体型肥胖2型糖尿病患者血清胆红素、胆汁酸、25(OH)D3水平及与胰岛素抵抗的关系研究  

Study on the Relationship between Serum Bilirubin, BA, 25(OH)D and Insulin Resistance in T2DM Patients with Obesity

作　　者：王翠娟 王锐 王蕊 田伊茗 贾小娇 马宁 罗小兵 陆强 WANG Cui-juan;WANG Rui;WANG Rui;TIAN Yi-ming;JIA Xiao-jiao;MA Ning;LUO Xiao-bing;LU Qiang(Department of Endocrinology,Qinhuangdao First Hospital Affiliated to Hebei Medical University,Qinhuangdao,Hebei,066000,China;Department of Endocrinology,The first hospital of Hebei Medical University,Shijiazhuang,Hebei,050051,China)

机构地区：[1]河北医科大学附属秦皇岛市第一医院内分泌科,河北秦皇岛066000 [2]河北医科大学第一医院内分泌科,河北石家庄050051

出　　处：《现代生物医学进展》2020年第20期3933-3936,3928,共5页Progress in Modern Biomedicine

基　　金：河北省医学适用技术跟踪项目(G2018103)。

摘　　要：目的:探讨体型肥胖2型糖尿病(T2DM)患者血清胆红素、胆汁酸(BA)、25羟维生素D3[25(OH)D3]水平及其与胰岛素抵抗(IR)的关系。方法:选取2018年1月-2019年12月我院就诊的240例T2DM患者,根据体重指数(BMI)将患者分为T2DM-N组84例,T2DM-OW组92例,T2DM-OB组64例。分别测定总胆红素(TBIL)、间接胆红素(IBIL)、直接胆红素(DBIL)、胆汁酸(BA)、25(OH)D3等指标。以胰岛素抵抗指数(HOMA-IR)为因变量,行多元线性回归,分析IR的危险因素。结果:T2DM-OB组BMI、BA、甘油三酯(TG)、空腹血糖(FPG)、餐后2小时血糖(2hPG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、C反应蛋白(CRP)高于T2DM-N组,DBIL、25(OH)D3低于T2DM-N组,差异均有统计学意义(P<0.05)。Pearson相关性分析显示,HOMA-IR与BMI、BA呈正相关(P<0.05),与DBIL、25(OH)D3呈负相关(P<0.05);多元线性回归分析显示BMI升高,25(OH)D3、DBIL下降为IR的危险因素(P<0.05)。结论:肥胖的T2DM患者存在IR及血脂紊乱,心血管疾病患病风险增加,BA水平升高,DBIL、25(OH)D3水平下降,机体慢性低度炎症水平升高,除了BMI,25(OH)D3、DBIL水平下降亦有可能是体型肥胖T2DM患者IR的重要危险因素。Objective: To explore the relationship between serum bilirubin, bile acid(BA), 25 hydroxyvitamin D3[25(OH)D3] and insulin resistance(IR) in type 2 diabetes mellitus(T2DM) with obesity. Methods: From January 2018 to December 2019, 240 T2DM patients were divided into T2DM-N group(84 cases), T2DM-OW group(92 cases) and T2DM-OB group(64 cases). TBIL, IBIL, DBIL,BA and 25(OH)D3 were measured respectively.HOMA-IR was used as the dependent variable to analyze the risk factors of IR. Results:BMI, BA, TG, FPG, 2 hPG, HbA1c, FINS, HOMA-IR, CRP were higher in T2DM-OB group than in T2DM-N group, and DBIL, 25(OH)D3 were lower in T2DM-N group(P<0.05). Pearson correlation analysis showed that HOMA-IR was positively correlated with BMI and BA(P<0.05), negatively correlated with DBIL and 25(OH)D3(P<0.05). Multiple linear regression analysis showed that BMI increased,25(OH)D3 and DBIL decreased were the risk factors of IR(P<0.05). Conclusion: T2DM with obesity have IR and lipid disorders,increased risk of cardiovascular disease, increased levels of BA, decreased levels of DBIL and 25(OH)D3, and increased levels of chronic low grade inflammation, in addition to BMI, the decrease of 25(OH)D3 and DBIL may also be an important risk factor for IR in T2DM with obesity.

关 键 词：肥胖 2型糖尿病 胆红素 胆汁酸 胰岛素抵抗 25羟维生素D3 

分 类 号：R587.2[医药卫生—内分泌]