血清总脂联素水平在正常体重到超重/肥胖、正常糖耐量到血糖调节受损及2型糖尿病疾病谱发展中的变化及其预测价值  

Changes of serum total adiponectin levels on the spectrum from normal weight to overweight/obesity and from normal glucose tolerance to impaired glucose regulation to type 2 diabetes mellitus and its predictive values

作　　者：李娜[1] 李悦 黄新梅 吴跃跃 李晓雅 朱建萍 陶勇军 张小英 刘军 Li Na;Li Yue;Huang Xinmei;Wu Yueyue;Li Xiaoya;Zhu Jianping;Tao Yongjun;Zhang Xiaoying;Liu Jun(Department of General Practice,Wujing Community Health Service Center Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200241,China)

机构地区：[1]上海中医药大学附属吴泾社区卫生服务中心全科,上海200241 [2]复旦大学附属上海市第五人民医院内分泌科

出　　处：《临床内科杂志》2020年第9期627-631,共5页Journal of Clinical Internal Medicine

基　　金：上海市科技创新行动计划自然科学基金资助项目(19ZR1440200);上海市医学重点专科建设计划(ZK2019B15);闵行区卫生和计划生育委员会科研课题(2017MW20);上海市第五人民医院院级重点项目(2018WYZD04)。

摘　　要：目的探讨血清总脂联素(tAPN)水平在正常体重到超重/肥胖(Ow/Ob)、正常糖耐量(NGT)到血糖调节受损(IGR)及2型糖尿病(T2DM)疾病谱发展中的变化及其对Ow/Ob、IGR/T2DM的预测价值。方法纳入Ow/Ob合并初发IGR/T2DM患者60例及同期糖耐量正常的健康志愿者110例,根据BMI、空腹血糖(FPG)及餐后2小时血糖(2h PG)水平将所有受试者分成为4组:正常体重正常糖耐量组(NW-NGT组,60例)、超重/肥胖合并正常糖耐量组(Ow/Ob-NGT组,50例)、超重/肥胖合并血糖调节受损组(Ow/Ob-IGR组,20例)和超重/肥胖合并T2DM组(Ow/Ob-T2DM组,40例)。比较各组受试者的一般资料[包括性别、年龄、收缩压(SBP)、舒张压(DBP)、BMI]和实验室检查结果[ALT、FPG、2h PG、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血清肌酐(Scr)、空腹胰岛素(FINS)、tAPN、胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β)]。采用Spearman相关分析探讨血清tAPN与代谢参数的相关性。采用logistic回归分析确定血糖异常的危险因素。绘制受试者工作特征(ROC)曲线,并计算曲线下面积,评估tAPN对Ow/Ob和IGR/T2DM的诊断价值及最佳切点值。结果随着BMI和血糖升高,NW-NGT组、Ow/Ob-NGT组、Ow/Ob-IGR组及Ow/Ob-T2DM组受试者的SBP、DBP、ALT、UA、TC、TG、FINS、HOMA-IR逐渐增加,而HDL-C、HOMA-β、tAPN逐渐降低(P<0.05)。Spearman相关分析结果显示,血清tAPN水平与BMI、ALT、TG、FPG、2h PG、FINS、HOMA-IR均呈负相关,而与HDL-C呈正相关(P<0.05)。校正年龄、性别、BMI及FINS混杂因素后,logistic回归分析结果显示,tAPN是血糖异常的独立保护因素(OR=0.733,P<0.01)。ROC曲线分析结果提示,tAPN诊断Ow/Ob、IGR/T2DM的最佳切点值分别为4.24μg/ml及3.13μg/ml。结论血清tAPN与代谢相关危险因素呈明显负相关,可以预测Ow/Ob和IGR/T2DM的发生。Objective To investigate the changes in serum total adiponectin(tAPN)levels on the spectrum from the normal weight(NW)to overweight/obesity(Ow/Ob),from normal glucose tolerance(NGT)to impaired glucose regulation(IGR)and type 2 diabetes(T2DM),and the predictive values of tAPN for Ow/Ob and IGR/T2DM.Methods A total of 60 patients with Ow/Ob complicated with initial IGR/T2DM and 110 healthy volunteers with NGT were included.All subjects were divided into 4 groups according to their BMI,fasting plasma glucose(FPG)and 2 hour plasma glucose(2h PG)after meals:Normal weight and normal glucose tolerance group(NW-NGT group,60 cases),overweight/obesity combined with normal glucose tolerance group(Ow/Ob-NGT group,50 cases),overweight/obese with impaired glucose regulation group,20cases,overweight/obese with T2DM group(Ow/Ob-T2DMgroup,40 cases).The general data[including gender,age,systolic blood pressure(SBP),diastolic blood pressure(DBP),BMI]and laboratory test results[ALT,FPG,2h PG,triglycerides(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),serum creatinine(Scr),fasting insulin(FINS),tAPN,homeostasis model assessment of insulin resistance(HOMA-IR),homeostasis model assessment ofβcell function(HOMA-β)]of each group were compared.Spearman correlation analysis was used to explore the correlation between serum tAPN and metabolic parameters.Logistic regression analysis was used to determine the risk factors for abnormal blood glucose.Draw the receiver operating characteristic(ROC)curve and calculate the area under the curve to evaluate the diagnostic values and the best cut-off point values of tAPN for Ow/Ob and IGR/T2DM.Results With the increase of BMI and blood glucose,the levels of SBP,DBP,ALT,UA,TC,TG,FINS and HOMA-IR were gradually increased from Nw-NGT to Ow/Ob-NGT,Ow/Ob-IGR,and Ow/Ob-T2DM groups,while HDL-C,HOMA-β,and tAPN were gradually decreased(P<0.05).Spearman correlation analysis showed that tAPN levels were negatively correlated with BMI,ALT,TG,F

关 键 词：总脂联素 超重/肥胖 2型糖尿病 

分 类 号：R587.1[医药卫生—内分泌]