肥胖2型糖尿病患者血脂、HbA1C水平与胰岛素抵抗的相关性分析

Correlation analysis of serum lipids,HbA1C levels and insulin resistance in obese type 2 diabetes patients

目的探讨肥胖2型糖尿病(type 2 diabetes mellitus,T2DM)患者血脂和糖化血红蛋白(HbA1c)水平的变化及其与胰岛素抵抗(Homa-IR)的关系。方法选择2022年2月至10月于西藏墨脱县新诊断为T2DM120例作为观察组,根据BMI将患者分为糖尿病正常体重组(46例)、超重组(43例)和肥胖组(31例);选择145例健康受试者作为对照组。检测研究对象HbA1c、空腹血糖(FPG)、空腹胰岛素(FINS)、血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL-C)以及低密度脂蛋白(LDL-C)的水平,计算Homa-IR和Homa-β指数,并测量身高、体重、腹围等指标。将观察组患者分为正常组(n=46)、超重组(n=43)和肥胖组(n=31),再次比较上述指标水平。结果与对照组相比,观察组BMI、腹围、血压水平、HbA1c、FBG、FINS、TC、TG、LDL-C、UA、内脏脂肪面积、Homa-IR和Homa-β水平均显著升高(均P<0.05)。不同BMI水平的糖尿病患者在BMI、腹围、FINS、Homa-IR、Homa-β和HbA1c水平差异有统计学意义(均P<0.05)。相关性分析提示,观察组肥胖T2DM患者TG水平与HbA1c(r=0.396,P=0.027)、Homa-IR(r=0.405,P=0.024)和Homa-β(r=-0.401,P=0.025)显著相关,LDL-C与Homa-IR(r=0.411,P=0.022)和Homa-β(r=-0.412,P=0.021)显著相关;HbA1c与BMI显著正相关(r=0.371,P=0.040)。结论在西藏墨脱极少数民族的肥胖T2DM患者中,胰岛素抵抗与TG、LDL-C、BMI密切相关,提示以上因素可能在T2DM的发生存在作用。

Objective To investigate the changes of blood lipid and glycosylated hemoglobin(HbA1c)levels in obese type 2 diabetes(T2DM)patients and their relationship with insulin resistance(Homa-IR).Methods A total of 120 cases of T2DM newly diagnosed in Motuo County,Tibet from February to October 2022 were selected as the observation group.According to BMI,the patients were divided into diabetes normal weight group(46 cases),overweight group(43 cases)and obesity group(31 cases);145 healthy subjects were selected as the control group.The levels of HbA1c,fasting blood glucose(FPG),fasting insulin(FINS),serum total cholesterol(TC),triglycerides(TG),high-density lipoprotein(HDL-C),and low-density lipoprotein(LDL-C)were detected in the study subjects,and Homa-IR and Homa-βindices were calculated.The height,weight,and abdominal circumference were measured.The differences in the levels of the above indicators between the observation group patients and the control group,as well as among various subgroups within the observation group were compared.The influencing factors of Homa-IR in obese T2DM patients were analyzed.Results Compared with the control group,a significant increase in BMI,abdominal circumference,blood pressure,HbA1c,FBG,FINS,TC,TG,LDL-C,UA,visceral fat area,and the levels of Home-IR and Home-βwas found in the observation group(all P<0.05).There were significant differences in BMI,abdominal circumference,and the levels of FINS,Homa IR,Homa-β,and HbA1c in diabetes patients with different BMI(all P<0.05).Correlation analysis showed that TG levels in obese T2DM patients in the observation group were significantly correlated with HbA1c(r=0.396,P=0.027),Homa-IR(r=0.405,P=0.024),and Home-β(r=-0.401,P=0.025);LDL-C was significantly correlated with Homa-IR(r=0.411,P=0.022)and Homa-β(r=-0.412,P=0.021);HbA1c was significantly positively correlated with BMI(r=0.371,P=0.040).Conclusion Insulin resistance is closely related to TG,LDL-C,and BMI in obese T2DM patients from the Motuo ethnic minority of Tibet,suggesting that these factors may play a role in the occurrence of T2DM.