血清瘦素水平与胰岛素原、真胰岛素及胰岛素敏感性的关系  

The relationship between serum leptin, proinsulin, true insulin levels and insulin resistance in non-diabetic subjects:a population-based study

作　　者：黎明[1] 詹志伟[2] 吴从愿[1] 杨静[3] 张葵[1] 李晓光[2] 甘利虹[2] 

机构地区：[1]中国医学科学院,中国协和医科大学北京协和医院内分泌科,100730 [2]解放军第二炮兵总医院 [3]山西医科大学第一医院内分泌科

出　　处：《中华内科杂志》2002年第11期754-757,共4页Chinese Journal of Internal Medicine

基　　金：首都医学发展科研基金 (ZD19990 8);山西省自然科学基金 ( 996 0 5)部分资助

摘　　要：目的　研究中国人群空腹瘦素水平与真胰岛素 (TI)、胰岛素原 (PI)、PI/TI比值及胰岛素敏感性之间的关系。方法　 90 2例非糖尿病者均系 2 0 0 0年接受糖尿病流行病学调查者。测定空腹瘦素、TI和PI浓度以及空腹及餐后 2h血糖。瘦素、TI及PI检测采用本室建立的特异的酶联免疫分析法 (ELISA)。胰岛素敏感性以HOMA胰岛素抵抗指数 (HOMA IR)评价。结果　血清瘦素水平女性高于男性。相关分析显示血清瘦素水平与空腹TI、PI及HOMA IR显著正相关 (男性 792例 ,r分别为0 345、0 2 36和 0 364 ;女性 1 1 0例 ,r分别为 0 574、0 375和 0 576 ,P <0 0 0 1 ) ,但与空腹血糖仅在男性呈弱相关 (r=0 1 5 ,P =0 0 1 5) ,与空腹PI/TI比值不相关。在调整年龄、体重指数 (BMI)和腰臀围比(WHR)后 ,尽管相关性减弱 ,瘦素水平仍然与TI、PI以及HOMA IR显著相关。结论　本组的血清瘦素浓度与TI、PI以及胰岛素抵抗显著正相关 ,且在一定程度上独立于肥胖和脂肪分布。瘦素水平高或瘦素抵抗的个体可能存在高胰岛素血症和胰岛素抵抗 ,提示其瘦素 胰岛素轴的调节异常。本研究未发现瘦素水平与空腹PI/TI比值的相关 ,提示瘦素可能与这一反映胰岛 β细胞的功能异常的标志无关。本研究揭示的高瘦素 高胰岛素血症或胰岛素抵抗之间的?Objective Leptin is involved in the regulation of body weight and metabolism Previous data have suggested that leptin levels are related to insulin resistance and in a few reports with impaired insulin secretion Some even revealed the existence of adipoinsular axis However, little is known of these relations in Chinese population With the availability of measurements of true insulin (TI), proinsulin (PI) and leptin, we examined the possible correlation of leptin with TI, PI and with insulin resistance (the HOMA model) in non diabetic subjects of north China We also evaluated whether leptin levels were associated with impaired insulin secretion, as evaluated by the fasting PI/TI ratio Methods 902 non diabetic subjects (670 with normal and 232 impaired glucose tolerance, aged 30-80 y) from a population of Beijing residents who underwent a diabetes survey in 2000 were studied Fasting serum leptin, PI and TI levels were detected by sensitive and specific enzyme linked immunosorbent assays (ELISA) which were all developed in our laboratory Results Serum leptin values were higher in women Correlation analysis showed that leptin levels were significantly correlated with fasting TI, PI and insulin resistance(HOMA IR) (in men, n =794, r =0 345,0 236 and 0 364 respectively;in women, n =110, r =0 574,0 375 and 0 576 respectively, P <0 001), but not with PI/TI ratio ( r =-0 09, P <0 01) in both sex After adjustment for age, body mass index (BMI) and waist to hip ratio (WHR), leptin levels remained significantly correlated with TI, PI and HOMA IR, although the magnitude of the association was considerably attenuated Conclusions TI and PI levels were positively related to leptin levels independent of obesity and body fat distribution Thus, subjects with increased insulin levels and/or insulin resistance may be relatively resistant to the effects of leptin, suggesting a dysfunction of leptin insulin axis However, leptin levels are not significantly associated

关 键 词：血清 瘦素 胰岛素原 真胰岛素 糖尿病 肥胖 胰岛素敏感性 

分 类 号：R587[医药卫生—内分泌]