糖尿病与肥胖/脂代谢异常

　　[摘要]目的 观察新诊断T2DM患者血清高分子量脂联素(HMW-APN)水平，探讨其与糖脂代谢、IR及胰岛β细胞功能的关系。 方法 176例研究对象，根据75 g OGTT结果分为新诊断T2DM组88例和NGT组88名，两组再以BMI 25 kg/m2为切点分为正常体重(NW)亚组和肥胖(OB)亚组。检测各组HbA1c、血糖、胰岛素、血脂及HMW-APN水平。 结果 T2DM组血清HMW-APN水平低于NGT组[0.99(0.52~1.56) vs 2.53(1.69~5.44)ng/L](P<0.01)。OB亚组HMWAPN水平均低于同组内NW亚组[0.74(0.35~1.39) vs 1.21(0.74~2.08) ng/L;2.11(1.47.00~4.01) vs 4.49(2.40~6.11)ng/L](P<0.05)。相关性分析提示，HMW-APN与BMI、WC、WHR、SBP、TG、FPG、2 hPG、HbA1c、FIns、2 hIns、胰岛素抵抗指数(HOMA-IR)、高敏C反应蛋白(hsC-RP)呈负相关(P<0.05或P<0.01)，与HDL-C、胰岛β细胞功能指数(HOMA-β)呈正相关(P<0.01)。多元逐步回归分析提示，2 hPG、hsC-RP及WHR是血清HMW-APN水平的独立影响因素。 结论 血清HMW-APN水平在新诊断T2DM患者中降低，其与肥胖、糖脂代谢、IR、胰岛β细胞功能及hsC-RP密切相关，提示血清HMW-APN下降可能参与了肥胖和T2DM的发生发展。

　　[关键词]新诊断;糖尿病，2型;高分子量脂联素;高敏C反应蛋白

　　[Abstract] Objective Toinvestigatethe change of serum high-molecular-weight adiponectin(HMWAPN)level in newly diagnosed type2 diabetes mellitus (T2DM)patientsand investigate therelationships between serum HMW APN leveland glycolipid metabolism, insulin resistance and pancreas β cell function. Methods A total of 176 Chinese subjects were enrolled in the study, including eighty-eight patients with newly-diagnosed type 2 diabetes(T2DM)and eighty-eight subjects with normal glucose tolerance(NGT). NGT and T2DMgroups were further divided into normal weight(NW) and obese(OB) subgroups separately. Obesity was defined as BMI≥25 kg/m2 according to the WHO-Western Pacific Region diagnostic set forth in 2000. 75g oral glucose tolerance test (OGTT) was performed in all subjects. HbA1c, blood glucose, blood insulin, blood lipids and HMWAPN level were also determined. Results The serum HMWAPN level wassignificantly lower in T2DM group thanin NGT group[0.99(0.52~1.56)vs2.53(1.69~5.44) ng/L, P<0.01].Within subgroupsofT2DMandNGT, serum HMW-APN level was lower in OB subgroups than in NW subgroups[0.74(0.35~1.39) vs 1.21(0.74~2.08) ng/L; 2.11(1.47~4.01)vs4.49(2.40~6.11)ng/L, P<0.05]. Pearson correlationanalysis showedthat serum HMW APNlevelwas negatively correlatedwithBMI, WC, WHR, SBP, TG, FPG, 2hPG,HbA1c, FIns, 2hIns, HOMA-IR and hsC-RP(P<0.05or P<0.01),and was positively correlated with HDL-C and HOMA-β(P<0.01). Multiple linear regression analysis showed that 2 hPG, hsC-RP and WHR wereindependentlyrelatedtoserum HMW APN level(P<0.01). Conclusion Serum HMW APN level is decreased in subjects with newly diagnosed type 2 diabetes.Serum HMW APN level is closely correlated with obesity, glycolipid metabolism, insulin resistance, pancreas β cell function and hsC-RP. It suggests that the HMW APNdecline may play an importantrole in the pathogenesis of obesity and T2DM.

　　[Key words]Newly diagnosed; Diabetes mellitus，type 2; High-molecular-weight adiponectin(HMWAPN); Highly sensitive C-reactive protein(hsC-RP)