肥胖程度和类型与2型糖尿病患者血清氨基酸关系的差异  

Differences in the association between degree and type of obesity and serum amino acids in patients with type 2 diabetes mellitus

作　　者：王敏 欧杨[2] 袁祥莲 朱秀芳[1] 牛奔[2] 康庄[2] 邢国强 苏恒[2] Wang Min;Ou Yang;Yuan Xianglian;Zhu Xiufang;Niu Ben;Kang Zhuang;Xing Guoqiang;Su Heng(School of Chemical Science and Technology,Yunnan University,Kunming 650091,China;Department of Endocrinology,First People's Hospital of Yunnan Province,Kunming 650032,China;Department of Internal Medicine,Driving Township Health Center,Qujing 655000,China;Department of Science and Education,Nanchong Central Hospital,Second Affiliated Clinical Medical College of North Sichuan Medical University,Nanchong 637000,China)

机构地区：[1]云南大学化学科学与工程学院,昆明650091 [2]云南省第一人民医院内分泌科,昆明650032 [3]曲靖市驾车乡卫生院内科,曲靖655000 [4]川北医科大学附属第二临床医学院南充中心医院科教科,南充637000

出　　处：《中华糖尿病杂志》2024年第1期69-76,共8页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：云南省临床医学中心开放项目(2019LCZXKF-NM03);云南省卫生和计划生育委员会医学领军人才培养项目(L-201624);云南省万人计划名医"专项(YNWR-MY-2019-020)。

摘　　要：目的:探讨肥胖程度及类型与2型糖尿病(T2DM)患者血清氨基酸关系的差异。方法:为横断面研究,回顾性选取2016年12月至2018年6月就诊于云南省第一人民医院内分泌科的T2DM患者为研究对象。测量研究对象腰围、身高、体重并计算体重指数(BMI),检测其血清支链氨基酸(BCAA)和芳香族氨基酸、糖化血红蛋白(HbA 1c)、高密度脂蛋白胆固醇(HDL-C)、血尿酸、甘油三酯(TG)、空腹血糖(FPG)和空腹胰岛素(FINS)并计算稳态模型评估胰岛素抵抗指数(HOMA-IR)。根据BMI将T2DM患者分为体重正常组、超重组和肥胖组,根据腰围将T2DM患者分为非腹型肥胖(NAO)组和腹型肥胖(AO)组。采用 t检验、单因素方差分析、非参数秩和检验、 χ^(2)检验进行组间比较。采用Pearson/Spearman相关分析法分析血清氨基酸水平与代谢指标、胰岛β细胞功能及胰岛素抵抗的相关性。采用多元线性回归分析法分析色氨酸的相关影响因素。采用受试者工作特征(ROC)曲线分析血清氨基酸对肥胖程度和类型的预测作用。 结果:共纳入T2DM患者97例。其中,体重正常组33例,超重组42例,肥胖组22例;NAO组41例,AO组56例。与体重正常组相比,肥胖组T2DM患者的HbA 1c和HDL-C均更低,血尿酸、TG、HOMA-IR、BCAA中的异亮氨酸及芳香族氨基酸中的色氨酸、酪氨酸均更高( P<0.05)。与NAO组相比,AO组T2DM患者的HDL-C更低,TG、色氨酸均更高( P<0.05)。T2DM患者血清BCAA(亮氨酸、异亮氨酸、缬氨酸)和芳香族氨基酸(色氨酸、酪氨酸、苯丙氨酸)水平与BMI均呈正相关( P<0.05),且血清色氨酸水平与腰围亦呈正相关( P=0.036)。多元线性回归分析结果显示,腰围为血清色氨酸的影响因素( P=0.048)。ROC曲线分析结果显示,血清色氨酸对肥胖和AO均具有一定的预测价值,曲线下面积分别为0.645(95%CI 0.533~0.758, P=0.019)和0.629(95%CI 0.517~0.742, P=0.029)。 结论:肥胖的程度和类型与T2DM患者血�ObjectiveTo investigate differences in the relationship between degree and type of obesity and serum amino acids in type 2 diabetes(T2DM).MethodsThis was a cross-sectional study.T2DM patients who visited Endocrinology Department in the First People′s Hospital of Yunnan Province from December 2016 to June 2018 were retrospectively enrolled.Waist circumference,height and weight were collected,and body mass index(BMI)was calculated.Serum branched chain amino acids(BCAA)and aromatic amino acids,glycosylated hemoglobin A 1c(HbA 1c),high-density lipoprotein cholesterol(HDL-C),uric acid,triglycerides(TG),fasting plasma glucose(FPG),and fasting insulin(FINS)were measured,and homeostasis model homeostasis model assessment of insulin resistance(HOMA-IR)was calculated.T2DM patients were divided into normal weight,overweight and obese groups based on BMI;additionally,T2DM patients were divided into non abdominal obesity(NAO)and abdominal obesity(AO)groups based on waist circumference.Using t-test/one-way analysis of variances(ANOVA),non-parametric rank sum test,χ^(2) tests for inter group comparison.Pearson/Spearman correlation analysis was used to analyze serum amino acid levels and metabolic indicators,as well as pancreatic isletsβcell function and insulin resistance.Multiple linear regression analysis was used to analyze the relevant influencing factors of tryptophan.The predictive effect of serum amino acids on the degree and type of obesity was analyzed by means of the receiver operating characteristic(ROC)curve.ResultsA total of 97 T2DM patients were included.Among them,there were 33 cases in the normal weight group,42 cases in the overweight group,and 22 cases in the obese group.There were 41 cases in the NAO group and 56 cases in the AO group.Compared with normal weight group,T2DM patients in obese group had significantly lowered levels of HbA 1c and HDL-C;elevated levels of uric acid,TG,HOMA-IR,serum concentrations of BCAA isoleucine,aromatic amino acids tryptophan and tyrosine(P<0.05).T2DM patients in AO group

关 键 词：糖尿病 2型 肥胖 氨基酸 代谢生物标志物 

分 类 号：R587.1[医药卫生—内分泌]