脂联素、肿瘤坏死因子α和铁蛋白测定在2型糖尿病伴脂肪肝中的应用  

Application of adiponectin, TNF-α and ferrtin in Type 2 diabetes with intrahepatic lipid infiltration

作　　者：朱翠英[1] 周峘[1] 韩源[1] 凌力群[1] 黄钢[1] 

机构地区：[1]上海交通大学医学院附属仁济医院,上海200001

出　　处：《核技术》2008年第5期356-359,共4页Nuclear Techniques

摘　　要：寻找和确立能反映2型糖尿病患者肝内脂肪浸润程度并能进行疗效考核的血清学指标,以利能在控制血糖代谢情况下同时观察肝内脂肪沉积的改善情况。选择经腰椎3断面CT扫描示有明显肝内脂肪沉浸的23例2型糖尿病患者分作单纯罗格列酮治疗组11例(女6例,男5例)和罗格列酮、二甲双胍联合治疗组12例(男女各6例),治疗剂量为罗格列酮4 mg/天,联合治疗组加以二甲双胍2 g/天,疗程24周。在治疗前后均分别测定空腹血糖、糖基血红蛋白、胰岛素、胰岛素抵抗指数和脂联素、瘦素、肿瘤坏死因子α(TNF-α)、铁蛋白等相关指标,进行统计学指标比较和观察。经24周治疗后,两治疗组的空腹血糖和糖基血红蛋白均有明显下降,尤其是联合治疗组疗效更佳。在肝内脂肪含量方面,单纯罗格列酮组和联合治疗组均见肝内脂肪含量百分比下降(43.3±25.8 vs 29.1±18.7,P<0.01;43.4±21.8 vs 22.0±16.7,P<0.01)。相关的脂联素和TNF-α却与肝内脂肪含量变化密切相关。两治疗组均有明显改善(脂联素为11.96±7.3 vs 20.61±12.0 ng/mL和12.76±6.7 vs 25.81±12.8 ng/mL。TNF-α为6.92±2.5 vs 5.89±1.9 pg/mL和6.81±2.14 vs 5.45±2.0 pg/mL,P<0.01)。尤其联合治疗组治疗前后血清铁蛋白的浓度有显著改善。(铁蛋白为345±116 vs 288±71 ng/mL和362±194 vs 258±109 ng/mL,分别为<0.05和<0.01)。结果表明:(1)应用增敏胰岛素类药物罗格列酮和二甲双胍治疗2型糖尿病患者时,除能控制血糖代谢和增加胰岛素敏感外,同时有改善肝内脂肪浸润的疗效。尤以联合治疗效果更好。(2)脂联素和TNF-α是反映肝内脂肪浸润的有效指标,与肝内脂肪浸润程度相关,可作疗效考核之用。(3)铁蛋白水平同样能反映肝内脂肪浸润程度,且方法简便和普及,在排除其他有关因素外亦可供肝内脂肪浸润程度的监测之用。The aim of this study was to find and establish the serum marker which can reflect the degree of intrahepatic lipid infiltration in Type 2 diabetes patients and assess the therapeutic effect. It helps us to observe the improvement of intrahepatic lipid deposit under controlled serum glucose metabolism. Twenty-three Type 2 diabetes patients with obvious intrahepatic lipid infiltration diagnosed by CT scan were divided into two groups, one group took rosiglitazone orally （male： female 5：6 ）, and the combined treatment group took rosiglitazone and metformin simultaneously （male： female 6：6 ）, in daily therapeutic dose of 4 mg rosiglitazone and 2 g metformin for 24 weeks. Before and after treatment, we measured fasting serum glucose, glycated hemoglobin （GHb）, insulin, insulin resistant index, plasma adiponectin, leptin, tumor necrotic factor a （TNF-α）, ferrtin respectively. After the treatment, fasting serum glucose and GHb decreased obvious, especially the combined treatment group. Intrahepatic lipid content percent decreased, too, in both groups （the rosiglitazone group： 43.3±25.8 vs 29.1±18.7, P〈0.01, the combined group： 43.4±21.8 vs 22.0±16.7, P〈0.01）. Plasma adiponecfin and TNF-α had correlation to intrahepatic lipid contend percent change. Plasma adiponectin and TNF-α was obviously improved in the rosiglitazone group and the combined treatment group （Adiponectin： 11.96±7.3 vs 20.61±12.0 ng/mL, 12.76±6.7 vs 25.81±12.8 ng/mL; TNFα： 6.92±2.5 vs 5.89±1.9 pg/mL, 6.81±2.14 vs 5.45±2.0 pg/mL; P〈0.01）. In addition, serum ferrtin concentration decreased obviously, especially the combined treatment group （rosiglitazone group： 345±116 vs 288±71ng/mL, P〈0.05, combined treatment group： 362±194 vs 258±109 ng/mL, P〈0.01）. It can be concluded that 1） rosiglitazone and metfornain controls serum glucose metabolism and improves intrahepatic lipid infiltration by especially the combined treatment, 2） plasma adiponectic and TNF-α are effective marke

关 键 词：2型糖尿病 脂肪肝 脂联素 肿瘤坏死因子Α 铁蛋白 

分 类 号：R587.1[医药卫生—内分泌]