2型糖尿病合并非酒精性脂肪肝病患者Metrnl、Spexin表达水平与胰岛素抵抗的关系

The Relationship Between Metrnl and Spexin Expression Levels and Insulin Resistance in Patients with Type 2 Diabetes Mellitus Complicated with Nonalcoholic Fatty Liver Disease

目的 研究2型糖尿病(type 2 diabetes mellitus, T2DM)合并非酒精性脂肪性肝病(nonalcoholic fatty liver disease, NAFLD)患者Metrnl和Spexin表达水平与胰岛素抵抗的关系。方法 选择2020年10月至2022年9月到本院进行治疗的T2DM患者128例,其中有68例患者并发NAFLD,将其归为观察组,60例患者未出现NAFLD,将其归为对照组。依据观察组患者病情严重程度将患者分为轻度组、中度组和重度组。应用化学免疫法检测空腹胰岛素含量(FINS)、胰岛β细胞指数(HOMA-ISI)、胰岛素抵抗指数(HOMA-IR)。应用酶联免疫吸附法对血清Metrnl和Spexin水平进行检测。结果 观察组患者的Metrnl和HOMA-IR水平高于对照组,Spexin和HOMA-ISI水平低于对照组(P<0.05)。经过ROC曲线分析,血清Metrnl、Spexin对T2DM并发NAFLD均有一定诊断价值,其中Metrnl的曲线下面积(AUC)为0.783,截断值为0.65,其诊断灵敏度和特异性分别为0.78和0.72,其中Spexin的曲线下面积(AUC)为0.791,截断值为2.46,其诊断灵敏度和特异性分别为0.74和0.74。经过对比,病情不同患者的性别、年龄和T2DM病程相似(P>0.05),不同组患者的腰臀比(WHR)和体质量指数(BMI)存在差异(P<0.05)。相比中度和轻度组,重度组患者的Metrnl和HOMA-IR水平高表达,而Spexin和HOMA-ISI低表达(P<0.05)。经过Pearson相关性分析,血清Metrnl、Spexin表达与HOMA-IR呈现正相关,与HOMA-ISI呈负相关(P<0.05)。将连续数值的自变量取均值进行分层,经回归分析,患者BMI、血清Metrnl、Spexin、HOMA-IR、HOMA-ISI是T2DM并发NAFLD的独立危险因素(P<0.05)。结论 T2DM合并NAFLD患者血清Metrnl表达升高,Spexin表达降低,且两者与患者IR存在相关性。

Objective To identify type 2 diabetes mellitus(T2DM)associated with nonalcoholic fatty liver disease,and to evaluate the relationship between Metrnl and Spexin expression levels and insulin resistance in patients with NAFLD.Methods A total of 128 T2DM patients admitted to our hospital from October,2020 to September,2022 were selected for the study,among which 68 patients with NAFLD were classified as the observation group and 60 patients without NAFLD were classified as control group.According to the severity of the disease in the observation group,these patients were further divided into the mild group,moderate group and severe group.Fasting insulin content(FINS)and islet beta cell index(HOMA-ISI)were determined by chemical immunoassay,as well as insulin resistance index(HOMA-IR).Serum Metrnl and Spexin levels were measured by enzyme-linked immunosorbent assay.Results Levels of Metrnl and HOMA-IR in the observation group were higher than those in the control group,while levels of Spexin and HOMA-ISI were lower than those in the control group(P<0.05).According to ROC curve analysis,both Metrnl and Spexin had certain diagnostic values for T2DM complicated NAFLD.The area under the curve(AUC)of Metrnl was 0.783.With the cut-off value of 0.65,the diagnostic sensitivity and specificity were 0.78 and 0.72,respectively.The area under the curve(AUC)of Spexin was 0.791.With the cut-off value of 2.46,its diagnostic sensitivity and specificity were 0.74 and 0.74,respectively.Gender,age and course of T2DM were similar among patients with different disease conditions(P>0.05),while waist-to-hip ratio(WHR)and body mass index(BMI)were different among different groups(P<0.05).Compared with moderate and mild groups,Metrnl and HOMA-IR levels were higher in the severe group,while Spexin and HOMA-ISI levels were lower(P<0.05).Pearson correlation analysis showed that serum Metrnl and Spexin were positively correlated with HOMA-IR while negatively correlated with HOMA-ISI(P<0.05).The mean value of independent variables of continuous values was used for stratification.According to regression analysis,BMI,serum Metrnl,Spexin,HOMA-IR and ISI were independent risk factors for T2DM complicated with NAFLD(P<0.05).Conclusion Metrnl expression is increased and Spexin expression is decreased in patients with T2DM and NAFLD,and both are correlated with IR.