血清1,5-脱水葡萄糖醇水平与2型糖尿病患者胰岛素抵抗和微血管并发症的关系

Relationship between serum 1,5-anhydroglucitol level and insulin resistance,microvascular complications in type 2 diabetes mellitus

目的探讨血清1,5-脱水葡萄糖醇(1,5-AG)水平与2型糖尿病(T2DM)患者胰岛素抵抗、微血管并发症的关系。方法采用回顾性横断面方法,分析2023年5—12月南华大学附属长沙中心医院收治的836例T2DM患者的临床资料。所有患者入院后采用吡喃糖氧化酶法检测血清1,5-AG水平。同时根据微血管并发症情况(糖尿病周围神经病变、糖尿病肾病、糖尿病视网膜病变)将患者分为单纯组(无微血管并发症,n=490)、并发症1组(1种微血管并发症,n=217)、并发症2组(2种及以上微血管并发症,n=129)。采用Spearman相关分析探讨T2DM患者血清1,5-AG水平与胰岛素抵抗相关指标的关系,采用多元有序logistic回归分析探讨T2DM患者微血管并发症的影响因素。结果单纯组空腹血糖(fasting blood glucose,FBG)[(7.37±0.56)mmol/L]、空腹胰岛素(fasting insulin,FINS)[(11.34±1.86)mU/L]、胰岛素抵抗指数(homeostatic model assessment of insulin resistance,HOMA-IR)(0.96±0.31)水平低于并发症1组[(8.37±1.02)mmol/L、(16.26±2.32)mU/L、(1.32±0.41)]、并发症2组[(10.25±2.13)mmol/L、(18.53±2.67)mU/L、(1.54±0.44)],且并发症1组FBG、FINS、HOMA-IR低于并发症2组,差异均有统计学意义(F=537.470、791.690、136.340,均P<0.001)。单纯组血清1,5-AG水平[77.16(16.30,128.07)μg/ml]高于并发症1组[51.05(14.67,63.18)μg/ml]、并发症2组[30.42(12.53,47.26)μg/ml],且并发症1组血清1,5-AG水平高于并发症2组,差异有统计学意义(H=210.020,P<0.001)。Spearman相关分析显示,T2DM患者血清1,5-AG水平与FBG、FINS、HOMA-IR均呈负相关(r=-0.431、-0.372、-0.546,均P<0.001)。多元有序logistic回归分析显示,糖尿病病程长(OR=2.261,95%CI:1.564~3.269)、HbA1c升高(OR=2.040,95%CI:1.456~2.858)、HOMA-IR升高(OR=2.158,95%CI:1.484~3.137)、1,5-AG降低(OR=2.512,95%CI:1.691~3.732)是T2DM患者微血管并发症的独立危险因素(P<0.05)。ROC曲线分析显示,血清1,5-AG鉴别T2DM患者1种微血管并发症的曲线下面积为0.763(95%CI:0.731~0.795),血清1,5-AG鉴别T2DM患者2种及以上微血管并发症的曲线下面积为0.730(95%CI:0.692~0.767)。结论血清1,5-AG水平与T2DM患者胰岛素抵抗呈负相关,低水平血清1,5-AG可能是T2DM患者微血管并发症的独立危险因素。

Objective To explore the relationship between serum 1,5-dehydratoglucitol(1,5-AG)level and insulin resistance,microvascular complications in patients with type 2 diabetes mellitus(T2DM).Methods The clinical data of 836 patients with T2DM admitted to the Changsha Central Hospital Affiliated to University of South China from May to December 2023 were retrospectively and cross-sectionally analyzed.Serum 1,5-AG levels were detected by pyranose oxidase method.According to the microvascular complications(diabetic peripheral neuropathy,diabetic nephropathy,diabetic retinopathy),the patients were divided into simple group(no microvascular complications,n=490),complication group 1(1 microvascular complications,n=217),and complication group 2(2 or more microvascular complications,n=129).The relationship between serum 1,5-AG level and the related indicators of insulin resistance in T2DM patients were explored by Spearman correlation analysis,and the influencing factors of microvascular complications in T2DM patients were explored by multiple ordered logistic regression analysis.Results The levels of FBG(fasting blood glucose)[(7.37±0.56)mmol/L],FINS(fasting insulin)[(11.34±1.86)mU/L]and HOMA-IR(homeostatic model assessment of insulin resistance)(0.96±0.31)in simple group were lower than those in complication group 1[(8.37±1.02)mmol/L,(16.26±2.32)mU/L,(1.32±0.41)],complication group 2[(10.25±2.13)mmol/L,(18.53±2.67)mU/L,(1.54±0.44)],and FBG,FINS and HOMA-IR in complication group 1 were lower than those in complication group 2,and the differences were statistically significant(F=537.470,791.690,136.340,P<0.001).Serum 1,5-AG level in simple group[77.16(16.30,128.07)μg/ml]was higher than that in complication group 1[51.05(14.67,63.18)μg/ml]and complication group 2[30.42(12.53,47.26)μg/ml],and the serum level of 1,5-AG in complication group 1 was higher than that in complication group 2,and the difference was statistically significant(H=210.020,P<0.001).The results of Spearman correlation analysis showed that serum 1,5-AG level was negatively correlated with FBG,FINS and HOMA-IR in T2DM patients(r=-0.431,-0.372,-0.546,P<0.001).The results of multiple ordered logistic regression analysis showed that Longer duration of diabetes(OR=2.261,95%CI:1.564-3.269),increased HbA1c(OR=2.040,95%CI:1.456-2.858),and increased HOMA-IR(OR=2.158,95%CI:1.484-3.137)and decreased 1,5-AG(OR=2.512,95%CI:1.691-3.732)were independent risk factors for microvascular complications in T2DM patients(P<0.05).The results of ROC curve analysis showed that the area under the curve of serum 1,5-AG in the identification of one microvascular complication was 0.763(95%CI:0.731-0.795),and the area under the curve of serum 1,5-AG in the identification of two or more microvascular complications was 0.730(95%CI:0.692-0.767).Conclusion Serum 1,5-AG level is negatively correlated with insulin resistance in T2DM patients.Low serum 1,5-AG level may be an independent risk factor for microvascular complications in T2DM patients.