasting Fins level and HOMA-IR in group A and C were higher than those in group B,HOMA-βwas lower than that in group B,the difference was statistically significant(P<0.05).The level of butyric acid and intestinal SCFA in group B were higher than that in group A and C(P<0.05).The concentration of butyric acid in group A was positively correlated with UIC,but negatively correlated with HbA1c,FPG,HOMA-IR(P<0.05).The concentration of butyric acid in group C was negatively correlated with UIC,but positively correlated with HbA1c,FPG,HOMA-IR(P<0.05).Conclusion:Iodine malnutrition is related to the levels of IR and glucose and lipid metabolism in newly diagnosed T2DM patients,gut-derived iodine nutrition in T2DM patients may be involved by affecting the abundance of butyric acid produced by intestinal butyric acid-producing bacteria.