胰岛素抵抗及其相关疾病

[摘要] 目的 通过比较不同糖耐量人群血浆载脂蛋白A5(ApoA5)、脂联素(APN)、TG水平，探讨其相互关系，以及ApoA5及APN降低TG的可能机制。方法　选取新诊断T2DM患者35例(T2DM组), IGR者30例(IGR组)及正常对照者35名(NGT组)，行静脉葡萄糖耐量试验(IVGTT)。ELISA测定空腹ApoA5及APN水平；比色法测定FFA。稳态模型评估胰岛素抵抗指数（HOMA-IR）及胰岛β细胞功能（HOMA-β）。探讨ApoA5与APN、血脂、FFA、HOMA-IR、HOMA-β的关系。结果　（1）T2DM、IGR组ApoA5及APN水平低于NGT组(P<0.05), 且T2DM组较IGR组降低更明显(P<0.05)。（2）T2DM、IGR组TG、FFA、2 hFFA、LDL-C、FPG、2 hPG、FIns、HOMA-IR、BMI及WHR水平高于NGT组(P<0.05),且DM组较IGR组升高更明显(P<0.05)。（3）ApoA5与TG、FFA、2 hFFA、LDL-C、FPG、2 hPG、FINS、HOMA-IR、BMI及WHR呈负相关；与APN、HDL-C及HOMA-β呈正相关。（4）多元逐步回归分析显示，APN、TG、FFA、WHR及HOMA-IR是ApoA5的独立影响因素。结论 低ApoA5及APN水平可能是IGR时期的早期敏感指标，低ApoA5及APN水平不能有效抑制血中FFA水平，可能导致高甘油三酯（HTG）血症及IR，从而共同导致IGR及T2DM的发生发展。

【关键词】载脂蛋白A5；脂联素；甘油三酯；葡萄糖耐量；糖尿病，2型

The comparison of plasma apolipoprotein A5，adiponectin and triglyceride levels in type 2 diabetic subjects with impaired glucose tolerance 

[Abstract] 　Objective To compare the levels of apolipoprotein A5(apoA5), adiponectin (APN), triglyceride(TG) in individuals with different glucose tolerance and investigate their interrelation and the possible mechanism of apoA5，APN reducing triglyceride. Methods 35 patients newly diagnosed as type 2 diabetes mellitus (DM group), 30 patients with impaired glucose regulation (IGR group), and 35 individuals with normal glucose tolerance (NGT group, as control) were enrolled and underwent intravenous glucose tolerance test (IVGTT). The levels of fasting apoA5 and APN were assayed by enzyme linked immunosorbent assay（ELISA）. And fasting free fatty acid was measured by colorimetry. Insulin resistance (HOMA-IR) andβ-cell function (HOMA-β) were assessed by homeostasis model.Furthermore, the relationship among apoA5 and APN, plasma lipid, free fatty acids（FFA）, HOMA-IR, HOMA-B was investigated. Results （1）The levels of apoA5 and APN were significantly lower in DM group and IGR group than those in NGT group (P< 0.05), the levels of apoA5 and APN declined more significantly in DM group than those in IGR group ( P < 0.05). （2）The levels of TG, FFA, 2hFFA, LDL-C, FPG, 2hPG, FINS, BMI,WHR and HOMA-IR were significantly higher in DM group and IGR group than those in NGT group ( P< 0.05), and their levels increased more significantly in DM group than those in IGR group ( P < 0.05).（3）ApoA5 was negatively correlated with TG, FFA, 2 hFFA, LDL-C,FPG, 2 hPG, FINS, HOMA-IR, BMI and WHR. And ApoA5 positively correlated with APN，HDL-C, HOMA-B.（4）Multiple stepwise regression analysis showed that APN, TG, FFA, WHR and HOMA-IR were independent effect factors of apoA5. Conclusions The lower levels of ApoA5, APN may be sensitive indexes of earlier period of impaired glucose regulation. The lower levels of plasma apoA5 and APN can not suppress FFA level effectively, therfore the higher FFA level may lead to hypertrigIyceridemia and IR. The lower levels of plasma apoA5 and APN may play a joint action in the process from NGT to IGR to T2DM.

　[Keywords] Apolipoprotein A5；Adiponectin；Triglyceride；Glucose tolerance test；Type 2 diabetes mellitus